Name: mobile game-based virtual reality program for upper extremity stroke rehabilitation
Uploaded: 2018-03-08T14:00:00.000+00:00
Duration: 5 min 52 s
Description: Watch this Scientific Journal Video about Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation at JoVE.com

This research was supported by grant no. 06-2013-105 from the SK Telecom Research Fund. This work was supported by the Soonchunhyang University Research Fund.

The study was approved by the Seoul National University Bundang Hospital Institutional Review Board, and all participants gave written informed consent before screening.
1. Game Contents Development
NOTE: The mobile game-based upper extremity virtual reality program for patients with stroke (MoU-Rehab) consists of mobile game applications.
<ol>
	<li>Install the studio and environment for development using a programing language.</li>
	<li>Collect data on x, y and z-axis locations of patients&#39; movements through the built-in sensors of the smartphone.</li>
	<li>Allocate storage for data on the motion, location, and velocity with the following source code: 
	float[ ] gravity_data = new float[3]; 
	float[ ] accel_data = new float[3]; 
	float[ ] m_acc_data = new float[3]; 
	final float alpha = (float)0.8; 
	Gather data measured by the built-in sensor with the following source code. 
	SensorManager sm = (SensorManager) getSystemService(SENSOR_SERVICE); 
	Sensor mSensor = sm.getDefaultSensor(Sensor.TYPE_ACCELEROMETER);</li>
	<li>Send the data to the tablet PC after image processing through the short-distance wireless connection to display x, y, and z-coordinates as images on the screen.</li>
	<li>Design all game applications to improve the strength, endurance, range of motion, control, speed, and accuracy of movement in the upper extremity. 
	NOTE: Board-certified physiatrists (rehabilitation medicine doctors) and occupational therapists gathered and discussed what therapeutic maneuvers would be appropriate to transform into game programs. Movements in each joint was targeted based on the conventional occupational therapy methods that promote the recovery of upper limb function and improve the strength, endurance, range of motion, control, speed, and accuracy of movement in the upper extremity</li>
	<li>Recommend game applications to each patient according to their upper extremity function measured by the Brunnstr&#246;m stage. 
	NOTE: The Brunnstr&#246;m stage (B-stage) for the arm and hand evaluates the upper extremity recovery stages (1=flaccid, no voluntary movements; 7= normal function)16. For example, patients categorized as Brunnstr&#246;m stage 1 used applications that induce shoulder flexion/extension movements with the assistance of the unaffected arm. Patients categorized as Brunnstr&#246;m stage 5 used applications that require precise control of movements.</li>
	<li>Adjust the level of difficulty of the game applications individually, by changing the speed, maintenance time for the specific posture, and range of motion according to the severity of the upper extremity dysfunction. Refer to the examples with detailed information as below (Figure 2).</li>
</ol>
2. Study Design
NOTE: A quasi-randomized, double-blind, controlled trial was conducted to evaluate the program&#39;s feasibility and effectiveness. Participants who (1) were diagnosed with ischemic stroke; (2) had the ability to follow a one-step command; (3) had the medical stability to participate in active rehabilitation, and (4) had upper extremity impairment, were included. Patients were excluded if they (1) had delirium, confusion, or other severe consciousness problems, (2) suffered from uncontrolled medical conditions, (3) were unable to follow commands because of severe cognitive impairment, (4) had a visual disturbance, and (5) had poor sitting balance. Participants were recruited at the university hospital.
<ol>
	<li>To make the participants completely blinded to the group assignment, assign them to either control or experimental group by admission period because participants needed to share the OT room.</li>
	<li>Ensure that the patients in the intervention group received 30 min of conventional OT and 30 min of the mobile game-based VR upper extremity rehabilitation program using a smartphone and a tablet PC.</li>
	<li>Ensure that the patients in the control group received conventional OT alone for 1 h per day. 
	NOTE: The rehabilitation program for both groups consisted of 10 sessions of therapy, 5 days per week, for 2 weeks.</li>
	<li>Educate the patients in the intervention group on how to use the program in the first treatment session, although each game application provided brief instructions at the beginning. Ensure that the patients used the program for 30 min on their own during the study.</li>
