A System in the Wild: Deploying a Two Player Arm Rehabilitation System for Children With Cerebral Palsy in a School Environment

This paper outlines a system for arm rehabilitation for children with upper-limb hemiplegia resulting from cerebral palsy. Our research team designed a two-player, interactive (competitive or collaborative) computer play therapy system that provided powered assistance to children while they played specially designed games that promoted arm exercises. We designed the system for a school environment. To assess the feasibility of deploying the system in a school environment, the research team enlisted the help of teachers and staff in nine schools. Once the system was set up, it was used to deliver therapy without supervision from the research team. Ultimately, the system was found to be suitable for use in schools. However, the overriding need for schools to focus on academic activities meant that children could not use the system enough to achieve the amount of use desired for therapeutic benefit. In this paper, we identify the key challenges encountered during this study. For example, there was a marked reluctance to report system issues (which could have been fixed) that prevented children from using the system. We also discuss future implications of deploying similar studies with this type of system

Tele-Rehabilitation Versus Local Rehabilitation Therapies Assisted by Robotic Devices: A Pilot Study with Patients

The present study aims to evaluate the advantages of a master-slave robotic rehabilitation therapy in which the patient is assisted in real-time by a therapist. We have also explored if this type of strategy is applicable in a tele-rehabilitation environment. A pilot study has been carried out involving 10 patients who have performed a point-to-point rehabilitation exercise supported by three assistance modalities: fixed assistance (without therapist interaction), local therapist assistance, and remote therapist assistance in a simulated tele-rehabiliation scenario. The rehabilitation exercise will be performed using an upper-limb rehabilitation robotic device that assists the patients through force fields. The results suggest that the assistance provided by the therapist is better adapted to patient needs than fixed assistance mode. Therefore, it maximizes the patient’s level of effort, which is an important aspect to improve the rehabilitation outcomes. We have also seen that in a tele-rehabilitation environment it is more difficult to assess when to assist the patient than locally. However, the assistance suits patients better than the fixed assistance mode.This work was funded by the Conselleria d’Educacio, Cultura i Esport of Generalitat Valenciana by the European Social Fund—Investing in your Future, through the grant ACIF 2018/214, PEJ2018-002684-A and PEJ2018-002670-A, and by the Spanish Ministry of Science and Innovation through the project PID2019-108310RB-I00

Exoskeletons with virtual reality, augmented reality and gamification for stroke patients' rehabilitation : systematic review

Background: Robot-assisted therapy has become a promising technology in the field of rehabilitation of post-stroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for a majority of stroke survivors. With the advancement in technology, there has been the introduction of Virtual Reality, Augmented Reality, customizable games or a combination thereof that aid robotic therapy in retaining or increasing the interests of patients to keep performing the exercises. However, there are gaps in evidence regarding the transition from clinical rehabilitation to home-based therapy and it calls for an updated synthesis of literature showcasing this trend. The present review proposes a categorization of these studies according to technologies used by them and also details research in upper limb and lower limb applications. Objective: The goal of this work was to review the practices and technologies implemented for the rehabilitation of post-stroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies, Virtual Reality, Augmented Reality or Gamification for improving activity and participation in post-stroke survivors. Methods: A systematic search of the literature on exoskeleton robotics applied with any of the three technologies, Virtual Reality, Augmented Reality or Gamification, was performed in the databases namely; MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), Science Direct & The Cochrane Library. Exoskeleton based studies that did not include any VR, AR or gamification elements were excluded and publications from the year 2010 to 2017 were included. Results in the form of improvements in patients were also recorded and taken into consideration in finding the effectiveness of therapy on patients. Results: Thirty studies were identified based on the inclusion criteria that included randomised controlled trials as well as explorative research pieces. There was a total of around 385 participants across the studies. Use of technologies such as Virtual Reality/Augmented Reality/Gamification based Exoskeletons are capable of filling the transition from clinical to home-based settings. Our analysis showed that there were in general improvements in the motor deficiency for patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps in understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation. Conclusions: Future studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the therapy individually

Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke

Abstract Background Impairment of upper extremity function is a common outcome following stroke, to the detriment of lifestyle and employment opportunities. Yet, access to treatment may be limited due to geographical and transportation constraints, especially for those living in rural areas. While stroke rates are higher in these areas, stroke survivors in these regions of the country have substantially less access to clinical therapy. Home therapy could offer an important alternative to clinical treatment, but the inherent isolation and the monotony of self-directed training can greatly reduce compliance. Methods We developed a 3D, networked multi-user Virtual Environment for Rehabilitative Gaming Exercises (VERGE) system for home therapy. Within this environment, stroke survivors can interact with therapists and/or fellow stroke survivors in the same virtual space even though they may be physically remote. Each user’s own movement controls an avatar through kinematic measurements made with a low-cost, Kinect™ device. The system was explicitly designed to train movements important to rehabilitation and to provide real-time feedback of performance to users and clinicians. To obtain user feedback about the system, 15 stroke survivors with chronic upper extremity hemiparesis participated in a multisession pilot evaluation study, consisting of a three-week intervention in a laboratory setting. For each week, the participant performed three one-hour training sessions with one of three modalities: 1) VERGE system, 2) an existing virtual reality environment based on Alice in Wonderland (AWVR), or 3) a home exercise program (HEP). Results Over 85% of the subjects found the VERGE system to be an effective means of promoting repetitive practice of arm movement. Arm displacement averaged 350 m for each VERGE training session. Arm displacement was not significantly less when using VERGE than when using AWVR or HEP. Participants were split on preference for VERGE, AWVR or HEP. Importantly, almost all subjects indicated a willingness to perform the training for at least 2–3 days per week at home. Conclusions Multi-user VR environments hold promise for home therapy, although the importance of reducing complexity of operation for the user in the VR system must be emphasized. A modified version of the VERGE system is currently being used in a home therapy study

