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Virtual Rehabilitation. Prof. Patrice L. (Tamar) Weiss [email protected] Laboratory for Innovations in Rehabilitation Technology Department of Occupational Therapy University of Haifa, Israel. Neurological Rehabilitation. - PowerPoint PPT Presentation
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Prof. Patrice L. (Tamar) [email protected]
Laboratory for Innovations in Rehabilitation Technology
Department of Occupational TherapyUniversity of Haifa, Israel
Virtual Rehabilitation
Neurological RehabilitationAssessment and intensive therapy to
enable participation of clients in community life by improving motor,
cognitive, and metacognitive abilities as well as activities of daily living.
Neurological RehabilitationAssessment and intensive therapy to
enable participation of clients in community life by improving motor,
cognitive, and metacognitive abilities as well as activities of daily living.
BalanceGait,
EnduranceStrength,Dexterity
Range of Motion
Major Goals for Motor Rehabilitation
Increase level of interaction
with the physical
environment
Decrease impairments
and maximize return to
community life
Key Principles for Motor Rehabilitation
Rehabilitation following a neurological deficit requires:
• task-specific practice• high intensity, repetitive exercise• demanding, • varied, meaningful & purposeful environmental
contexts • increased patient empowerment
(Carr & Shepherd 1987; Winstein 1991; Dean et al. 2000; Lamontagne & Fung, 2005)
Why do we need VR?
Consider conventional therapy…….
StaticBoring
RoteIsolated
Effective?
Why do we need VR?
. . .its well-known assets
MotivatingEcologically valid
DocumentationDynamic
Effective?
“Virtual presence...is experienced by a person when sensory information generated only by and within a computer compels a feeling of being present in an environment other than the one the person is actually in.”
(Sheridan,1992,pg.6)
Virtual Presence – subjective feeling of being present in a simulated environment
A key concept for VR-based therapy: Presence
• increased motivation
• deeper emotional response
• enhanced performance
A high sense of presence may lead to..…
However, the evidence from the literature is still controversialSchuemie et al., 2001
Presence and its relationship to the effectiveness of VR-based
therapy
Low Tech
Virtual Reality Continuum – Desktop Systems
High Tech
Veridian System
Low Tech
Virtual Reality Continuum – Head Mounted Displays
High Tech
Low Tech
Virtual Reality Continuum – Video/Marker Capture
High Tech
Stroke Sony PlayStation II EyeToy
Using VR Games for Different Clinical Populations:Mental retardation (and Cerebral Palsy)
Improving physical fitness of individuals with intellectual and developmental disability through a Virtual Reality
Intervention Program
Objective: To test the effectiveness of a VR-based exercise program in improving the physical fitness of adults with IDD.
Methods:
• Research group (N=30; age range = 37-60 years, mean age = 52.3 ± 5.8 years; IDD level - moderate)
• Matched control group
• Both groups were divided into two sub-groups; ambulatory and wheelchair users
• 5-6 weeks fitness program, two 30 min sessions per week
• game-like exercises provided by the Sony PlayStation II EyeToy video capture VR system
• Pre- and post-intervention changes in physical fitness were monitored by the Energy Expenditure Index (EEI), the modified 12 min walk\run Cooper test and the Total Heart Bit Index (THBI)
Study ParticipantsParametersResearchControl
Demographic parameters
Mean age52.354Age range37-6034-60Males1615Females1216Mean weight 62.866.5
Mean height1.51.6Mean rest pulse 80.472.9Mean activity pulse 97.194.6
Overall N2831Assistive
technologyWheelchair1215Rolator1314Crutches22Walking cane10
FacilityQuitmann1312Kfar Nahman156Ruhama----6Bare Dror----9
Pre-Post Intervention TestsGroupNAmbulation
styleCooper test (m)
Mean ± (SD)Energy
Expenditure Index (EEI)
Mean
Total heart Beat Index
(HB/m )Mean
PrePostPrePostPrePost
Research28All211.8304.3**
*3.472.7428.315.6*
16Walking Aid
340.1486.7**1.20.878.13.9
12Wheelchair40.761.1**6.55.353.531.3
Control31All175.6183.92.12.315.214.8
15Walking Aid
253.3261.41.92.17.58.8
16Wheelchair87.696.12.52.523.921.5
P value <0.05-0.01*P value <0.01-0.001**P value <0.001***
VividGroup’s GX / IREX VR
Birds and Balls
Virtual Environments
Snowboard
Soccer
Using VR Games for Different Clinical Populations
Stroke
Using VR Scenarios for Different Populations
Sample Therapeutic Objectives Used in the VMall :
• Range of motion• Strength• Endurance• Planning• Memory• Multi-tasking
Sample Therapeutic Strategies Used in the VMall :
• Patient with a stroke initially has a list of products that he needs to buy.