	<li>Assess the outcome measurements at the beginning, at the end of the treatment and at a one-month follow-up.</li>
	<li>Let a single blinded evaluator who is an experienced occupational therapist perform all the clinical assessments during all the testing sessions. 
	NOTE: The primary outcome measure was the Fugl-Meyer Assessment of the upper extremity (FMA-UE), which measures the motor function of the patients&#39; hemiparetic arm (0 = lowest score; 66 = highest score).17 The secondary outcome was evaluated by the Brunnstr&#246;m stage (B-stage) for the arm and hand and manual muscle testing (0&#8211;5).</li>
</ol>
3. Usage of Mobile Game-based VR Upper Extremity Rehabilitation Program
<ol>
	<li>Have the participant sit on the desk.</li>
	<li>Place the tablet PC on the desk and turn the tablet PC on.</li>
	<li>Turn the smartphone on and turn on the short-distance wireless connection on the smartphone.</li>
	<li>Select the game application on the tablet PC by touching the screen of the tablet PC.</li>
	<li>Enable short-distance wireless connection on the tablet PC and connect to the smartphone.</li>
	<li>Put the smartphone in the armband and attach the armband to the upper arm or forearm using a commercially available smartphone armband according to the desired movement.</li>
	<li>Choose either the basic version or the customized version.</li>
	<li>Select the game speed, time, a number of target movements, and the expected achievement of the game on the touchscreen of the tablet PC on the customized version according to the participants&#8217; ability.</li>
	<li>Let the participant touch the start button. Ask the participant to take a posture following the commands of the game. Move the maximal range of motion for calibration.</li>
	<li>Start playing the game and move to the next game when the game ends (generally 5&#8211;10 min long).
	<ol>
		<li>&#34;Honey Pot Guard&#34; Game 
		NOTE: This game targets the elbow flexion and extension motion.
		<ol>
			<li>Ask the patients to beat a bear from the honey pot by throwing apples using the movement of the elbow joint.</li>
			<li>Let the patient throw apples when the flexed elbow is extended.</li>
			<li>Adjust the level of difficulty by the location where the bear appears and the speed at which a new bear appears based on the available range of motion and speed of the motion in the patient&#39;s elbow joint.</li>
		</ol>
		</li>
		<li>&#34;Protect the Bunny&#34; Game 
		NOTE: This game targets the shoulder abduction and adduction motion.
		<ol>
			<li>Ask the patients to protect the bunny by catching stones with a net using the movement of the shoulder joint.</li>
			<li>Ensure that the net moves when the adducted shoulder is abducted.</li>
			<li>Adjust the level of difficulty by the location where the stone appears and the speed with which a new stone appears based on the available range of motion and speed of motion in the patient&#39;s shoulder joint.</li>
		</ol>
		</li>
		<li>&#34;Put out Fire&#34; game 
		NOTE: This game targets the shoulder abduction and adduction or shoulder flexion and extension.
		<ol>
			<li>Ask the patients to put the fire out with the water hose through the window; the water hose is moved according to the motion of the shoulder.</li>
			<li>Ensure that the water hose moves right and left and up and down according to the motion of the shoulder joint; the time needed to put out the fire depends on the size of the fire.</li>
			<li>Adjust the level of difficulty by the location where the fire appears, the speed with which a new fire appears, and the size of the fire based on the available range of motion and the speed and endurance of motion of the patient&#8217;s shoulder joint.</li>
		</ol>
		</li>
		<li>&#34;Flower Splash&#34; game 
		NOTE: This game targets the shoulder abduction and adduction, elbow flexion and extension, or wrist pronation and supination motion.
		<ol>
			<li>Ask the patients to water the moving seed with a watering can by the motion of the joint and make the flowers blossom.</li>
			<li>Ensure that when the seed moves, the watering follows according to the motion of the joint.</li>
			<li>Adjust the level of difficulty by the moving speed of the seed with respect to the accuracy and speed of motion.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Track the patients&#39; upper extremity movements by the built-in sensors (accelerometer, gyroscope) of the smartphone, and transfer information about the movement to the tablet PC through the short-distance wireless connection.</li>
	<li>Provide visual and auditory feedback for patients on their movement with the display on the tablet PC.</li>
	<li>Demonstrate the real achievement of the game as compared with the expected achievement at the end of the game.</li>
</ol>

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All authors declare no conflict of interest.

