Usability of an Immersive Augmented Reality Based Telerehabilitation System with Haptics (ARTESH) for Synchronous Remote Musculoskeletal Examination

This study describes the features and utility of a novel augmented reality based telemedicine system with haptics that allows the sense of touch and direct physical examination during a synchronous immersive telemedicine consultation and physical examination. The system employs novel engineering features: (a) a new force enhancement algorithm to improve force rendering and overcoming the “just-noticeable-difference” limitation; (b) an improved force compensation method to reduce the delay in force rendering; (c) use of the “haptic interface point” to reduce disparity between the visual and haptic data; and (d) implementation of efficient algorithms to process, compress, decompress, transmit and render 3-D tele-immersion data. A qualitative pilot study (n=20) evaluated the usability of the system. Users rated the system on a 26-question survey using a seven-point Likert scale, with percent agreement calculated from the total users who agreed with a given statement. Survey questions fell into three main categories: (1) ease and simplicity of use, (2) quality of experience, and (3) comparison to in-person evaluation. Average percent agreements between the telemedicine and in-person evaluation were highest for ease and simplicity of use (86%) and quality of experience (85%), followed by comparison to in-person evaluation (58%). Eighty-nine percent (89%) of respondents expressed satisfaction with the overall quality of experience. Results suggest that the system was effective at conveying audio-visual and touch data in real-time across 20.3 miles, and warrants further development.

Can rehabilitation through virtual reality improve the quality of the health care communication? = ¿La realidad virtual en rehabilitación puede mejorar la calidad de la comunicación en los servicios sanitarios?

Abstract: Introduction: Exercises on prescription given by physiotherapist are sometimes complex to explain & difficult to remember by the patient. Implementation of virtual reality could maybe improve such communication. Objective: demonstrate the effectiveness of using a VR-based protocol, with a “teaching by example” approach Methods: Total of 6 participants were exposed to two different exercise set: 1- with a 3D agent; 2- with a video of a real person. Each test person was: 1- video recorded to keep track on his/her experience using both programs; 2- tested with Modified PSSUQ & Words questionnaires after each performance; 3- video recorded in an interview with open questions to clarify the participants’ personal experiences. Results: Three of the participants would prefer to use the video: Three preferred the 3D virtual reality application and all participants felt both approach were easy to use & follow. However, from the video recorded observations some participants did not perform the exercises as well as they thought themselves; Conclusions: No difference was found in how well the participants performed with the two approaches or how they perceived the movements of the video instructor compared to the 3D virtual trainer. Improvement of the 3D set up, could potentially show further differences between the two approaches in future studies. Keywords: Virtual rehabilitation, virtual reality, Communications, physiotherapy, exercise on prescription Resumen: Introducción: Los ejercicios prescritos por el fisioterapeuta son a veces difícil de explicar y difícil de recordar por parte del paciente. La aplicación de la realidad virtual (VR) quizás pudiera mejorar dicha comunicación. Objetivo: demostrar la eficacia de la utilización de un protocolo basado en VR , utilizando "enseñanza con ejemplos" Métodos : un total de 6 participantes fueron expuestos a dos programas de ejercicios diferentes: 1 - con un agente de 3D ; 2 - con un video de una persona . Cada participante fue: 1– grabado/a en video para realizar un seguimiento de su experiencia utilizando ambos programas; 2– testeado/a con los cuestionarios modificados de PSSUQ y Words después de cada actuación; 3- grabado/a en video en una entrevista con preguntas abiertas para esclarecer las experiencias vividas. Resultados: Tres de los participantes prefirieron el programa de ejercicios en video, el resto el de realidad virtual, todos los participantes pensaron que los dos programas de ejercicios eran fácil de usar y seguir. Sin embargo, las observaciones registradas en vídeo muestran que algunos de los participantes, a pesar de que creyeron realizar correctamente los ejercicios, no los hicieron como se esperaba; Conclusión: No se encontró diferencia entro los dos enfoques en lo que atiene la perfección del movimiento o cómo los participantes percibieron los movimientos del instructor. El mejoramiento del programa 3D de ejercicios, podrían mostrar mayores diferencias entre los dos enfoques en estudios futuros. Palabras clave: Rehabilitación virtual, realidad virtual, comunicación, fisioterapia, prescripción de ejercicio

Virtual Reality Applications in Rehabilitation

The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-319-39510-4_1One of the most valuable applications of virtual reality (VR) is in the domain of rehabilitation. After brain injuries or diseases, many patients suffer from impaired physical and/or cognitive capabilities, such as difficulties in moving arms or remembering names. Over the past two decades, VR has been tested and examined as a technology to assist patients’ recovery and rehabilitation, both physical and cognitive. The increasing prevalence of low-cost VR devices brings new opportunities, allowing VR to be used in practice. Using VR devices such as head-mounted displays (HMDs), special virtual scenes can be designed to assist patients in the process of re-training their brain and reorganizing their functions and abilities. However, such VR interfaces and applications must be comprehensively tested and examined for their effectiveness and potential side effects. This paper presents a review of related literature and discusses the new opportunities and challenges. Most of existing studies examined VR as an assessment method rather than a training/exercise method. Nevertheless, promising cases and positive preliminary results have been shown. Considering the increasing need for self-administered, home-based, and personalized rehabilitation, VR rehabilitation is potentially an important approach. This area requires more studies and research effort

Immersive Environment for Occupational Therapy: Pilot Study

There has been increasing interest in the application of virtual reality (VR) to occupational therapy and rehabilitation fields. This work presents a VR-based city adventure framework designed for occupational therapy. Its concept is based on taking the user to travel around a virtual city, where the motion is powered by the execution of some type of physical exercise, namely cycling in the current example. This framework is extensible and may integrate different goals focused on improving/maintaining motor and cognitive skills necessary for daily activities, mainly through upper and lower limb exercises and mental challenges. This led to the development of an immersive system, which was tested with an elderly sample (15 participants) in a day center and at a retirement home. Usability, satisfaction, performance and side effects were evaluated to understand future applicability and work directions.info:eu-repo/semantics/publishedVersio

Quality of experience for 3-d immersive media streaming

Recent advances in media capture and processing technologies have enabled new forms of true 3-D media content that increase the degree of user immersion. The demand for more engaging forms of entertainment means that content distributors and broadcasters need to fine-tune their delivery mechanisms over the Internet as well as develop new models for quantifying and predicting user experience of these new forms of content. In the work described in this paper, we undertake one of the first studies into the quality of experience (QoE) of real-time 3-D media content streamed to virtual reality (VR) headsets for entertainment purposes, in the context of game spectating. Our focus is on tele-immersive media that embed real users within virtual environments of interactive games. A key feature of engaging and realistic experiences in full 3-D media environments, is allowing users unrestricted viewpoints. However, this comes at the cost of increased network bandwidth and the need of limiting network effects in order to transmit a realistic, real-time representation of the participants. The visual quality of 3-D media is affected by geometry and texture parameters while the temporal aspects of smooth movement and synchronization are affected by lag introduced by network transmission effects. In this paper, we investigate varying network conditions for a set of tele-immersive media sessions produced in a range of visual quality levels. Further, we investigate user navigation issues that inhibit free viewpoint VR spectating of live 3-D media. After reporting on a study with multiple users we analyze the results and assess the overall QoE with respect to a range of visual quality and latency parameters. We propose a neural network QoE prediction model for 3-D media, constructed from a combination of visual and network parameters

Thought-controlled games with brain-computer interfaces

Nowadays, EEG based BCI systems are starting to gain ground in games for health research. With reduced costs and promising an innovative and exciting new interaction paradigm, attracted developers and researchers to use them on video games for serious applications. However, with researchers focusing mostly on the signal processing part, the interaction aspect of the BCIs has been neglected. A gap between classification performance and online control quality for BCI based systems has been created by this research disparity, resulting in suboptimal interactions that lead to user fatigue and loss of motivation over time. Motor-Imagery (MI) based BCIs interaction paradigms can provide an alternative way to overcome motor-related disabilities, and is being deployed in the health environment to promote the functional and structural plasticity of the brain. A BCI system in a neurorehabilitation environment, should not only have a high classification performance, but should also provoke a high level of engagement and sense of control to the user, for it to be advantageous. It should also maximize the level of control on user’s actions, while not requiring them to be subject to long training periods on each specific BCI system. This thesis has two main contributions, the Adaptive Performance Engine, a system we developed that can provide up to 20% improvement to user specific performance, and NeuRow, an immersive Virtual Reality environment for motor neurorehabilitation that consists of a closed neurofeedback interaction loop based on MI and multimodal feedback while using a state-of-the-art Head Mounted Display.Hoje em dia, os sistemas BCI baseados em EEG estão a começar a ganhar terreno em jogos relacionados com a saúde. Com custos reduzidos e prometendo um novo e inovador paradigma de interação, atraiu programadores e investigadores para usá-los em vídeo jogos para aplicações sérias. No entanto, com os investigadores focados principalmente na parte do processamento de sinal, o aspeto de interação dos BCI foi negligenciado. Um fosso entre o desempenho da classificação e a qualidade do controle on-line para sistemas baseados em BCI foi criado por esta disparidade de pesquisa, resultando em interações subótimas que levam à fadiga do usuário e à perda de motivação ao longo do tempo. Os paradigmas de interação BCI baseados em imagética motora (IM) podem fornecer uma maneira alternativa de superar incapacidades motoras, e estão sendo implementados no sector da saúde para promover plasticidade cerebral funcional e estrutural. Um sistema BCI usado num ambiente de neuro-reabilitação, para que seja vantajoso, não só deve ter um alto desempenho de classificação, mas também deve promover um elevado nível de envolvimento e sensação de controlo ao utilizador. Também deve maximizar o nível de controlo nas ações do utilizador, sem exigir que sejam submetidos a longos períodos de treino em cada sistema BCI específico. Esta tese tem duas contribuições principais, o Adaptive Performance Engine, um sistema que desenvolvemos e que pode fornecer até 20% de melhoria para o desempenho específico do usuário, e NeuRow, um ambiente imersivo de Realidade Virtual para neuro-reabilitação motora, que consiste num circuito fechado de interação de neuro-feedback baseado em IM e feedback multimodal e usando um Head Mounted Display de última geração

Rehabilitation of Post-COVID Patients: A Virtual Reality Home-Based Intervention Including Cardio-Respiratory Fitness Training

The post-COVID syndrome is emerging as a new chronic condition, characterized by symptoms of breathlessness, fatigue, and decline of neurocognitive functions. Rehabilitation programs that include physical training seem to be beneficial to reduce such symptoms and improve patients' quality of life. Given this, and considering the limitations imposed by the pandemic on rehabilitation services, it emerged the need to integrate telerehabilitation programs into clinical practice. Some telerehabilitation solutions, also based on virtual reality (VR), are available in the market. Still, they mainly focus on rehabilitation of upper limbs, balance, and cognitive training, while exercises like cycling or walking are usually not considered. The presented work aims to fill this gap by integrating a VR application to provide cardio-respiratory fitness training to post-COVID patients in an existing telerehabilitation platform. The ARTEDIA application allows patients to perform a cycling exercise and a concurrent cognitive task. Patients can cycle in a virtual park while performing a "go/no-go" task by selecting only specific targets appearing along the way. The difficulty of the practice can be adjusted by the therapists, while the physiological response is continuously monitored through wearable sensors to ensure safety. The application has been integrated into the VRRS system by Khymeia. In the next months, a study to assess the feasibility of a complete telerehabilitation program based on physical and cognitive training will take place. Such a program will combine the existing VRRS exercises and the cardio-respiratory fitness exercise provided by the ARTEDIA application. Feasibility, acceptance, and usability will be assessed from both the patients' and the therapists' sides

Kires: a data-centric telerehabilitation system based on kinect

185 p.It is widely accepted that the worldwide demand for rehabilitation services. To meet these needs, there will have to be developed systems of telerehabilitation that will bring services to even the most remote locations, through Internet and related technologies.This thesis is addressing the area of remote health care delivery, in particular telerehabilitation. We present KiReS; a Kinect based telerehabilitation system which covers the needs of physiotherapists in the process of designing, managing and evaluating physiotherapy protocols and sessions and also covers the needs of the users providing them an intuitive and encouraging interface and giving useful feedback to enhance the rehabilitation process. As required for multi-disciplinary projects, physiotherapists were consulted and feedback from patients was incorporated at different development stages.KiReS aims to outcome limitations of other telerehabilitation systems and bring some novel features: 1) A friendly and helpful interaction with the system using Kinect and motivational interfaces based on avatars. 2) Provision of smart data that supports physiotherapists in the therapy design process by: assuring the maintenance of appropriate constraints and selecting for them a set of exercises that are recommended for the user. 3) Monitoring of rehabilitation sessions through an algorithm that evaluates online performed exercises and sets if they have been properly executed. 4) Extensibility, KiReS is designed to be loaded with a broad spectrum of exercises and protocols