• He navigates using the stronger upper extremity first only in a single aisle.
• The products are then located in multiple aisles and he needs to plan an efficient way to purchase them.
• Next he has to listen to the loudspeaker announcements in order to identify which sale products to buy.
• Number, location and distracters can be increased and then use of only impaired upper extremity can be enforced.
The use of the VMall as an intervention tool with post-stroke patients
Objective: To explore the potential of the VMall, a virtual supermarket running on a video-capture VR system, as an
intervention tool for post-stroke participants. Methods :
• Seven post-stroke participants using an A-B-A design
• 10 60-minute sessions using the VMall and other virtual games
• Intervention focused on improving the motor and functional ability of the upper extremity and executive function deficits while the participant was engaged in a task that was similar to the daily functional task of shopping.
0
0.2
0.4
0.6
0.8
1
Relative improvement of the Fugl-Meyer Assessment (to assess motor impairment of the weak upper extremity,
scores range from 0-60 points)
Pure Motor Executive Function All & Motor Participants
Intervention phase follow-up
Rel
ativ
e
imp
rove
men
t
0
0.2
0.4
0.6
0.8
1
PM EFM All
Relative improvement of the Arm Function Questionnaire (14 questions about ADL functions graded on
3-point scale ability of weak upper extremity)
Pure Motor Executive Function All & Motor Participants
Intervention phase follow-up
Rel
ativ
e
imp
rove
men
t
0
10
20
30
40
50
PM EFM All
Percent improvement of time to perform Wolf Motor Function Test
(17 simple tasks to assess functional ability of weak upper extremity)
Pure Motor Executive Function All & Motor Participants
Intervention phase follow-up
Per
cent
im
prov
emen
t
Social and
Clinical Validation
Motion Capture (marker-based) systems with dynamic platforms
Motek-CAREN, Haim Sheba, Israel
VR and Motor Rehabilitation:Open Questions
Link to ST
Realism (vividness)Some aspects of realism appear to
be more important than others– Motion– Gravity– Texture– Shadows– Ambient Sound
How important is realism?
And, to whom is it important
Meaningfulness– Context– Relevance
How important is meaning?
“I like soccer the best since it reminds me of my grandson who plays soccer in a professional youth team”.
Larry Hodges ,Georgia Institute of Technology
CAREN System,MOTEK B.V. Amsterdam
Multimodality Number and quality of feedback channels (visual, auditory, haptic, olfactory, vesitbular)
What about more than just audio-visual feedback?
Encumbrance
Can patients cope with encumbrance?
Encumbrance
Can patients cope with encumbrance?
Representation (Fear of Public Speaking, Les
Posen, Australia)
- how the user and others in the VE are represented– 1st Person– 3rd Person– Avatar
Fear of Public Speaking, Slater, London
How should the patient be represented?
How much should it cost?
Versus
There are still some significant limitations
• Subject numbers in clinical effectiveness studies still small
• Time and effort still needed for system development
• New field - therefore tools and terminology still under development
• Unanswered issues still problematic (e.g., encumbrance, 3D, cost)
Is VR effective for motor rehabilitation?
• reliability and validity of many of the VR tools has been demonstrated on control subjects
• clinical feasibility has been demonstrated (with small numbers of patient subjects)
• outcome measures are evolving well
• major research groups are now conducting clinical trials
VR does appear to have great potential for motor rehabilitation!
The bottom line (to date) is. . .
Clinical effectiveness for many VR based interventions for motor rehabilitation will likely be unequivocally demonstrated within the next 2 years.
Given VR’s “added value” (e.g., motivation, ecological validity, safety, documentation), it doesn’t have to be more effective than conventional rehabilitation in order to be useful!
The bottom line is. . .
Caesarea-Rothschild InstituteFondation Ida et Avrohom Baruch
Israeli Ministry of HealthIsraeli Ministry of Defense
Yad Hanadiv-Keren RothschildIsraeli Foundation for Spinal Cord Injured due to Gunshot
Israel Science FoundationKeren Shalem
Koniver FoundationRayne Foundation
AcknowledgementsLaboratory for Innovations
in Rehabilitation TechnologyUniversity of Haifa, Haifa, Israel