Patients with stroke usually have disabilities related to motor impairments due to incomplete motor recovery. Such disabilities, lengthy travel time to a clinic, or socioeconomic difficulties can hinder patients&#39; access to adequate rehabilitation therapy. A ubiquitous healthcare (u-Health) program can be a good option for removing those barriers. As a part of such a u-Health program, a mobile game-based VR rehabilitation program was developed for upper limb recovery after ischemic stroke in the present study. Our findings suggest that this program is feasible and more effective in promoting upper limb function recovery compared to conventional therapy. At the one-month follow-up evaluation, improvements were successfully maintained.
We speculate that the therapeutic effectiveness of MoU-Rehab was equal to or greater than that of conventional therapy, because of the game&#39;s effects, such as immediate feedback from the patients&#39; movement, enjoyment, high motivation, and engagement. Participation games may facilitate motor learning19 while increasing interest in rehabilitation and promoting motivation. Moreover, auditory and visual feedback can facilitate patients&#39; desire for interaction. These factors may increase the efficacy of rehabilitation therapy by achieving a high level of patient adherence to training and increasing engagement in therapy.
Most of the previous game-based studies used commercial off-the-shelf games14. However, these games were not specifically designed for patients with stroke. The game program developed in this study specifically targets patients with stroke. Various kinds of game applications were developed, from which applications that could be used for such patients were selected. We chose only game applications that could induce desired movements and avoided synergistic movements.
The mobile program was designed for use with a smartphone and tablet PC because smartphones and tablet PCs are increasingly used by the general population; thus, it is relatively easy to implement treatment programs using these handheld mobile devices at low cost. Considering the lightweight aspect and small size of these mobile devices, they are portable and easy to use, regardless of a person&#39;s location. Although the program was administered in the therapy room to ensure strict matching of the treatment time between the two groups, this program can also be used in home settings.
However, the study has a few limitations. The first limitation stems from the study&#39;s small sample size. Although attempts were made to allocate patients to the two groups randomly, patients were allocated by admission period to keep them unaware of their group allocation. Treatment time was strictly matched during the 2-week treatment period but was not possible during post-treatment and follow-up. The motor activity of the affected arms could not be monitored during the study period. Measuring the activity of the affected arms by accelerometers could indicate the influence of the program on the non-use phenomenon20,21. In the present study, no kinematic data were available. By obtaining kinematic data such as linear and angular displacements, velocity, and acceleration, information on the characteristics of the patients&#39; movements could be used to optimize individualized rehabilitation therapies through bidirectional feedback between patients and clinicians.
The findings of the present study suggest that this mobile game-based VR upper extremity rehabilitation program can be a substitute for some parts of conventional therapy that are delivered one-on-one by an occupational therapist. The program would be a good candidate tool for tele-rehabilitation for upper extremity recovery in patients with stroke.

Stroke is one of the most common causes of neurological impairment in adults. Recovery from impairment after a stroke is usually incomplete, and approximately 50% of patients are left with disabilities, making them dependent on others1. In particular, upper limb dysfunction makes stroke survivors dependent on others for assistance with activities of daily living (ADL)2. Regaining the lost function in the upper extremities may be more difficult to achieve than returning the normal function of ambulation to the lower extremities. Although bilateral lower extremity movement is indispensable for locomotion, patients can perform ADL with unilateral upper extremity movement. This leads to a learned non-use phenomenon of the affected limb3. This phenomenon is an obstacle to the rehabilitation of the upper extremity in stroke survivors. Therefore, a tremendous amount of research is focused on the upper limb function recovery. Studies have highlighted the importance of extensive practice and repetitive task-specific training4,5,6.
Virtual reality (VR) technology has recently been introduced into the field of rehabilitation7. VR allows users to interact with a simulated environment and receive continuous, immediate feedback related to performance. VR has the potential to apply basic concepts of neurorehabilitation in stroke patients, such as intensive, repetitive, and task-oriented training8. Specifically, non-immersive VR does not require high-level graphics performance or special hardware. Therefore, non-immersive VR is a good candidate for providing a low-cost, ubiquitous, and interesting treatment program. Previous studies used computers, monitors, and special devices, such as consoles, sensor gloves, joy-sticks, and commercial gaming systems for non-immersive VR9. Higher start-up costs and sufficient space were mandatory for using such systems. Recently, low-cost tools, such as commercial gaming devices, have been utilized to develop new rehabilitation systems10,11. However, the consoles with sensors in those devicesare not sufficiently small and lightweight for carrying. Nevertheless, to improve the popularity of non-immersive VR as a post-stroke upper extremity treatment method and to create a ubiquitous rehabilitation environment for stroke survivors, portable and inexpensive tools are needed.
Furthermore, game-based therapy can be a good option for stroke rehabilitation. Many patients complain that conventional occupational therapy (OT) for upper limb function recovery is boring and monotonous12,13. A more interesting and motivating tool for the therapy is, therefore, necessary to promote patients&#39; engagement in rehabilitation training. Many studies that involve the use of commercial games have been conducted14,15,16. However, the games used do not target the desired movement of the upper extremity in patients with stroke, and they lack special consideration for the spasticity that may be present after a stroke.
This paper describes the development of a mobile game-based VR program and its use for patients who have experienced a stroke and suffer from upper limb dysfunction (Figure 1).

