An objective evaluation method for rehabilitation exergames

The aim of this work is to objectively evaluate the performance of patients using a virtual rehabilitation system called MIRA. MIRA is a software platform which converts conventional therapeutic exercises into games, enabling the user to practice the given exercise by playing a game. The system includes a motion sensor to track and capture user's movements. Our assessment of the performance quality is based on the recorded trajectories of the human skeleton joints. We employ two different machine learning approaches, dynamic time warping (DTW) and hidden Markov modeling (HMM), both widely used for gesture recognition, to compare the user's performance with that of a reference as ground truth

Exergames for motor rehabilitation in older adults: an umbrella review

Background: Exergames have been used as an innovative motor rehabilitation method with the main aim of improving motivation and exercise. As research interest in exergaming for rehabilitation is rapidly growing, a review of existing systematic reviews is important to synthesize the available evidence and provide recommendations. Objectives: In this article, we systematically synthesized the information from reviews that have examined the effects if exergames on different body movement parameters in older adults with and without specific pathologies. Method: Searches were conducted in Web of Science, Scopus, PsycARTICLES, PsycINFO, Psychology and Behavioural Sciences Collection, PubMed, SciELO, B-On and Google Scholar, articulating different terms and Boolean operators. Systematic reviews, meta-analysis and literature reviews published until May 2017 that investigated exergame interventions on physical outcomes, such as balance, gait, limb movements, muscle strength, in healthy and non-healthy older adults. Results: Based on prior reviews, exergaming, as a standalone intervention, has a positive effect on balance, gait, muscle strength, upper limb function, and dexterity. When compared to traditional physiotherapy, exergaming has at least similar effects on these outcomes. Many of the investigated studies indicated low methodological quality for the evaluation of the effects of exergames on different outcomes related to motor rehabilitation. Conclusions: Exergames could be used as a complement to traditional forms of motor rehabilitation, but future individual studies and reviews should follow more rigorous methodological standards in order to improve the quality of the evidence and provide guidelines for the use of exergames in motor rehabilitation.info:eu-repo/semantics/acceptedVersio

Design and Development of ReMoVES Platform for Motion and Cognitive Rehabilitation

Exergames have recently gained popularity and scientific reliability in the field of assistive computing technology for human well-being. The ReMoVES platform, developed by the author, provides motor and cognitive exergames to be performed by elderly or disabled people, in conjunction with traditional rehabilitation. Data acquisition during the exercise takes place through Microsoft Kinect, Leap Motion and touchscreen monitor. The therapist is provided with feedback on patients' activity over time in order to assess their weakness and correct inaccurate movement attitudes. This work describes the technical characteristics of the ReMoVES platform, designed to be used by multiple locations such as rehabilitation centers or the patient's home, while providing a centralized data collection server. The system includes 15 exergames, developed from scratch by the author, with the aim of promoting motor and cognitive activity through patient entertainment. The ReMoVES platform differs from similar solutions for the automatic data processing features in support of the therapist. Three methods are presented: based on classic data analysis, on Support Vector Machine classification, and finally on Recurrent Neural Networks. The results describe how it is possible to discern patient gaming sessions with adequate performance from those with incorrect movements with an accuracy of up to 92%. The system has been used with real patients and a data database is made available to the scientific community. The aim is to encourage the dissemination of such data to lay the foundations for a comparison between similar studies

Design and implementation of an integrative system for configurable exergames targeting the senior population