StableHand VR: a virtual reality serious game for hand rehabilitation

Dissertação de mestrado integrado em Biomedical Engineering Medical InformaticsA third of all injuries at work are sustained to the hand, and hand and wrist injuries are estimated to account between 10% to 30% of all Emergency Department (ED) attendances. In 2017, there were approximately 18 million hand and wrist fractures, 2 million thumb amputations and 4 million non-thumb digit amputations worldwide. Several injuries, disabilities and diseases can affect manual motor control. Hand physiotherapy is indispensable to restore hand functionality. However, this process is often a strenuous and cognitively demanding experience. This work proposes a Virtual Reality (VR) serious game to improve conventional physiotherapy in hand rehabilitation. It focuses on resolving recurring limitations reported in most technological solutions to the problem, namely the limited diversity support of movements and exercises, complicated calibrations, and exclusion of patients with open wounds or other disfigurements of the hand. Concepts such as mixed reality, serious games for health, and hand rehabilitation are addressed in this dissertation to provide the reader with a background for the project. The latest developments of digital games and technologies in the hand rehabilitation field, specifications, requirements, general game characteristics and the most relevant details of the game implementation process are also presented in this dissertation. The system was assessed in two mid-term validations to test its viability and adjust the development. The first validation was performed with eight able-bodied participants and the second with four health professionals working in the rehabilitation field. The validations were performed following ten minutes of guided functional task practices followed by a Semi-Structured Interview for the first validation and an online questionnaire for the second validation. The questions made in the interview and online questionnaire focused on the participants’ familiarity with videogames, opinion about the Oculus Quest and its hand tracking system, and the StableHand VR game. The System Usability Scale (SUS) scores obtained and the participants’ positive feedback showed the potential of both conceptual and technological approaches adopted for this game as a viable complement to conventional hand rehabilitation. The project’s main objectives were achieved, and several relevant topics for further research were identified.Um terço de todos os ferimentos no trabalho afetam a mão e estima-se que 10% a 30% de todos os atendimentos nas Urgências se devem a ferimentos na mão e no pulso. Em 2017, houve aproximadamente 18 milhões de fraturas da mão e do pulso, 2 milhões de amputações do polegar e 4 milhões de amputações de dígitos não polegares em todo o mundo. Vários ferimentos, deficiências e doenças podem afetar o controlo motor manual. A fisioterapia é indispensável para recuperar a funcionalidade da mão. No entanto, este processo é frequentemente uma experiência extenuante e cognitivamente exigente. Este trabalho propõe um jogo sério em Realidade Virtual para melhorar a fisioterapia convencional na reabilitação da mão. O trabalho desenvolvido concentra-se na resolução de recorrentes limitações relatadas na maioria das soluções tecnológicas para o problema, nomeadamente o apoio limitado de diversidade de movimentos e exercícios, calibrações complicadas e exclusão de pacientes com feridas abertas ou outras desfigurações da mão. Esta dissertação aborda conceitos como a realidade mista, jogos sérios para a saúde e reabilitação para fornecer ao leitor contextualização para o projeto. Os últimos desenvolvimentos de jogos digitais e tecnologias no campo da reabilitação da mão são também apresentados nesta dissertação, assim como especificações, requisitos, características gerais do jogo e o processo de implementação do mesmo. O sistema foi avaliado através de dois ensaios realizados durante o processo de desenvolvimento, para testar a viabilidade e proceder a ajustes da solução especificada. A primeira validação foi conduzida com oito participantes saudáveis e a segunda validação com quatro profissionais de saúde que trabalham em reabilitação. As validações foram realizadas após dez minutos de práticas funcionais orientadas, seguidas de uma Entrevista Semiestruturada, no caso da primeira validação, ou de um questionário online, no caso da segunda validação. As perguntas feitas na entrevista e no questionário online centraram-se na familiaridade dos participantes com os videojogos, opinião sobre o Oculus Quest e o seu sistema de localização de mãos e o jogo StableHand VR. As pontuações obtidas no System Usability Scale e o feedback positivo dos participantes demostrou o potencial das abordagens conceptuais e tecnológicas adotadas para que este jogo fosse visto como um complemento viável para a reabilitação convencional das mãos. Os principais objetivos do projeto foram alcançados, tendo também sido identificado um conjunto de tópicos relevantes de investigação futura

Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research

Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task.  Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach.  The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions

A RGBD-Based interactive system for gaming-driven rehabilitation of upper limbs

Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings

Motion-Based Video Games for Stroke Rehabilitation with Reduced Compensatory Motions

Stroke is the leading cause of long-term disability among adults in industrialized nations, with 80% of people who survive strokes experiencing motor disabilities. Recovery requires daily exercise with a high number of repetitions, often without therapist supervision. Motion-based video games can help motivate people with stroke to perform the necessary exercises to recover. We explore the design space of video games for stroke rehabilitation using Wii remotes and webcams as input devices, and share the lessons we learned about what makes games therapeutically useful. We demonstrate the feasibility of using games for home-based stroke therapy with a six-week case study. We show that exercise with games can help recovery even 17 years after the stroke, and share the lessons that we learned for game systems to be used at home as a part of outpatient therapy. As a major issue with home-based therapy, we identify that unsupervised exercises lead to compensatory motions that can impede recovery and create new health issues. We reliably detect torso compensation in shoulder exercises using a custom harness, and develop a game that meaningfully uses both exercise and compensation as inputs. We provide in-game feedback that reduces compensation in a number of ways. We evaluate alternative ways for reducing compensation in controlled experiments and show that using techniques from operant conditioning are effective in significantly reducing compensatory behavior compared to existing approaches