<table><tbody><tr><td>Galaxy Note 10.0</td><td>Samsung</td><td>Galaxy Note 10.0</td><td>Tablet PC</td></tr><tr><td>Galaxy S2</td><td>Samsung</td><td>Galaxy S2</td><td>Smartphone</td></tr><tr><td>Bluetooth</td><td>Bluetooth SIG</td><td>Bluetooth</td><td>short-distance wireless connection&amp;nbsp;</td></tr><tr><td>Java</td><td>Oracle</td><td>Java</td><td>programming language</td></tr></tbody></table>

mobile game-based virtual reality program for upper extremity stroke rehabilitation

Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. Virtual reality (VR) has the potential to satisfy these requirements. Game-based therapy can promote patients&#39; engagement in rehabilitation therapy as a more interesting and a motivating tool. Mobile devices such as smartphones and tablet PCs can provide personalized home-based therapy with interactive communication between patients and clinicians. In this study, a mobile VR upper extremity rehabilitation program using game applications was developed. The findings from the study show that the mobile game-based VR program effectively promotes upper extremity recovery in patients with stroke. In addition, patients completed two weeks of treatment using the program without adverse effects and were generally satisfied with the program. This mobile game-based VR upper extremity rehabilitation program can substitute for some parts of the conventional therapy that are delivered one-on-one by an occupational therapist. This time-efficient, easy to implement, and clinically effective program would be a good candidate tool for tele-rehabilitation for upper extremity recovery in patients with stroke. Patients and therapists can collaborate remotely through these e-health rehabilitation programs while reducing economic and social costs.