Exergames have been proposed as a solution for the promotion of physical activity in the senior population. The diversity of needs and limitations of the target users demand that the exergaming systems allow the configuration and adjustment of game parameters according to each user profile. Such systems are ideal to use in nursing homes, senior gymnasiums, or even rehabilitation centers. Health and sports professionals are then the main interacting users with the interface of such exergaming systems. Configuration can be difficult and time-consuming when considering complex systems with a significant amount of parameter choices. Since professionals working on such places already have time constraints, if they face long-time configuration of these systems they might give up of using them. Therefore, there is an evident need for systems that assist professionals in two ways. First, providing management support for training sessions and plans with exergames. Second, providing automatic decision-making processes that assist in game selection and parameters configuration to fit the user needs. The acceptance and effectiveness of such systems can only be achieved if the main prospective interactors with the system are involved in the development process so that the system can fulfill the users’ needs and expectations. This thesis reports on the design, implementation, and usability evaluation of an integrative system using some of the most-known human-centric techniques, such as interviews, card sorting, and paper prototyping. Results of a usability study of the UI and the main functionalities of the system showed a considerable acceptance and interest by the professionals. The usability study revealed to be a great resource to find aspects of the system that should be further considered for improvement in future iterations. Furthermore, the high results of the USE (Usefulness, Satisfaction, and Ease of use) questionnaire confirm that this system is a promising tool that sports professionals may be willing to use in their daily practice.A literatura suporta que os exergames, ou jogos que requerem exercício físico, constituem uma opção válida para promoção da atividade física na população idosa. A diversidade de necessidades e limitações do público-alvo exige que estes exergames sejam configuráveis de forma a permitir ajustar os parâmetros do jogo de acordo com o perfil de cada indivíduo. Estes sistemas personalizáveis são ideais para a utilização em lares, centros de dia, ginásios específicos para idosos ou até mesmo em centros de reabilitação. Os profissionais de saúde e de desporto são, assim, os principais utilizadores a definir as configurações destes exergames. Neste contexto, escolher as definições ideais para cada perfil pode ser um processo difícil e demorado, tendo em conta que a interface destes sistemas apresenta normalmente uma quantidade significativa de opções. Considerando que estes profissionais já têm constrangimentos de tempo na sua prática diária, se forem confrontados com uma interação longa e complexa com estes sistemas, podem acabar por desistir de usá-los. Neste sentido, existe uma clara necessidade de sistemas que auxiliem os profissionais a incluir os exergames na sua prática diária com a população idosa. Este sistema deverá assistir os profissionais de duas maneiras. Primeiro, que permita gerir sessões e planos de treino com os exergames. Segundo, que disponibilize processos de decisão automáticos de forma a auxiliar na escolha dos jogos, bem como nas configurações ideais para cada perfil de utilizador. A aceitação e a eficácia destes sistemas podem apenas ser alcançadas se os profissionais forem envolvidos no processo de desenvolvimento desde o início. Tal permitirá que este possa ser desenhado tendo em conta as suas necessidades e expectativas. Esta dissertação descreve as técnicas aplicadas no desenho, implementação e avaliação de um sistema integrativo para exergames, com base em algumas técnicas bem conhecidas na área de interação homemmáquina, como por exemplo entrevistas, card sorting e prototipagem em papel. Resultados de um estudo de usabilidade da interface do sistema integrativo demonstraram uma considerável aceitação e interesse por parte dos profissionais. O estudo de usabilidade revelou ser um bom recurso para encontrar aspetos do sistema que devem ser considerados para melhoramento em futuras iterações. Além disso, os resultados promissores do questionário USE (Utilidade, satisfação e facilidade de uso) confirmam que os profissionais poderão estar interessados em usar este sistema na sua prática diária

Applying vision-based pose estimation in a telerehabilitation application

In this paper, an augmented reality mirror application using vision-based human pose detection based on vision-based pose detection called ExerCam is presented. ExerCam does not need any special controllers or sensors for its operation, as it works with a simple RGB camera (webcam type), which makes the application totally accessible and low cost. This application also has a system for managing patients, tasks and games via the web, with which a therapist can manage their patients in a ubiquitous and totally remote way. As a final conclusion of the article, it can be inferred that the application developed is viable as a telerehabilitation tool, as it has the resource of a task mode for the calculation of the range of motion (ROM) and, on the other hand, a game mode to encourage patients to improve their performance during the therapy, with positive results obtained in this aspect.This work has been partially supported by the Spanish State Research Agency, under project grant AriSe2: FINe (Ref. PID2020-116329GB-C22/AEI/10.13039/501100011033), the Spanish Government projects “GenoVision” (Ref. BFU2017-88300-C2-2-R), the “Research Programme for Groups of Scientific Excellence in the Region of Murcia” of the Seneca Foundation (Agency for Science and Technology in the Region of Murcia—19895/GERM/15) and HORECOV2 (Ref: 2I20SAE00082_HORECOV2) of Fondo Europeo de Desarrollo Regional (FEDER)

Clinical Decision Support Systems with Game-based Environments, Monitoring Symptoms of Parkinson’s Disease with Exergames

Parkinson’s Disease (PD) is a malady caused by progressive neuronal degeneration, deriving in several physical and cognitive symptoms that worsen with time. Like many other chronic diseases, it requires constant monitoring to perform medication and therapeutic adjustments. This is due to the significant variability in PD symptomatology and progress between patients. At the moment, this monitoring requires substantial participation from caregivers and numerous clinic visits. Personal diaries and questionnaires are used as data sources for medication and therapeutic adjustments. The subjectivity in these data sources leads to suboptimal clinical decisions. Therefore, more objective data sources are required to better monitor the progress of individual PD patients. A potential contribution towards more objective monitoring of PD is clinical decision support systems. These systems employ sensors and classification techniques to provide caregivers with objective information for their decision-making. This leads to more objective assessments of patient improvement or deterioration, resulting in better adjusted medication and therapeutic plans. Hereby, the need to encourage patients to actively and regularly provide data for remote monitoring remains a significant challenge. To address this challenge, the goal of this thesis is to combine clinical decision support systems with game-based environments. More specifically, serious games in the form of exergames, active video games that involve physical exercise, shall be used to deliver objective data for PD monitoring and therapy. Exergames increase engagement while combining physical and cognitive tasks. This combination, known as dual-tasking, has been proven to improve rehabilitation outcomes in PD: recent randomized clinical trials on exergame-based rehabilitation in PD show improvements in clinical outcomes that are equal or superior to those of traditional rehabilitation. In this thesis, we present an exergame-based clinical decision support system model to monitor symptoms of PD. This model provides both objective information on PD symptoms and an engaging environment for the patients. The model is elaborated, prototypically implemented and validated in the context of two of the most prominent symptoms of PD: (1) balance and gait, as well as (2) hand tremor and slowness of movement (bradykinesia). While balance and gait affections increase the risk of falling, hand tremors and bradykinesia affect hand dexterity. We employ Wii Balance Boards and Leap Motion sensors, and digitalize aspects of current clinical standards used to assess PD symptoms. In addition, we present two dual-tasking exergames: PDDanceCity for balance and gait, and PDPuzzleTable for tremor and bradykinesia. We evaluate the capability of our system for assessing the risk of falling and the severity of tremor in comparison with clinical standards. We also explore the statistical significance and effect size of the data we collect from PD patients and healthy controls. We demonstrate that the presented approach can predict an increased risk of falling and estimate tremor severity. Also, the target population shows a good acceptance of PDDanceCity and PDPuzzleTable. In summary, our results indicate a clear feasibility to implement this system for PD. Nevertheless, long-term randomized clinical trials are required to evaluate the potential of PDDanceCity and PDPuzzleTable for physical and cognitive rehabilitation effects

