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Virtual Reality in Gait Rehabilitation

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  1. Virtual Reality in Gait Rehabilitation By Nigel W. Tierney Department of Computer Science Old Dominion University Co-Authors: Jessica Crouch, Hector Garcia, Martha Walker, Bonnie Van Lunen, Gianluca DeLeo, George Maihafer, Stacie Ringleb MODSIM World 2007Virginia Beach, VA Conference & Expo

  2. Introduction – Issue • Gait disabilities • Serious problem • Affect millions of people • Accompanied by exorbitant costs MODSIM World 2007 Virginia Beach, VA Conference & Expo

  3. Introduction – Causes • A multitude of causes lead to gait disability • Stroke • Limb amputation • Traumatic brain injury • Spinal cord injury • Cerebral palsy • Progressive neurological disorders MODSIM World 2007 Virginia Beach, VA Conference & Expo

  4. Introduction – Solution To create an innovative approach to gait rehabilitation via a system that combines the use of traditional and advanced rehabilitation techniques with a virtual reality (VR) training environment MODSIM World 2007 Virginia Beach, VA Conference & Expo

  5. Introduction – Goal The goal of this approach is to help patients achieve their maximum functional capacity as efficiently as possible The first population targeted by this work is stroke patients MODSIM World 2007 Virginia Beach, VA Conference & Expo

  6. Current Traditional Rehabilitation • Patients practice motor skills and compensatory strategies for daily living activities • Within a clinical setting • Skills gained in a clinical environment • Generalize to the patients’ home environments MODSIM World 2007 Virginia Beach, VA Conference & Expo

  7. Issues with Traditional Rehabilitation • Labor intensive • Limited in intensity and duration of repetition • Carryover outside of the rehabilitation setting is uncertain MODSIM World 2007 Virginia Beach, VA Conference & Expo

  8. Improvements to Traditional Rehab. • Virtual reality technology can help address these limitations • Low-cost training environments • Consistent with a client's environment • Adaptable • Practice under a variety of simulated circumstances MODSIM World 2007 Virginia Beach, VA Conference & Expo

  9. Improvements to Trad. Rehab. Cont’d • Adjust difficulty level of the training scenarios • Speed and slope of the treadmill • Complexity of tasks • Amount of body weight support • Immediate feedback on performance • Important component of learning* *Shumway-Cook, et al. - “Motor Control: Theory and Practical Applications” MODSIM World 2007 Virginia Beach, VA Conference & Expo

  10. Previous Work with VR • Extensive research conducted • Examine the efficacy of VR-enhanced training and rehabilitation • Successfully used in teaching both decision-making skills and physical skills* *Gallagher, et al. - “Virtual reality training for the operating room and catheterization laboratory,” Loftin, et al. - “Training in peacekeeping operations using virtual environments,” Scerbo, et al. - “Assessing surgical skill training under hazardous conditions in a virtual environment,” and Seymour, et al. - “Virtual reality training improves operating room performance: Results of a randomized, double-blinded study” MODSIM World 2007 Virginia Beach, VA Conference & Expo

  11. Our Solution • Aims to demonstrate improved gait rehabilitation using a VR environment constructed of hardware components • Widely available • Inexpensive • Unobtrusive • Easily replicated and deployed in a variety of clinical settings MODSIM World 2007 Virginia Beach, VA Conference & Expo

  12. Methods Consist of… • Treadmill with overhead suspension • Interactive GUI • VR software • Avatar • Inertial Tracking Device MODSIM World 2007 Virginia Beach, VA Conference & Expo

  13. Hardware Setup • The overhead suspension device:Biodex Unweighing System • The inertial orientation tracking device:Intersense InertiaCube2 • The mounted television display:51 inch Sharp Aquos HDTV • The programmable treadmill:Biodex Gait Trainer 2 • The desktop computer: Windows™ Vista PC(Not shown in photo) MODSIM World 2007 Virginia Beach, VA Conference & Expo

  14. Interactive GUI Screenshot • Accepts as input • User’s personal information • Base speed • Selection of simulation scenarios • Data collection tool • Entry point into the VR program • Trigger early termination of the simulation MODSIM World 2007 Virginia Beach, VA Conference & Expo

