Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence - key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.The National Health Service (NHS) London Regional Innovation Fund

In-home and remote use of robotic body surrogates by people with profound motor deficits

By controlling robots comparable to the human body, people with profound motor deficits could potentially perform a variety of physical tasks for themselves, improving their quality of life. The extent to which this is achievable has been unclear due to the lack of suitable interfaces by which to control robotic body surrogates and a dearth of studies involving substantial numbers of people with profound motor deficits. We developed a novel, web-based augmented reality interface that enables people with profound motor deficits to remotely control a PR2 mobile manipulator from Willow Garage, which is a human-scale, wheeled robot with two arms. We then conducted two studies to investigate the use of robotic body surrogates. In the first study, 15 novice users with profound motor deficits from across the United States controlled a PR2 in Atlanta, GA to perform a modified Action Research Arm Test (ARAT) and a simulated self-care task. Participants achieved clinically meaningful improvements on the ARAT and 12 of 15 participants (80%) successfully completed the simulated self-care task. Participants agreed that the robotic system was easy to use, was useful, and would provide a meaningful improvement in their lives. In the second study, one expert user with profound motor deficits had free use of a PR2 in his home for seven days. He performed a variety of self-care and household tasks, and also used the robot in novel ways. Taking both studies together, our results suggest that people with profound motor deficits can improve their quality of life using robotic body surrogates, and that they can gain benefit with only low-level robot autonomy and without invasive interfaces. However, methods to reduce the rate of errors and increase operational speed merit further investigation.Comment: 43 Pages, 13 Figure

Display Enhanced Testing For Concussions And Mild Traumatic Brain Injury

Cognitive assessment systems and methods that provide an integrated solution for evaluating the presence or absence of cognitive impairment. The present invention is used to test cognitive functions of an individual including information processing speed, working memory, work list learning and recall, along with variations of these tasks. Immersive and non-immersive systems and methods are disclosed. Testing and results feedback using the present invention may be completed in real time, typically in less than 15 minutes.Emory UniversityGeorgia Tech Research Corporatio

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Control of virtual environments for young people with learning difficulties

Purpose: The objective of this research is to identify the requirements for the selection or development of usable virtual environment (VE) interface devices for young people with learning disabilities. Method: a user-centred design methodology was employed, to produce a design specification for usable VE interface devices. Details of the users' cognitive, physical and perceptual abilities were obtained through observation and normative assessment tests. Conclusions : A review of computer interface technology, including virtual reality and assistive devices, was conducted. As there were no devices identified that met all the requirements of the design specification, it was concluded that there is a need for the design and development of new concepts. Future research will involve concept and prototype development and user-based evaluation of the prototypes

A virtual hand assessment system for efficient outcome measures of hand rehabilitation

Previously held under moratorium from 1st December 2016 until 1st December 2021.Hand rehabilitation is an extremely complex and critical process in the medical rehabilitation field. This is mainly due to the high articulation of the hand functionality. Recent research has focused on employing new technologies, such as robotics and system control, in order to improve the precision and efficiency of the standard clinical methods used in hand rehabilitation. However, the designs of these devices were either oriented toward a particular hand injury or heavily dependent on subjective assessment techniques to evaluate the progress. These limitations reduce the efficiency of the hand rehabilitation devices by providing less effective results for restoring the lost functionalities of the dysfunctional hands. In this project, a novel technological solution and efficient hand assessment system is produced that can objectively measure the restoration outcome and, dynamically, evaluate its performance. The proposed system uses a data glove sensorial device to measure the multiple ranges of motion for the hand joints, and a Virtual Reality system to return an illustrative and safe visual assistance environment that can self-adjust with the subject’s performance. The system application implements an original finger performance measurement method for analysing the various hand functionalities. This is achieved by extracting the multiple features of the hand digits’ motions; such as speed, consistency of finger movements and stability during the hold positions. Furthermore, an advanced data glove calibration method was developed and implemented in order to accurately manipulate the virtual hand model and calculate the hand kinematic movements in compliance with the biomechanical structure of the hand. The experimental studies were performed on a controlled group of 10 healthy subjects (25 to 42 years age). The results showed intra-subject reliability between the trials (average of crosscorrelation ρ = 0.7), inter-subject repeatability across the subject’s performance (p > 0.01 for the session with real objects and with few departures in some of the virtual reality sessions). In addition, the finger performance values were found to be very efficient in detecting the multiple elements of the fingers’ performance including the load effect on the forearm. Moreover, the electromyography measurements, in the virtual reality sessions, showed high sensitivity in detecting the tremor effect (the mean power frequency difference on the right Vextensor digitorum muscle is 176 Hz). Also, the finger performance values for the virtual reality sessions have the same average distance as the real life sessions (RSQ =0.07). The system, besides offering an efficient and quantitative evaluation of hand performance, it was proven compatible with different hand rehabilitation techniques where it can outline the primarily affected parts in the hand dysfunction. It also can be easily adjusted to comply with the subject’s specifications and clinical hand assessment procedures to autonomously detect the classification task events and analyse them with high reliability. The developed system is also adaptable with different disciplines’ involvements, other than the hand rehabilitation, such as ergonomic studies, hand robot control, brain-computer interface and various fields involving hand control.Hand rehabilitation is an extremely complex and critical process in the medical rehabilitation field. This is mainly due to the high articulation of the hand functionality. Recent research has focused on employing new technologies, such as robotics and system control, in order to improve the precision and efficiency of the standard clinical methods used in hand rehabilitation. However, the designs of these devices were either oriented toward a particular hand injury or heavily dependent on subjective assessment techniques to evaluate the progress. These limitations reduce the efficiency of the hand rehabilitation devices by providing less effective results for restoring the lost functionalities of the dysfunctional hands. In this project, a novel technological solution and efficient hand assessment system is produced that can objectively measure the restoration outcome and, dynamically, evaluate its performance. The proposed system uses a data glove sensorial device to measure the multiple ranges of motion for the hand joints, and a Virtual Reality system to return an illustrative and safe visual assistance environment that can self-adjust with the subject’s performance. The system application implements an original finger performance measurement method for analysing the various hand functionalities. This is achieved by extracting the multiple features of the hand digits’ motions; such as speed, consistency of finger movements and stability during the hold positions. Furthermore, an advanced data glove calibration method was developed and implemented in order to accurately manipulate the virtual hand model and calculate the hand kinematic movements in compliance with the biomechanical structure of the hand. The experimental studies were performed on a controlled group of 10 healthy subjects (25 to 42 years age). The results showed intra-subject reliability between the trials (average of crosscorrelation ρ = 0.7), inter-subject repeatability across the subject’s performance (p > 0.01 for the session with real objects and with few departures in some of the virtual reality sessions). In addition, the finger performance values were found to be very efficient in detecting the multiple elements of the fingers’ performance including the load effect on the forearm. Moreover, the electromyography measurements, in the virtual reality sessions, showed high sensitivity in detecting the tremor effect (the mean power frequency difference on the right Vextensor digitorum muscle is 176 Hz). Also, the finger performance values for the virtual reality sessions have the same average distance as the real life sessions (RSQ =0.07). The system, besides offering an efficient and quantitative evaluation of hand performance, it was proven compatible with different hand rehabilitation techniques where it can outline the primarily affected parts in the hand dysfunction. It also can be easily adjusted to comply with the subject’s specifications and clinical hand assessment procedures to autonomously detect the classification task events and analyse them with high reliability. The developed system is also adaptable with different disciplines’ involvements, other than the hand rehabilitation, such as ergonomic studies, hand robot control, brain-computer interface and various fields involving hand control

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