Future Trends of Virtual, Augmented Reality, and Games for Health

Serious game is now a multi-billion dollar industry and is still growing steadily in many sectors. As a major subset of serious games, designing and developing Virtual Reality (VR), Augmented Reality (AR), and serious games or adopting off-the-shelf games to support medical education, rehabilitation, or promote health has become a promising frontier in the healthcare sector since 2004, because games technology is inexpensive, widely available, fun and entertaining for people of all ages, with various health conditions and different sensory, motor, and cognitive capabilities. In this chapter, we provide the reader an overview of the book with a perspective of future trends of VR, AR simulation and serious games for healthcare

Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Development of augmented reality rehabilitation games integrated with biofeedback for upper limb

Stroke is one of the leading causes of disability in all over the world. This disability greatly impacts the stroke patients' daily life activities. Thus, rehabilitation exercises are essential for post stroke patients to restore their lost functions gradually for daily life activities. Traditional rehabilitation exercises do not motivate the post stroke patients as they are normally humdrum and required expensive equipments. Therefore, this paper presents the development of low -cost motivating webcam colour based visual tracking augmented reality (AR) system with biofeedback for upper-limb post stroke rehabilitation therapy. Augmented Reality is a novel form of human-computer interface which overlay the computer-generated information on the real world environment rather than replaces it. In the developed AR system, two games; Ping Pong Rehab (PPR) and Balloon Collection Rehab (BCR) are created based on game design principle. PPR game trains shoulder and arm muscles during rehabilitation therapy whilst BCR game trains shoulder, arm and forearm muscles. Both games have been built and integrated with Biograph Infiniti software to monitor the muscles' performance. The integrated system will obtain the biofeedback EMG signals from patients that will be utilised for future developments. It allows the patients to monitor their arms and muscles movements in real time on the display screen via low-cost webcam. The system aims for home based rehabilitation system and friendly used by patients themselves. The developed integrated system has tested with able subject and it worked perfectly during the test

Serious game augmented reality 3D for physical rehabilitation

This research consists in the development of a PhysioAR framework (Augmented Reality Physiotherapy) that consider a set of two wearable sensors (Left Controller and Right Controller and Meta/Oculus Quest headset controller for use in natural interactions with a set of AR therapeutic serious games developed on the Unity 3D. The system allows to perform training sessions for hands and fingers, knees and legs motor rehabilitation bearing in mind that the games are for people who have suffered from stroke. The training is part of special care that must be taken for this through the serious games that are properly adapted to be a source of motivation and easy to be played. This FisioAR project includes, two different apps designed, one for calendar and for physiotherapists has a background data with all information needed to do and other to make login in main app and have the possibility to interact with our three types of games specifically designed, developed and implemented for Oculus Quest. Two different mobile apps were constructed on Outsystems platform, where one is destinated to physiotherapists and other is destinated to AVC patient’s. Three Different types of serious games were developed on Unity Platform Engine and all the games have specific contents to be played according with motor and cognitive rehabilitation objectives. The first game called Boxes Game, has six cubes displayed with different colors and six spheres also with six different colors. The main goal of this game is to put the maximum number of spheres in a box with the same color. This game will involve the use of legs, knees and arms and can be easily adapted to each patients’ conditions, making it more or less demanding. The Second Game is called Garden Care Game. Its scenario was made with prefabs (assets) and materials from Unity asset store to simulate a realistic garden, with a watering can, fences and a set of flowers. The main goal of this game is to care the flowers with water. This simple goal is related with the measurement of the wrist rotation made by the patient through wearable sensors while watering each flower. This game as a score for each flower watered. In the Third Game called Puzzle Game, there’s a white screen with the same number of divisions as the existing image blocks in project.Esta pesquisa consiste no desenvolvimento de uma solução do projeto FisioAR baseada em dispositivos vestíveis, combinando um conjunto de sensores vestíveis e controlador de headset para uso em interações naturais com um conjunto de serious games terapêuticos VR desenvolvidos na plataforma de games 3D Unity. O sistema permite realizar treinos de reabilitação motora de mãos e dedos, joelhos e pernas tendo em vista que os jogos são para pessoas que sofreram AVC e devem ser tomados cuidados especiais com isso e que os jogos estão devidamente adaptados para serem mais simples. ser jogado. Este projeto FisioAR tem em todas as implementações, dois aplicativos diferentes projetados, três tipos diferentes de jogos projetados no Oculus Quest. Dois aplicativos diferentes foram construídos na plataforma Outsystems sendo um destinado a fisioterapeutas e outro a pacientes AVC. Três tipos diferentes de jogos foram especialmente projetados no Unity Platform Engine e todos os jogos possuem conteúdos específicos para serem jogados. O primeiro jogo denominado Boxes Game, tem seis cubos apresentados com cores diferentes e seis esferas também com seis cores diferentes. O principal objetivo deste jogo é colocar o número máximo de esferas em uma caixa com a mesma cor e com distância mínima percorrida. Este jogo envolverá o uso de pernas, joelhos e braços e pode ser facilmente adaptado às condições de cada paciente, tornando-o mais ou menos exigente. O segundo jogo é chamado de jogo de cuidado de jardim. Seu cenário foi feito com pré-fabricados e materiais da loja de ativos da unidade para simular um jardim realista, com regador, cercas e um conjunto de flores. O objetivo principal deste jogo é regar as flores. Esse objetivo simples está relacionado à medição da rotação do punho feita pelo paciente por meio de sensores vestíveis ao regar cada flor. Este jogo é uma pontuação para cada flor regada. No terceiro jogo, chamado Puzzle Game, há uma tela branca com o mesmo número de divisões que os blocos de imagem existentes no projeto