A total of 24 patients were enrolled and assigned to either the control or the experimental group (Table 1). A greater improvement in the FMA-UE, B-stage, and manual muscle testing was found after treatment with the mobile game-based VR upper extremity rehabilitation program than with conventional therapy (Figure 3). The effect was maintained until the one-month follow-up. This means MoU-Rehab was not inferior to the conventional therapy that is delivered one-on-one by an occupational therapist.
Patients in the experimental group completed the two-week treatment without adverse effects, and were generally satisfied with MoU-Rehab (Table 2), even though participants had various levels of IT (computer, tablet PC, and smartphone) familiarity (Figure 4). Patients in the experimental group responded positively about the display of the program (4.25 &#177; 0.62), the readability of the program (4.25 &#177; 0.62) and the convenience of program usage (4.08 &#177; 0.67) in 5-point Likert rating (0&#8211;5). In addition, they stated that they were willing to pay $22 &#177; 10 for the game applications. There was no relation between IT familiarity and the amount of improvement.
The MoU-Rehab is feasible and effective in promoting upper limb recovery after an ischemic stroke.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56241/56241fig1.jpg" /> 
Figure 1: The Configuration of the mobile game-based upper extremity VR program. The system for the mobile game-based upper extremity VR program includes a mobile device (tablet PC) for display and a mobile device (smartphone) for obtaining information on the movement using built-in sensors. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56241/56241fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56241/56241fig2.jpg" /> 
Figure 2: Game contents and applications of the mobile game-based upper extremity VR program. Each game application targets a specific movement of the hemiplegic arm. The level of difficulty is adjusted according to each patient&#39;s upper extremity function.The target movements in the target joints is represented by yellow lines and circles. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56241/56241fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56241/56241fig3.jpg" /> 
Figure 3: Changes in the outcome measures at the end of the treatment and at the 1 month follow-up after treatment. (A) Changes in the Fugl-Meyer Assessment of the upper extremity. (B) Changes in the Brunnstr&#246;m stage (arm and hand). (C) Changes in muscle power measured by the manual muscle test (shoulder/ elbow/ wrist). Mo: month, pre: before treatment with mobile game-based upper extremity VR program, post: after the two-week treatment with the mobile game-based upper extremity VR program, F/U: follow-up. The error bars indicate standard deviations (SD). <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56241/56241fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56241/56241fig4.jpg" /> 
Figure 4: Results of the IT familiarity survey. Participants in the experimental group (n = 12) were asked about their IT familiarities such as their computer, tablet PC, or smartphone experience. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56241/56241fig4large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
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		<tr>
			<td></td>
			<td>Experimental group (n=12)</td>
			<td>Control group (n=12)</td>
			<td>p-value</td>
		</tr>
		<tr>
			<td>Sex (M/F)</td>
			<td>7/5</td>
			<td>6/6</td>
			<td>0.5 a</td>
		</tr>
		<tr>
			<td>Age (years)</td>
			<td>61.0&#177;15.2 (21-76)</td>
			<td>72.1&#177;9.9 (53-88)</td>
			<td>0.046 b</td>
		</tr>
		<tr>
			<td>Affected limb (L/R)</td>
			<td>8/4</td>
			<td>10/2</td>
			<td>0.32 a</td>
		</tr>
		<tr>
			<td>FMA-UE (range)</td>
			<td>24.5&#177;22.2 (4-63)&#160;</td>
			<td>21.5&#177;20.6 (4-57)</td>
			<td>0.735 b</td>
		</tr>
		<tr>
			<td>Brunnstrom-stage (arm)</td>
			<td>2.7&#177;1.5 (1-5)</td>
			<td>2.7&#177;1.5 (1-5)</td>
			<td>1.00 b</td>
		</tr>
		<tr>
			<td>Brunnstrom-stage (hand)</td>
			<td>1.9&#177;1.4 (1-5)</td>
			<td>2.1&#177;1.4 (1-4)</td>
			<td>0.775 b</td>
		</tr>
		<tr>
			<td>MMT (shoulder)</td>
			<td>2.7&#177;1.1 (1-4)</td>
			<td>2.2&#177;1.2 (0-4)</td>
			<td>0.292 b</td>
		</tr>
		<tr>
			<td>MMT (elbow)</td>
			<td>1.9&#177;1.4 (1-5)</td>
			<td>2.1&#177;1.4 (1-4)</td>
			<td>0.775 b</td>
		</tr>
		<tr>
			<td>MMT (wrist)</td>
			<td>2.7&#177;1.1 (1-4)</td>
			<td>2.2&#177;1.2 (0-4)</td>
			<td>0.292 b</td>
		</tr>
	</tbody>
</table>
Table 1: Baseline demographic and clinical characteristics of the patients. There were no statistically significant differences between the two groups except with regard to age. a &#967;2 test, b t-test. FMA-UE: Fugl-Meyer Assessment of the Upper Extremity, MMT: Manual Muscle Test, M: male; F: female, L: left, R: right. Data indicate mean &#177;SD (range).
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Question</td>
			<td>Experimental group (n = 12)</td>
			<td>Control group (n = 12)</td>
		</tr>
		<tr>
			<td>The upper extremity rehabilitation program provided sufficient treatment for me.</td>
			<td>4.17 &#177; 0.72</td>
			<td>4.00 &#177; 0.85</td>
		</tr>
		<tr>
			<td>The upper extremity rehabilitation program provided on target services to you</td>
			<td>4.42 &#177; 0.52</td>
			<td>3.92 &#177; 1.00</td>
		</tr>
		<tr>
			<td>In general, I am satisfied with the upper extremity rehabilitation program .</td>
			<td>4.25 &#177; 0.75</td>
			<td>3.92 &#177; 1.00</td>
		</tr>
		<tr>
			<td>The upper extremity rehabilitation program helped me to better manage my health and medical needs.</td>
			<td>4.33 &#177; 0.65</td>
			<td>4.00 &#177; 0.74</td>
		</tr>
	</tbody>
</table>
Table 2: Results of the user satisfaction survey for mobile game-based upper extremity VR program. User satisfaction in the experimental group was not inferior to that in the control group. Participants in the experimental group responded positively to all items.

