=Paper=
{{Paper
|id=None
|storemode=property
|title=Virtual Reality Based Rehabilitation and Game Technology
|pdfUrl=https://ceur-ws.org/Vol-727/eics4med9.pdf
|volume=Vol-727
|dblpUrl=https://dblp.org/rec/conf/eics/Mauro11
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==Virtual Reality Based Rehabilitation and Game Technology==
https://ceur-ws.org/Vol-727/eics4med9.pdf
Virtual Reality Based Rehabilitation and Game Technology
Alessandro De Mauro
eHealth & Biomedical Applications
Vicomtech
Mikeletegi Pasealekua 57
San Sebastián 20009 Spain
+34 943 30 92 30
ademauro@vicomtech.org
5) capability for precise assessment;
ABSTRACT 6) safety.
Virtual Reality technology is currently part of advanced
physical rehabilitation therapy. However, several questions VR offers the possibility to be precisely adapted to the
remain unanswered: Can this technology improve or even patient’s therapy and to be specific. VR environments can
substitute the traditional methodologies? Can it really provide realistic training for the patient in different
influence the nervous system or does moving within a scenarios and phases of the rehabilitation.
virtual environment just motivate the individual to Repetition is crucial for the re-learning of motor functions
perform? In this paper we present the state of the art, the and for the training of the cortical activity. This task has to
new advanced technology available and the most promising be connected with the sensorial feedback on every single
applications in this field. Finally we will introduce our exercise.
research as a case study in the area. Patient motivation is fundamental because active
cooperation of the patient is needed to achieve a more
Keywords functional outcome of the therapy. Motivation can be
Rehabilitation, Therapy, Virtual Reality, Motor Disorders, improved by assigning a serious game format to the
Game Technology therapy. In this way the training activity becomes more
attractive and interesting [4, 5].
INTRODUCTION TO VIRTUAL REHABILITATION Remote data access is a fundamental requirement,
Following an authoritative description of traditional especially for rural patients, since they do not have to travel
rehabilitation therapy of motor disorders [1] it is by its to urban clinics.
nature repetitive, and repetition tends to “decouple” the
In addition, VR represents a precise tool for the assessment
mind, and reduce patient’s motivation. In other words: it is
of the therapy during each session. The (tracked/saved)
boring.
data can be used by the rehabilitation specialists for
There are several universally accepted definitions of monitoring and managing the therapy [6].
Virtual reality (VR). One of the most clear was provided in
By using VR in conjunction with Human Computer
[2]: VR is an immersive, interactive, 3-dimensional
Interfaces (HCI) the training of daily life activities can be
computer experience occurring in real time.
much improved in terms of time and quality. This approach
Virtual reality has the ability to simulate real-life tasks [3] permits a realistic and ergonomic training in a safe,
and comes together with several evident benefits for interactive and immersive environment. In particular, VR
rehabilitation: provides the user with the possibility to perform tasks with
1) specificity and adaptability to each patient and disease; a degree of safety which is normally not possible in the
traditional rehabilitation. VR provides the rehabilitators
2) repeatability; with the possibility to influence qualitatively the training
3) ability to provide patient engagement; program, even in real-time. Another evident benefit is the
4) tele-rehabilitation and remote data access; patient’s engagment which is a key factor in rehabilitation
(especially for children).
Examples of interfaces able to interact with VR are mice,
joysticks, haptic interfaces with force feedback and motion
Copyright © 2011 for the individual papers by the papers' tracking systems.
authors. Copying permitted only for private and academic
purposes. This volume is published and copyrighted by Several researches have shown that, during VR
the editors of EICS4Med 2011. rehabilitation, the movements are very similar to those used
48
in traditional therapy. Although they appear to be a bit according to the cognitive abilities and the specific needs of
slower and less accurate, [7, 8] show that they are anyway each patient.
appropriate for rehabilitation. Finally, [9] have proven good
results in executing the movements trained in VR in reality.
Low Cost VR based Rehabilitation using game
In [10], [11], and [12] good results are shown in improving technology
of motor skills for post-stroke rehabilitation of functional
deficits in reaching, hand function and walking, Recently there has been an explosion of new technologies:
respectively. A personal computer based desktop VR especially low cost gaming devices based on optical
system was developed in [13] for rehabilitating hand tracking systems, radio frequencies, infrared cameras, and
function in stroke patients. The system uses a tracking haptics are accessible to almost everybody.
system based on gloves to exercise four parameters of hand Considering the general trend to decrease the costs for the
movement: range, speed, fractionation, and strength. Their health systems all over the world one question comes up
results show that each patient showed improvement on urgently: can low-cost gaming technology serve the needs
most of the hand parameters over the course of the training of at least not severely injured patients with motor
and that some of the subjects have re-learned difficult disorders?
functions of daily life like buttoning a shirt. In terms of costs and deployment logistics it is evident that
Some of the significant studies on the application of a transition of the rehabilitation from traditional hospitals
robotics and VR for rehabilitation purposes shall be or clinics to home environments can be a winning
introduced briefly. In [14], results were presented obtained challenge [21].
from the comparison of a training with a robot-virtual
Many research groups have started the exploration of the
reality system with a robot alone on the gait of individuals
use of such systems like Nintendo Wii® or more recently
after stroke. Kinect® as tools for rehabilitative therapy, including
[15] presents a development of an advanced upper occupational and physical therapy.
extremity prosthesis with the potential to restore full motor
An exploration of researches and low-cost programs is
and sensory capability to upper extremity amputee patients.
presented below.
