Development of an Augmented Treadmill for the Rehabilitation of Children with Cerebral Palsy: Pilot Perspectives from Young Healthy

Adult Users

Mohammad Al-Amri, Daniel Abásolo, Salim Ghoussayni, & David Ewins

Centre for Biomedical Engineering Gait LaboratoryUniversity of Surrey Queen Mary’s HospitalGuildford, Surrey, UK Roehampton, London, UK

PRESENTATION OUTLINE

Conclusion

Preliminary Study

Augmented Treadmill

Research Problem

CEREBRAL PALSY

Cerebral palsy (CP) is a group of disorders that:

• Presents in the developing infant brain

• Recognised as a non-progressive disorder

Different Clinical presentations :

• Abnormal muscle tone (spasticity)

• Abnormal coordination (ataxia)

• Movement abnormality (athetosis)

CP is generally managed by a

multidisciplinary approach:

• Orthopaedic Surgery

• Occupational therapy

• PhysiotherapyFrom Children’s Treatment Network,.

Aaccessed in 16/06/09

From FOOTSTEPS, Aaccessed in 04/06/12

REHABILITATION METHODS

Limitations of Current Rehabilitation Methods:

Staffing Number

Space Allocation

Number of Sessions

Intensity of Rehabilitation

Motivation and

Confidence

One approach to addressing some

of these limitations could be the inclusion

of treadmill training

From LiteGait, http://www.litegait.com/, accessed in 16/06/09

REHABILITATION METHODS

Advantages of Treadmill Training:

Unloading of weak lower extremities allows individuals to

safely practice gait

The number of steps can far exceed over-ground gait training

(intensity)

Stationary positioning of the subject convenient for therapist

assistance

Limitations

Motivation

Speed Control

VIR

TU

AL

RE

ALIT

Y

AU

GM

EN

TE

D

TR

EA

DM

ILL

THE SURREY VIRTUAL REALITY SYSTEM

(SVRS)

THE SURREY VIRTUAL REALITY SYSTEM

(SVRS)

SVRS

Treadmill

Conventional Augmented

Balance

Flexion, Reaching..e

tc

AUGMENTED TREADMILL

Real-time Treadmill Speed Control Algorithm (RTSCA)

The WoodWay treadmill. A: two markers define the walking area on the treadmill, X0: zero point,

Xref: reference point and B: pelvis clustur; clip with 3-point contact to calculate the origin of the

pelvis origin segment.

A: pelvis cluster – a sprung loaded frame with 3-point contact to calculate the origin of the pelvis segment; B: foot markers; C: motion capture camera

PRELIMINARY EVALUATION

Overall Aim

Evaluate the quality of the SVRS

presentation Evaluate

the quality of the SVR

system presentatio

n of 3D static

images

Evaluate the quality of the SVR

system presentatio

n of 3D scenarios

Evaluate the overall

performance of treadmill training

Evaluate the

performance of the RTSCA

Examine walking speeds

when using the RTSCA

and conventional treadmill

speed buttons

PRELIMINARY STUDY

Participants:13 young able-bodied ( 19-25 years old)

Conventional:To determine their walking speeds prior the use of the RTSCA

Maintained Normal, Slow, &

Fast walking

speeds for 20

seconds

RTSCA

Normal, Slow, & Fast without VR With VR

Completed a Questionnaire form

Get perspectives on : • Safety • Ease of using the RTSCA• Interaction between VR and RTSCA• Motivation

RTSCA vs. CONVENTIONAL

3 73

3 6 4

Worse Than the Use of

Conventional Speed Buttons

Comparable to the Use of

Conventional Speed Buttons

Better Than the Use of

Conventional Speed Buttons

In general, the ease of changing speeds from stationery

In general, the ability to maintain speeds

10 participants found the walking on the treadmill when using the RTSCA was similar or better to using conventional speed buttons

Sample of Questions

Adapted Scale

TREADMILL SPEEDS

Speed Buttons RTSCA Wilcoxon test

Mean (m/ s)

St dev (m/ s)

Mean (m/ s)

St dev (m/ s)

z-value p-value (2-tailed)

Normal walking speed 1.06 0.15 1.27 0.09 -2.98 0.003

Slow walking speed 0.76 0.10 0.94 0.10 -3.18 0.001

Fast walking speed 1.74 0.11 1.75 0.06 -0.275 0.783

+ 0.18 m/s when using the RTSCA

Was there a significant difference between walking speeds on the treadmill when using the conventional treadmill speed buttons and the RTSCA?A Wilcoxon test was conducted

Significant

CONCLUSIONS

Participants found the RTSCA:

Safe (100%

of them)

Motivated

(100% of them)

Preferred to use

the treadmil

l with VR

(84.5% of them)

Satisfied with its

performance when

incorporated into the

VR scenario

Walked faster

CONCLUSIONS

• Investigating its performance in a clinical environment by recruiting children with CP and cliniciansNext

Stage

• Implementing a low-cost markless system such as the Microsoft Kinect Sensor

Future Work

THANK YOU FORClinical team in the Gait

Laboratory at Queen Mary’s Hospital for their

feedback and support during the initial trials of

tuning the RTSCA

Participants from the University of Surrey for

their time, enthusiasm and feedback

THANK YOU FOR

YOUR ATTENTION