Watch this Scientific Journal Video about Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation at JoVE.com

Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation

Here, we present a protocol to develop and apply a mobile game-based virtual reality program for the recovery of upper limb dysfunction in patients with stroke. The present study shows that the mobile program is feasible and effectively promotes upper limb recovery in stroke patients.

Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. Virtual reality (VR) has the potential to satisfy these requirements. ...

mobile-game-based-virtual-reality-program-for-upper-extremity-stroke

Nanyang Technological University

Research

JoVE Journal

Behavior

18.7K Views.  Seoul National University College of Medicine, Seoul National University Bundang Hospital. Hier presenteren we een protocol te ontwikkelen en toepassen van een mobiele spel gebaseerde virtuele reality-programma voor het herstel van de bovenste extremiteit disfunctie bij patiënten met een beroerte. De huidige studie toont aan dat de mobiele programma haalbaar is en effectief herstel van de bovenste extremiteit bij beroerte-patiënten bevordert.

Video: Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation

Two-photon Calcium Imaging in Mice Navigating a Virtual Reality Environment

In recent years, two-photon imaging has become an invaluable tool in neuroscience, as it allows for chronic measurement of the activity of genetically identified cells during behavior1-6. Here we describe methods to perform two-photon imaging in mouse cortex while the animal navigates a virtual reality environment. We focus on the aspects of the experimental procedures that are key to imaging in a behaving animal in a brightly lit virtual environment. The key problems that arise in this experimental setup that we here address are: minimizing brain motion related artifacts, minimizing light leak from the virtual reality projection system, and minimizing laser induced tissue damage. We also provide sample software to control the virtual reality environment and to do pupil tracking. With these procedures and resources it should be possible to convert a conventional two-photon microscope for use in behaving mice.

Here we describe the experimental procedures involved in two-photon imaging of mouse cortex during behavior in a virtual reality environment.

In recent years, two-photon imaging has become an invaluable tool in neuroscience, as it allows for chronic measurement of the activity of genetically ...

Haptic/Graphic Rehabilitation: Integrating a Robot into a Virtual Environment Library and Applying it to Stroke Therapy

Recent research that tests interactive devices for prolonged therapy practice has revealed new prospects for robotics combined with graphical and other forms of biofeedback. Previous human-robot interactive systems have required different software commands to be implemented for each robot leading to unnecessary developmental overhead time each time a new system becomes available. For example, when a haptic/graphic virtual reality environment has been coded for one specific robot to provide haptic feedback, that specific robot would not be able to be traded for another robot without recoding the program. However, recent efforts in the open source community have proposed a wrapper class approach that can elicit nearly identical responses regardless of the robot used. The result can lead researchers across the globe to perform similar experiments using shared code. Therefore modular "switching out"of one robot for another would not affect development time. In this paper, we outline the successful creation and implementation of a wrapper class for one robot into the open-source H3DAPI, which integrates the software commands most commonly used by all robots.

Recently, a vast amount of prospects have come available for human-robot interactive systems. In this paper we outline the integration of a new robotic device with open source software that can rapidly make possible a library of interactive functionality. We then outline a clinical application for a neurorehabilitation application.

Recent research that tests interactive devices for prolonged therapy practice has revealed new prospects for robotics combined with graphical and other ...

Bioengineering

Development of a Virtual Reality Assessment of Everyday Living Skills

Cognitive impairments affect the majority of patients with schizophrenia and these impairments predict poor long term psychosocial outcomes.&#160; Treatment studies aimed at cognitive impairment in patients with schizophrenia not only require demonstration of improvements on cognitive tests, but also evidence that any cognitive changes lead to clinically meaningful improvements.&#160; Measures of &#8220;functional capacity&#8221; index the extent to which individuals have the potential to perform skills required for real world functioning. &#160;Current data do not support the recommendation of any single instrument for measurement of functional capacity.&#160; The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a novel, interactive gaming based measure of functional capacity that uses a realistic simulated environment to recreate routine activities of daily living. Studies are currently underway to evaluate and establish the VRFCAT&#8217;s sensitivity, reliability, validity, and practicality.&#160;This new measure of functional capacity is practical, relevant, easy to use, and has several features that improve validity and sensitivity of measurement of function in clinical trials of patients with CNS disorders.