Serious Games for Wrist Rehabilitation in Juvenile Idiopathic Arthritis

Rehabilitation is a painful and tiring process involving series of exercises that patients must repeat over a long period. Unfortunately, patients often grow bored, frustrated, and lose motivation making rehabilitation less effective. In the recent years video games have been widely used to implement rehabilitation protocols so as to make the process more entertaining, engaging and to keep patients motivated. In this paper, we present an integrated framework we developed for the wrist rehabilitation of patients affected by Juvenile Idiopathic Arthritis (JIA) following a therapeutic protocol at the Clinica Pediatrica G. e D. De Marchi. The framework comprises four video games and a set modules that let the therapists tune and control the exercises the games implemented, record all the patients actions, replay and analyze the sessions. We present the result of a preliminary validation we performed with four poliarticular JIA patients at the clinic under the supervision of the therapists. Overall, we received good feedback both from the young patients, who enjoyed performing known rehabilitation exercises using video games, and therapists who were satisfied with the framework and its potentials for engaging and motivating the patients

Augmented reality system with application in physical rehabilitation

The aging phenomenon causes increased physiotherapy services requirements, with increased costs associated with long rehabilitation periods. Traditional rehabilitation methods rely on the subjective assessment of physiotherapists without supported training data. To overcome the shortcoming of traditional rehabilitation method and improve the efficiency of rehabilitation, AR (Augmented Reality) which represents a promissory technology that provides an immersive interaction with real and virtual objects is used. The AR devices may assure the capture body posture and scan the real environment that conducted to a growing number of AR applications focused on physical rehabilitation. In this MSc thesis, an AR platform used to materialize a physical rehabilitation plan for stroke patients is presented. Gait training is a significant part of physical rehabilitation for stroke patients. AR represents a promissory solution for training assessment providing information to the patients and physiotherapists about exercises to be done and the reached results. As part of MSc work an iOS application was developed in unity 3D platform. This application immersing patients in a mixed environment that combine real-world and virtual objects. The human computer interface is materialized by an iPhone as head-mounted 3D display and a set of wireless sensors for physiological and motion parameters measurement. The position and velocity of the patient are recorded by a smart carpet that includes capacitive sensors connected to a computation unit characterized by Wi-Fi communication capabilities. AR training scenario and the corresponding experimental results are part of the thesis.O envelhecimento causa um aumento das necessidades dos serviços de fisioterapia, com aumento dos custos associados a longos períodos de reabilitação. Os métodos tradicionais de reabilitação dependem da avaliação subjetiva de fisioterapeutas sem registo automatizado de dados de treino. Com o principal objetivo de superar os problemas do método tradicional e melhorar a eficiência da reabilitação, é utilizada a RA (Realidade Aumentada), que representa uma tecnologia promissora, que fornece uma interação imersiva com objetos reais e virtuais. Os dispositivos de RA são capazes de garantir uma postura correta do corpo de capturar e verificar o ambiente real, o que levou a um número crescente de aplicações de RA focados na reabilitação física. Neste projeto, é apresentada uma plataforma de RA, utilizada para materializar um plano de reabilitação física para pacientes que sofreram AVC. O treino de marcha é uma parte significativa da reabilitação física para pacientes com AVC. A RA apresenta-se como uma solução promissora para a avaliação do treino, fornecendo informações aos pacientes e aos profissionais de fisioterapia sobre os exercícios a serem realizados e os resultados alcançados. Como parte deste projeto, uma aplicação iOS foi desenvolvida na plataforma Unity 3D. Esta aplicação fornece aos pacientes um ambiente imersivo que combina objetos reais e virtuais. A interface de RA é materializada por um iPhone montado num suporte de cabeça do utilizador, assim como um conjunto de sensores sem fios para medição de parâmetros fisiológicos e de movimento. A posição e a velocidade do paciente são registadas por um tapete inteligente que inclui sensores capacitivos conectados a uma unidade de computação, caracterizada por comunicação via Wi-Fi. O cenário de treino em RA e os resultados experimentais correspondentes fazem parte desta dissertação