  15. VR Environment Screenshot • Simulates a cityscape • Made up of a series of blocks • Order of buildings, car, and character models are randomly generated each time the simulation is run • Different visual experience for each training session MODSIM World 2007 Virginia Beach, VA Conference & Expo

  16. VR Walkthrough Final Block • End of simulation: Session completed or triggering of early termination • Call will be made for a final block • Contains a model of the “l’Arc de Triomphe” • Signifying the “triumphant” completion of the simulation • Acts as a positive method • Informing the subject that he or she has successfully completed a session MODSIM World 2007 Virginia Beach, VA Conference & Expo

  17. Avatar • Embedded within the VR environment • Acts as virtual walking partner • Provides support and feedback for the subject within the system • Recorded auditory cues are triggered upon the performance of certain events • Congratulatory messages when certain milestones are achieved MODSIM World 2007 Virginia Beach, VA Conference & Expo

  18. Inertial Tracker • Monitors walking posture • Mounted on a hat worn by patient • Triggers some auditory cues • Warning messages from the avatar when the subject is looking down or leaning MODSIM World 2007 Virginia Beach, VA Conference & Expo

  19. System Integration • Combines many successful features that have been shown to be associated with motor learning and successful gait training • Progressive decrease in body weight support • Overhead suspension device • Repetitive practice and positive feedback on performance • VR environment and inertial tracker MODSIM World 2007 Virginia Beach, VA Conference & Expo

  20. Current Pilot Study • 3 patients using the system • All have had a stroke, completed their traditional physical therapy, but still have significant gait deviations • Pre-test: Functional Gait Assessment and Berg Balance Scale • Patients showed limitations in gait speed, balancing on one leg, and stepping over objects MODSIM World 2007 Virginia Beach, VA Conference & Expo

  21. Current Pilot Study Milestones • Treatment will be conducted • 12 sessions or until a subject can walk for 30 minutes at 3mph with 0% weight support assistance • Increasing Speed & Time • Decreasing Body Weight • Patients will be re-tested upon completion MODSIM World 2007 Virginia Beach, VA Conference & Expo

  22. Pilot Study Patient Response • 3 patients have completed 7 to 10 treatments • Patient response is positive i.e. feel it is “helping” • Patient 001 • Using a 4-pronged cane and now uses a straight cane • Able to go grocery shopping, which she couldn’t do prior to the intervention • Walked for 14 minutes • Patient 002 • Walk on the treadmill for 20 minutes • Patient 003 • Walk on the treadmill for 15 minutes • Came to treatment without his cane MODSIM World 2007 Virginia Beach, VA Conference & Expo

  23. Future Work • Treat any of the multiple gait disability causing ailments • Application with the amputee population • Increased motivation and participation • Add the gaming element of a scoring system • Appealing to younger patients • Such as young soldiers returning from combat MODSIM World 2007 Virginia Beach, VA Conference & Expo

  24. Future Work cont’d • Loss of vision on one side • Common symptom of stroke patients • Interactive events and distractions in the VR environment in the hemisphere with diminished vision • Stimulate development of a compensatory head-turning habit • Visual obstacles within the VR environment • Sensors to track the leg motion MODSIM World 2007 Virginia Beach, VA Conference & Expo

  25. Medical Decision Making • Aid in medical decision making in patient progress and prognosis • Intelligent System • Taking into account the patient’s abilities • Distance • Speed • Weight bearing • Movement responses • Automatic decision making • When and how much to advance the program’s difficulty • Based on patient performance parameters MODSIM World 2007 Virginia Beach, VA Conference & Expo

  26. In Conclusion • Establish a database of patient use parameters and endpoints • Track a patient’s starting point and the trajectory of progress • Predict the probable endpoint • Predicting a patient’s functional abilities and limitations • Help the patient, family and healthcare providers make decisions about the future • Predict who will not benefit from continued treatment MODSIM World 2007 Virginia Beach, VA Conference & Expo

  27. Questions??? Virtual Reality in Gait Rehabilitation By Nigel W. Tierney Department of Computer Science Old Dominion University Co-Authors: Jessica Crouch, Hector Garcia, Martha Walker, Bonnie Van Lunen, Gianluca DeLeo, George Maihafer, Stacie Ringleb MODSIM World 2007 Virginia Beach, VA Conference & Expo