A challenge for proving treatment efficacy for cognitive impairments in schizophrenia is finding the optimizing measurement of skills related to everyday functioning.&#160; The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is an interactive gaming based computerized measure aimed at skills associated with everyday functioning, including baseline impairments and treatment related changes.

Cognitive impairments affect the majority of patients with schizophrenia and these impairments predict poor long term psychosocial outcomes.&#160; ...

A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated systems require upper limb amputees to learn complex control schemes. Humans have the ability to learn new movements through imitation and other learning strategies. This protocol describes a structured rehabilitation method, which includes imitation, repetition, and reinforcement learning, and aims to assess if this method can improve multifunctional prosthetic control. A left below elbow amputee, with 4 years of experience in prosthetic use, took part in this case study. The prosthesis used was a Michelangelo hand with wrist rotation, and the added features of wrist flexion and extension, which allowed more combinations of hand movements. The participant&#8217;s Southampton Hand Assessment Procedure score improved from 58 to 71 following structured training. This suggests that a structured training protocol of imitation, repetition and reinforcement may have a role in learning to control a new prosthetic hand. A larger clinical study is however required to support these findings.

As prosthetic development moves towards the goal of natural control, harnessing amputees&#8217; inherent ability to learn new motor skills may enable proficiency. This manuscript describes a structured rehabilitation protocol, which includes imitation, repetition, and reinforcement learning strategies, for improved multifunctional prosthetic control.

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated ...

Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another

As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by observation or passive movement of trainee&#39;s hands by a robotic device). This obviously presents a major challenge in the rehabilitation of a paretic limb since voluntary control of physical movement is limited. Here, we describe a novel training scheme we have developed that has the potential to circumvent this major challenge. We exploited the voluntary control of one hand and provided real-time movement-based manipulated sensory feedback as if the other hand is moving. Visual manipulation through virtual reality (VR) was combined with a device that yokes left-hand fingers to passively follow right-hand voluntary finger movements. In healthy subjects, we demonstrate enhanced within-session performance gains of a limb in the absence of voluntary physical training. Results in healthy subjects suggest that training with the unique VR setup might also be beneficial for patients with upper limb hemiparesis by exploiting the voluntary control of their healthy hand to improve rehabilitation of their affected hand.

We describe a novel virtual-reality based setup which exploits voluntary control of one hand to improve motor-skill performance in the other (non-trained) hand. This is achieved by providing real-time movement-based sensory feedback as if the non-trained hand is moving. This new approach may be used to enhance rehabilitation of patients with unilateral hemiparesis.

As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by ...

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.

Spinal cord injury is a traumatic medical condition that may result in elevated risks of chronic secondary metabolic disorders. Here, we presented a protocol using surface neuromuscular electrical stimulation-resistance training in conjunction with functional electrical stimulation-lower extremities cycling as a strategy to ameliorate several of these medical problems.

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Measuring the Kinematics of Daily Living Movements with Motion Capture Systems in Virtual Reality

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based assessments of IADL are easy to use but prone to subjective bias. Here, we describe a novel virtual reality (VR) test to assess two complex IADL tasks: handling financial transactions and using public transportation. While a participant performs the tasks in a VR setting, a motion capture system traces the position and orientation of the dominant hand and head in a three-dimensional Cartesian coordinate system. Kinematic raw data are collected and converted into &#39;kinematic performance measures,&#39; i.e., motion trajectory, moving distance, and time to completion. Motion trajectory is the path of a particular body part (e.g., dominant hand or head) in space. Moving distance refers to the total distance of the trajectory, and time to completion is how long it took to complete an IADL task. These kinematic measures could discriminate patients with cognitive impairment from healthy controls. The development of this kinematic measuring protocol allows detection of early IADL-related cognitive impairments.

We designed a virtual reality test to assess instrumental activities of daily living (IADL) with a motion capture system. We propose a detailed kinematic analysis to interpret the participant&#39;s various movements, including trajectory, moving distance, and time to completion to evaluate IADL capabilities.

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based ...