Augmented Reality Based Reaching Exercise for shoulder Rehabilitation

Stroke or cerebrovascular accident (CVA) causes disability and affected the personâs quality of life. The rehabilitation therapies are normally conducted for post stroke patients to promote their quality of life and daily living standard. Among rehabilitation exercises, shoulder range of motion (ROM) exercise and muscle strengthening exercise are the most important rehabilitation therapies for post stroke patients as this can improve their activities of daily life. Among the shoulder ROM exercises, the reaching exercise is normally conducted with checkerboard in rehabilitation centre as a traditional therapy which becomes boring after trained for few times. To overcome this problem, same exercise with augmented reality (AR) based game like style incorporate with motivated visual and audio feedbacks has developed and details of the system is presented in this paper. The AR based reaching exercise has developed within the normal average range of motion. The system includes personal computer or laptop, webcam, marker and BioGraph Infiniti system. Thus, it can be used at home without modifying anything and patient can use easily by himself without extra help. The developed system has integrated with biofeedback system to become more effective in rehabilitation. The integrated system has already tested with healthy subject and worked perfectly with positive feedbacks

The Use of digital games to enhance the physical exercise activity of the elderly : a case of Finland

According to the World Health Organization (WHO), population ageing is a global phenomenon, which brings both challenges and opportunities for society. The current longer expected lifespan can create opportunities for the elderly to contribute in many ways to their families and communities. However, it greatly depends on their quality of life, which is affected by many factors, including physical and functional health, social well-being, and cognitive abilities. The WHO (2012) states that physical health is one of the indicators for the elderly’s quality of life, and it declines with increasing age. Participation in regular physical exercises can help the elderly improve their physical and mental health, and this has been aided by the use of modern technologies to promote the elderly’s physical and functional health. Of these latest technologies, digital games have shown promise to improve and enhance the elderly’s physical activities through fun and engaging gameplay. The literature highlights that some commercial games in the market (e.g. Microsoft Kinect- Sports and Nintendo Wii Sports games) have the potential to improve the elderly’s physical health such as gait, balance, and fall prevention. However, researchers argue that these commercial games are not designed specifically for the elderly and their physical exercise activities. They state that most commercial games are not user-friendly for the elderly whose functional and physical abilities are limited due to their advanced years. The literature points out that more studies need to be undertaken to understand the usability and usefulness of digital games for physical exercise activities so that game designers can create elderly-friendly digital games in the future. In Finland, the government has been focusing on promoting healthy ageing and increasing home care services for the elderly. In recent years, Finnish researchers have used digital games to promote older Finns’ healthy and active ageing. The existing literature, whilst showing the potential of digital games for elderly Finns’ physical health, also acknowledges further research is needed particularly in the context of Finland. Thus, in this study, we aimed at investigating digital games to specifically assess their applications for older Finns’ physical activities, focusing on the quality of users’ experiences, and their reported ease of use and perceived usefulness. We used the mixed methods approach, which applies both qualitative and quantitative research methods. The study design included four stages: requirements gathering, analysis and design, prototyping, and evaluation. Firstly, we conducted pre-studies to elicit users’ requirements. This was followed by the analysis of the resulting data to identify trends and patterns, which fuelled ideas in the brainstorming game design and development phases. The final product was a digital game-based physical exercise called the Skiing Game. We then evaluated the Skiing Game in Finland with 21 elderly Finns (M=7, F=14, Average Age =76). By using questionnaires, observation, and interviews, we investigated user experiences, focusing on the game’s usability, and usefulness for enhancing the physical activity and wellbeing of the elderly. We also conducted a comparative test of the Skiing Game in Japan with 24 elderly Japanese participants (M=12, F=12, Average Age = 72) to further understand non-Finnish elderly users’ experiences. The findings from the usability study of the Skiing Game in Finland demonstrated that elderly Finns had a positive experience in the gameplay, and their motivation was noticeably high. It also confirmed that elderly Finns have a genuine interest in digital game-based exercises and strong intentions to play digital games as a form of physical exercise in the future. Although prior to the study most of them had negative views and misconceptions about digital games, after the gameplay their attitudes were decidedly positive. They acknowledged that whilst playing digital games could be an alternative way of exercising for them their use would primarily be when they don’t have access to their usual non-digital physical exercise. The Japanese usability of the Skiing Game showed that the elderly Japanese people also had positive user experiences in playing digital games, and also intend to use them in the future. Similarly, after playing the game they reported that their attitudes towards digital games become positive, and indicated playing digital games could be an alternative way of exercising. Although the comparison of the two studies suggests that the elderly Finns had relatively more positive experiences whilst playing the Skiing Game, compared to their Japanese counterparts, in general, both groups had a positive experience in the gameplay and showed interest in digital games as an alternative exercise. Based on the usability lessons learned from these two studies, recommendations for practitioners and designers regarding improvements in game design and development are made in this report. Implementing these modifications into future designs and further development of digital games for the elderly will improve their commercial viability and user uptake. The findings from this study can provide valuable insights, particularly for Finnish policymakers and healthcare practitioners who are keen to introduce digital games into the aged-care sector in Finland. The studies have also provided valuable insights into the optimal methods for introducing Finnish digital games to international markets, in particular, digital games tailored specifically for the physical exercise needs and motivations of the elderly. By taking into consideration the limitations of the study, we provide our future studies and further improvements of the game to be conducted

A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52–65.5), and 129 (52–486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3–56.7) h. Non-compliance doubled during weeks 7–12. Modified Rankin scores improved in 6/13 patients, 3 of whom were \u3e3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5–12.5) points in the arm and 1 (−0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR