Motion Assessments in Virtual Reality Environments

Traditional upper extremity rehabilitation techniques are often tedious and repetitive. Recent improvements to Virtual Reality games have allowed for increased customizability and show potential in the area of rehabilitation, creating a more integrative and exciting rehabilitation environment. The purpose of this thesis is to use Virtual Reality (VR) and motion capture to quantify different movement deficits that may arise due to MS, and to understand how the reaching motions of patients with MS may differ from healthy controls. Reaching motions are one of the motions commonly used in upper extremity rehabilitation measures, and through the study of reaching motions this research will have a long-term purpose of determining whether virtual reality can be used as an effective upper extremity rehabilitation tool. During data collection participants will wear a motion capture suit and a VR headset that displays movement targets. Participants will perform 3 levels focused on motions involving single arm movements and dual arm movements, in which they will be asked to perform reaching motions to hit the movement targets. The motion data collected from participants’ motion capture suits will then be analyzed and compared between MS and control groups.https://ecommons.udayton.edu/stander_posters/2857/thumbnail.jp

Upper extremity rehabilitation using interactive virtual environments

Stroke affects more than 700,000 people annually in the U.S. It is the leading cause of major disability. Recovery of upper extremity function remains particularly resistant to intervention, with 80% to 95% of persons demonstrating residual upper extremity impairments lasting beyond six months after the stroke. The NJIT Robot Assistive Virtual Rehabilitation (NJIT-RAVR) system has been developed to study optimal strategies for rehabilitation of arm and hand function. Several commercial available devices, such as HapticMaster™, Cyberglove™, trakSTAR™ and Cybergrasp™, have been integrated and 11 simulations were developed to allow users to interact with virtual environments. Visual interfaces used in these simulations were programmed either in Virtools or in C++ using the Open GL library. Stereoscopic glasses were used to enhance depth perception and to present movement targets to the subjects in a 3-dimensional stereo working space. Adaptive online and offline algorithms were developed that provided appropriate task difficulty to optimize the outcomes. A pilot study was done on four stroke patients and two children with cerebral palsy to demonstrate the usability of this robot-assisted VR system. The RAVR system performed well without unexpected glitches during two weeks of training. No subjects experienced side effects such as dizziness, nausea or disorientation while interacting with the virtual environment. Each subject was able to finish the training, either with or without robotic adaptive assistance. To investigate optimal therapeutic approaches, forty stroke subjects were randomly assigned to two groups: Hand and Arm training Together (HAT) and Hand and Arm training Separately (HAS). Each group was trained in similar virtual reality training environments for three hours a day, four days a week for two weeks. In addition, twelve stroke subjects participated as a control group. They received conventional rehabilitation training of similar intensity and duration as the HAS and HAT groups. Clinical outcome measurements included the Jebsen Test of Hand Function, the Wolf Motor Function Test, and the ReachGrasp test. Secondary outcome measurements were calculated from kinematic and kinetic data collected during training in real time at 100 Hz. Both HAS and HAT groups showed significant improvement in clinical and kinematic outcome measurements. Clinical improvement compared favorably to the randomized clinical trials reported in the literature. However, there was no significant improvement difference between the two groups. Subjects from the control group improved in clinical measurements and in the ReachGrasp test. Compared to the control group, the ReachGrasp test showed a larger increase in movement speed during reaching and in the efficiency of lifting an object from the table in the combined HAS and HAT group. The NJIT-RAVR system was further modified to address the needs of children with hemiplegia due to Cerebral Palsy. Thirteen children with cerebral palsy participated in the total of nine sessions of one hour training that lasted for three weeks. Nine of the children were trained using the RAVR system alone, and another four had training with the combined Constraint-Induced Movement therapy and RAVR therapy. As a group, the children demonstrated improved performance across measurements of the Arm Range of Motion (AROM), motor function, kinematics and motor control. While subjects\u27 responses to the games varied, they performed each simulation while maintaining attention sufficient to improve in both robotic task performance and in measures of motor function

Adaptable videogame platform for interactive upper extremity rehabilitation

The primary objective of this work is to design a recreational rehabilitation videogame platform for customizing motivating games that interactively encourage purposeful upper extremity gross motor movements. Virtual reality (VR) technology is a popular application for rehabilitation therapies but there is a constant need for more accessible and affordable systems. We have developed a recreational VR game platform can be used as an independent therapy supplement without laboratory equipment and is inexpensive, motivating, and adaptable. The behaviors and interactive features can be easily modified and customized based on players\u27 limitations or progress. A real-time method of capturing hand movements using programmed color detection mechanisms to create the simulated virtual environments (VEs) is implemented. Color markers are tracked and simultaneously given coordinates in the VE where the player sees representations of their hands and other interacting objects whose behaviors can be customized and adapted to fit therapeutic objectives and players\u27 interests. After gross motor task repetition and involvement in the adaptable games, mobility of the upper extremities may improve. The videogame platform is expanded and optimized to allow modifications to base inputs and algorithms for object interactions through graphical user interfaces, thus providing the adaptable need in VR rehabilitation

Immersive Virtual Reality and Robotics for Upper Extremity Rehabilitation

Stroke patients often experience upper limb impairments that restrict their mobility and daily activities. Physical therapy (PT) is the most effective method to improve impairments, but low patient adherence and participation in PT exercises pose significant challenges. To overcome these barriers, a combination of virtual reality (VR) and robotics in PT is promising. However, few systems effectively integrate VR with robotics, especially for upper limb rehabilitation. Additionally, traditional VR rehabilitation primarily focuses on hand movements rather than joint movements of the limb. This work introduces a new virtual rehabilitation solution that combines VR with KinArm robotics and a wearable elbow sensor to measure elbow joint movements. The framework also enhances the capabilities of a traditional robotic device (KinArm) used for motor dysfunction assessment and rehabilitation. A preliminary study with non-clinical participants (n = 16) was conducted to evaluate the effectiveness and usability of the proposed VR framework. We used a two-way repeated measures experimental design where participants performed two tasks (Circle and Diamond) with two conditions (VR and VR KinArm). We found no main effect of the conditions for task completion time. However, there were significant differences in both the normalized number of mistakes and recorded elbow joint angles (captured as resistance change values from the wearable sensor) between the Circle and Diamond tasks. Additionally, we report the system usability, task load, and presence in the proposed VR framework. This system demonstrates the potential advantages of an immersive, multi-sensory approach and provides future avenues for research in developing more cost-effective, tailored, and personalized upper limb solutions for home therapy applications.Comment: Submitted to International Journal of Human-Computer Interactio

Upper Extremity Motion Assessments in Virtual Reality Environments

Traditional upper extremity rehabilitation techniques often utilize tedious and repetitive reaching motions. Fully immersive virtual reality (VR), involving a VR headset, is a technology with the potential to have non-gaming uses and applications, specifically as an upper extremity rehabilitation tool. This study was designed with the long-term goal of evaluating immersive VR as an upper extremity rehabilitation tool. The purpose of this research is to quantify different movement deficits that may arise due to MS or Parkinson’s, and to understand how the motions of patients with MS or Parkinson’s may differ from healthy controls. This thesis documents the first step in that process: the development of a baseline standard for upper extremity reaching motions within this experimental rehabilitation method. The virtual environment utilized in this study is the game “Beat Sabers”. Custom levels were designed and coded to examine the impact of factors of Vertical Position, Horizontal Position, and Direction of the movement task on the outcome metrics. Additionally, three type of movements were tested: Unilateral, Bilateral, and Contralateral. A healthy control group of 16 young adults was recruited. Using an XSens Awinda motion capture suit, motion data was collected while participants performed roughly 500 movement tasks per person. Initial statistical assessment of the Unilateral movements showed that the factor of Direction was strongly significant for all joint angle and velocity metrics examined. Vertical Position was significant for most of the metrics examined. Finally, average range of motion for each joint was established. These results and motion profiles will serve as a control baseline for upper extremity motions, which will be later used in the evaluation of movement deficits in clinical populations including multiple sclerosis and Parkinson’s disease

The future of upper extremity rehabilitation robotics: research and practice

The loss of upper limb motor function can have a devastating effect on people’s lives. To restore upper limb control and functionality, researchers and clinicians have developed interfaces to interact directly with the human body’s motor system. In this invited review, we aim to provide details on the peripheral nerve interfaces and brain‐machine interfaces that have been developed in the past 30 years for upper extremity control, and we highlight the challenges that still remain to transition the technology into the clinical market. The findings show that peripheral nerve interfaces and brain‐machine interfaces have many similar characteristics that enable them to be concurrently developed. Decoding neural information from both interfaces may lead to novel physiological models that may one day fully restore upper limb motor function for a growing patient population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155489/1/mus26860_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155489/2/mus26860.pd

Adherence of Individuals in Upper Extremity Rehabilitation: A Qualitative Study

OBJECTIVE: To describe the rehabilitation experiences, expectations, and treatment adherence of patients receiving upper extremity (UE) rehabilitation who demonstrated discrepancy between functional gains and overall improvement. DESIGN: Qualitative (phenomenologic) interviews and analysis. SETTING: Outpatient UE rehabilitation. PARTICIPANTS: Patients with acute UE injuries (N=10). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Concerns related to UE rehabilitation patients demonstrating discrepancy between outcome measures. RESULTS: Five key themes emerged from the interviews of patients demonstrating discrepancy in their self-reported patient outcomes: (1) desire to return to normal, (2) initial anticipation of brief recovery, (3) trust of therapist, (4) cannot stop living, and (5) feelings of ambivalence. Challenges included living with the desire to move back into life. Multiple factors affected patient adherence: cost of treatment, patient-provider relation (difference between therapist and patient understanding on what is important for treatment), and patients expecting the treating therapists to be an expert and fix their problem. CONCLUSIONS: Patient adherence to UE rehabilitation presents many challenges. Patients view themselves as laypersons and seek the knowledge of a dedicated therapist who they trust to spend time with them to understand what they value as important and clarify their injury, collaboratively make goals, and explain the intervention to get them in essence, back into life, in the minimal required time. When categorized according to the World Health Organization\u27s multidimensional adherence model, domains identified in this model include social and economic, health care team and system, condition-related, therapy-related, and patient-related dimensions. Assessing factors identified to improve efficiency and effectiveness of clinical management can enhance patient adherence