Enhancing Stroke Rehabilitation with Virtual Reality-Based Occupational Training

Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the potential to meet these demands by providing engaging and motivating therapy options. The digital occupational training system is a VR application that utilizes cutting-edge technologies, including multi-touch screens, virtual reality, and human-computer interaction, to offer diverse training techniques for advanced cognitive capacity and hand-eye coordination abilities. The objective of this study was to assess the effectiveness of this program in enhancing cognitive function and upper extremity rehabilitation in stroke patients. The training and assessment consist of five cognitive modules covering perception, attention, memory, logical reasoning, and calculation, along with hand-eye coordination training. This research indicates that after eight weeks of training, the digital occupational training system can significantly improve cognitive function, daily living skills, attention, and self-care abilities in stroke patients. This software can be employed as a time-saving and clinically effective rehabilitation aid to complement traditional one-on-one occupational therapy sessions. In summary, the digital occupational training system shows promise and offers potential financial benefits as a tool to support the functional recovery of stroke patients.

Author Spotlight: Rehabilitation of Stroke Patients With a Digital Occupational Training System

The current protocol outlines how the VR-based digital occupational training system enhances the rehabilitation of patients with cognitive impairment and upper limb dysfunction following a stroke.

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the ...

Medicine

Integrated Robotic and Conventional Therapy for Post-Stroke Upper Limb Recovery

Enhancing Upper Limb Function and Motor Skills Post-Stroke Through an Upper Limb Rehabilitation Robot

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby profoundly affecting individuals' activities of daily living and diminishing their quality of life. Traditional rehabilitation methods for upper limb recovery post-stroke are often hindered by limitations, including therapist and patient fatigue, reliance on singular training methodologies, and lack of sustained motivation. Addressing these challenges, this study introduces an upper limb rehabilitation robot, which uses intelligent feedback motion control to improve therapeutic outcomes. The system is distinguished by its capability to adjust the direction and magnitude of force feedback dynamically, based on the detection of spastic movements during exercises, thereby offering a tailored therapeutic experience. This system is equipped with four distinct training modes, intelligent assessment of joint range of motion, and the ability to personalize training programs. Moreover, it provides an immersive interactive gaming experience coupled with comprehensive safety measures. This multifaceted approach not only elevates the engagement and interest of participants beyond traditional rehabilitation protocols but also demonstrates significant improvements in upper limb functionality and the activities of daily living among hemiplegic patients. The system exemplifies an advanced tool in upper limb rehabilitation, offering a synergistic blend of precision, personalization, and interactive engagement, thereby broadening the therapeutic options available to stroke survivors.

Author Spotlight: Enhancing Post-Stroke Upper Limb Rehabilitation with Robotic Technologies for Improved Motor Recovery and Functional Outcomes

This protocol describes an upper limb rehabilitation robot that provides intelligent feedback through four modes. These modes enhance upper limb function and flexibility, thereby improving patients' quality of life.

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby ...

Dual Upper Limb Robotic Training in Stroke Rehabilitation

Application of a Dual Upper Limb Task-Oriented Robotic System for the Functional Recovery of the Upper Limb in Stroke Patients

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm training can help stroke survivors regain their upper limb function and improve their daily activities. The dual upper limb task-oriented robotic system is designed to assist the healthy side of the stroke patient in driving the affected side to perform bilateral arm training through the use of a robotic device. It can also guide the patient in carrying out dual upper limb coordinated movements and engage them in a task-oriented virtual game using force feedback and human-computer interaction technology. This study aimed to assess the efficacy of the system in enhancing upper limb function and activities of daily living in stroke patients. The assessment methods used included motor evoked potential (MEP), functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), and modified Barthel index (MBI). The results of the study indicate that the dual upper limb task-oriented robotic system can significantly improve the corticospinal pathway, upper limb function, and activities of daily living in stroke patients after 6 weeks of treatment. This system can serve as an effective adjunct to upper limb functional rehabilitation in stroke survivors, reducing the dependence on rehabilitation therapists. In conclusion, the dual upper limb task-oriented robotic system provides a new strategy for post-stroke limb functional rehabilitation and holds great potential for application, as it offers certain social and financial benefits.

Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies

This experimental protocol outlines the use of a dual upper limb task-oriented robotic system for stroke patients with upper limb dysfunction. The findings indicate that this system can significantly improve stroke patients' upper limb function and daily living activities.

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm ...

Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation

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