In addition, a GUI interface for patient training and
therapeutic applications was developed during this An example of tele-rehabilitation can be found in [22],
research. The Rutgers Arm [16] is one of the first where a home-based tele-rehabilitation system based on
prototypes composed of a PC, a motion tracking system low-cost haptic devices (game pad and joysticks) is
and a low-friction table for the upper extremity described. The system focuses on a series of virtual reality
rehabilitation. The system has been tested on a chronic therapeutic exercises for upper limb motor rehabilitation. It
stroke subject and has shown improvements in arm motor provides effective visualization and quantification of the
control and shoulder range of motion (Fugl-Meyer [17] test patient’s motions and associated pathologies. Therapists
scores). The same group has developed the Rutgers Ankle can access remotely the collected data.
[18] for the lower extremity rehabilitation. It is a
haptic/robotic platform, which works with six degrees of
freedom, driving the patient’s feet movements (Fig. 1, up).
The tests of the Rutgers Ankle system have shown that the
group of patients trained with the robotic device coupled
with the VR demonstrated greater changes in velocity and
distance than the group trained with the robot alone [19].
Most of the gait rehabilitation systems currently used for
therapy are based both on treadmills and body weight
support. The state-of-art in rehabilitation using virtual
reality (VR) and robotics is provided by Lokomat ® and
Armeo® (from Hocoma) for the lower and the upper
extremity, respectively (Fig. 1 down left and right).
These two systems are validated by the medical community
and used in several rehabilitation centers [20]. Both are
completed by an augmented feedback module which
extends the conventional hardware with a computer and a
large monitor with acoustic stereo feedback together with
software for the interactive training tasks. This option Figure 1: Successful examples of applied technologies
provides various engaging virtual environments to motivate for rehabilitation. They are all based on
your patients, adjustable level of difficulty and intensity robots/exoskeletons and VR. Upper left: Rutgers Ankle,
lower left Armeo® and right Lokomat®.
49
Sony PlayStation2® was successfully used as low-cost VR A limitation to be considered is that the Kinect® IR tracking
system in home environment by [23] to improve suffers when the subject is illuminated strongly by the sun
sensory/motor recovery on an individual two years light. This is, however, a merely technological limitation
poststroke with residual sensorimotor deficits. which can be overridden.
Sony PlayStation3® was used for tele-rehabilitation of Finally, a further part of our research concerns the
children with hemiplegia togheter with 5DT 5 Ultra (five conjunction between a Brain Computer Interface and virtual
sensor) glove for the hand tracking, a computer, display, reality in order to create a good diagnostic and personalized
keyboard and a mouse [24]. environment in which it is possible to study the brain signals
The release of the Wii® Fit (software) and Wii Balance as answers to external (VR) stimuli or to assess the progress
(platform) has stimulated new researches. The system of the patient in the rehabilitation therapy.
eBavir is a low-cost balance virtual rehabilitation system
based on the Wii® balance board.
[25] has presented a comparison of the feasibility, safety,
and efficacy of virtual reality using the Nintendo Wii
gaming system (VRWii) versus standard rehabilitation to
evaluate arm motor improvement. They have shown that
gaming technology represents a safe, feasible, and
potentially effective alternative to facilitate rehabilitation
therapy and promote motor recovery after stroke.
Another reference research group in the field is working
about virtual rehabilitation using Kinect® [27]. In particular
they are developing a high level library (the Flexible
Action and Articulated Skeleton Toolkit) which can be
used upon the open source library OpenNI [28] to produce
virtual rehabilitation software.
Case Study: the HYPER project
We are currently working on providing a VR rehabilitation
platform for the HYPER project [29]. This research
involves different results in neurorobotics (NR) and motor
neuroprosthetics (MNP), both for rehabilitation and Figure 2: Snapshots of simple VR scenes: reaching,
functional compensation of motor disorders. moving and grasping a virtual object. Kinect ® is used
for the tracking of the upper part of the patient body
The project focuses its activities on new wearable NR-
MNP systems that will combine biological and artificial
structures in order to overcome the major limitations of the
current rehabilitation solutions to Cerebrovascular Accident CONCLUSIONS
(CVA) and Spinal Cord Injury (SCI). This paper reviews the state of art, advantages and
VR, an important part of the complex system, was initially perspectives of Virtual Rehabilitation used in various forms
based on radio frequency tracking technology. This of therapy. The recent introduction of new technology,
solution offers good tracking performances but it suffers originally developed for game purposes, provides a number
from the use of many cables. of challenges and increases the possibilities of Virtual
Rehabilitation to gain wide acceptance.
Considering the patient’s needs it is therefore not an
optimal solution. Therefore we are now exploring a new We have presented, as a case study, the first development
wireless and inexpensive technology: Kinect®. status of an advanced system that combines VR based on
game technology with a hybrid NR and MNP system for
First results (see Fig. 2) are very promising and even if the functional compensation of motor disorders.
accuracy of the tracking has to be measured exactly it
seems that for this type of application the needs in terms of
accuracy are not highly demanding. Additionally the ACKNOWLEDGMENTS
tracking system appears to be robust enough to track the This paper is a dissemination activity of the HYPER
patient and the related robotic exoskeleton or project funded by CONSOLIDER-INGENIO 2010,
neuroprosthetic devices on both upper and lower part of the Spanish Ministry for Science and Innovation.
body.
50
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