Effect of virtual reality rehabilitation on functional outcomes for return-to-work patients with Parkinson's disease: an umbrella review of systematic reviews

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease characterized by loss of substantia nigra neurons with deficiency of dopamine. The main symptoms are tremor, rigidity and bradykinesia. Rehabilitation has an important role in the treatment of this condition and virtual reality (VR) is one of the most recent tools. OBJECTIVE: The purpose of this umbrella review is to evaluate the effectiveness of VR systems on gait control for return to work in patients with PD. METHODS: The electronic search, for reviews and meta-analysis studies that investigated the effectiveness of VR on gait control in PD patients, was performed through December 2021 using the following databases: PubMed, Scopus, PEDro, and Google Scholar. Mesh terms used were: Job integration/reintegration OR return-to-work AND Parkinson's disease AND virtual reality OR exergame. No limit on the year of publication of the article was used. CONCLUSIONS: A total of 14 articles were included in our analysis. The included evidence shows a stride length improvement in patients treated with VR compared to conventional active treatments. No difference was found in walking speed. Also, the included articles show an improvement on various measures of balance, motor function and severity of PD motor symptoms. In addition, the literature shows an improvement in the quality of life and neuropsychiatric symptoms in patients undergoing VR rehabilitation training. RESULTS: he results of our study suggest that VR rehabilitation improves gait performance, particularly stride length, thus being able to provide an improvement in the quality of life and a more effective return to work training in patients with PD

Sustainable Technology and Elderly Life

The coming years will see an exponential increase in the proportion of elderly people in our society. This accelerated growth brings with it major challenges in relation to the sustainability of the system. There are different aspects where these changes will have a special incidence: health systems and their monitoring; the development of a framework in which the elderly can develop their daily lives satisfactorily; and in the design of intelligent cities adapted to the future sociodemographic profile. The discussion of the challenges faced, together with the current technological evolution, can show possible ways of meeting the challenges. There are different aspects where these changes will have a special incidence: health systems and their monitoring; the development of a framework in which the elderly can develop their daily lives satisfactorily; and in the design of intelligent cities adapted to the future sociodemographic profile. This special issue discusses various ways in which sustainable technologies can be applied to improve the lives of the elderly. Six articles on the subject are featured in this volume. From a systematic review of the literature to the development of gamification and health improvement projects. The articles present suggestive proposals for the improvement of the lives of the elderly. The volume is a resource of interest for the scientific community, since it shows different research gaps in the current state of the art. But it is also a document that can help social policy makers and people working in this domain to planning successful projects

New techniques for neuro-rehabilitation: Transcranial Electric Stimulation and Virtual Reality

Recovery of motor and cognitive performances after a neurological illness remains a significant challenge for rehabilitation specialists. The traditional rehabilitative interventions are usually delivered using a multidisciplinary approach, whose results are not always satisfactory. These limitations in functional recovery have led researchers to consider alternative approaches. The hypothesis of providing new therapeutic possibilities in the different patients treated is, as a rehabilitator, very rewarding and represents a challenge for the future. The application of simple and low-cost techniques, defined by the literature as "unconventional" or “novel”, can provide new ideas not only in the field of research but above all of application in clinical reality.A suitable approach to improve the rehabilitation outcome is to utilize these novel rehabilitation techniques that act as a substitute or an addition to the traditional ones. In this context, some recent approaches have been proposed that might increase the effectiveness of a traditional treatment. Among them, two techniques have been demonstrated to be very promising, namely non-invasive brain stimulation (NIBS) and Virtual Reality (VR).In light of the foregoing, my thesis has been divided into two main lines of research, namely: a) the study of the effects of transcranial direct current stimulation (tDCS) in different neurological conditions; b) the application of VR (used alone or combined with tDCS) in the treatment of some neurocognitive disorders. A semi-immersive VR tool (ReMOVES system) has been used as a user-friendly platform providing activities based on exergames