Motion Rehab AVE 3D: A VR-based exergame for post-stroke rehabilitation
Introduction
Stroke has often been described as a brain disease caused by the interruption of the blood supply to the brain, which can be classified in two main types: ischemic or hemorrhagic [1]. It's responsible for one death every 6 s [2], and the chance of having a stroke approximately doubles for each decade of life after age 55. Sometimes, this disease can affect individuals in the early age, including young adults [3].
About 50% of patients who survived a stroke have limitations in the daily life activities, affecting their quality of life [4]. The stroke causes several motor and functional changes to the individual, like paralysis on one side of the body. The most common paresis is hemiplegia (total loss) or contralateral hemiparesis (partial loss) to the affected hemisphere, being able to reach upper limb, trunk and lower limb [5].
The rehabilitation process consists a set of procedures to treat the most of function lost by the patient, improving the functional and intellectual capacities from neuroplasticity, and reeducating motor and cognitive functions [6]. The use of various techniques during therapy provides a better response to treatment, since the process of adaptation and cortical reorganization of each patient can happen in different ways. This way, it is necessary the constant use of new alternatives of treatment, without replacing those that already exist.
The goal of post-stroke rehabilitation therapies is to manipulate an interaction between motor recovery and cortical plasticity. However, as time goes by, patients tend to get tired and think the training process is monotonous, which often leads to loss of motivation for rehabilitation. According to Joo et al. [7], motivation is one of the elements that have great influence in the plasticity of the Central Nervous System (CNS), so it's important to offer alternatives of treatment that contemplate this factor. In this context, games for rehabilitation can increase motivation by offering a rich and distinctive environment [8].
Looking for attractive, motivating and effective rehabilitation techniques, technology has been highlighting [9]. According to Barros et al. [10], the use of digital therapeutic games in rehabilitation centers are increasing. For the authors, such games are considered very useful, since they allow therapy sessions to be customized according to the abilities of each individual. Moreover, the capture of natural movements enhances the motivation to perform the activities indicated by health professionals [11], [12], [13], [14].
Considering the types of games available for rehabilitation, the ones that stand out are the exergames. They have a stimulating and interactive nature, explicit educational purpose and offer an enriched environment of elements that motivate the learning of motor skills [15], [16].
Exergames that use motion sensors, such as Kinect, are able to capture the patient's natural movements, promoting a physical interaction. They work as a virtual mirror, because they assist the patient in the perception of movements and can offer a visual feedback [13], [17], [18].The use of interactive devices makes the treatment more encouraging, stimulating the human senses (mainly sight, hearing and, in some cases, touch).
In the same perspective, Hocine e Gouaich [19] say that using therapy with exergames, it is possible to provide instantaneous visual feedback, in addition to being a challenge to the patient. For Barcala et al. [20], this visual feedback is an active way for the motor control performance, and also benefits the motor learning process, because it considers the stages of self-correction of the executed movements, and benefits the neural plasticity of the patients.
With this in mind, our approach presents the first version of Motion Rehab AVE 3D, an exergame for rehabilitation of post-stroke patients with mild paresis. This game supports the motion sensor Kinect and virtual reality devices. This paper is organized as follow: Section 2 presents the game development. Section 3 shows results and discussions of the pilot study of one of the game exercises. Finally, Section 4 shows the conclusions and future work.
Section snippets
Development tools
The tools used for the development of the game Motion Rehab AVE 3D were: (1) Kinect for Windows SDK 2.0, (2) Unity game engine to create the game interface, (3) Kinect V2 examples with MS-SDK package and (4) the support for stereoscopic visualization.
Kinect is a device that recognizes body movements through a camera with RGB video detection; a depth sensor; an infrared sensor to capture spatial changes; and a microphone for voice commands [21]. This way, it is possible to capture and map the
Results
In order to test the game, a pilot study was conducted, considering the user interaction only the first activity of the game (Level 1, abduction movements and shoulder adduction, elbow and wrist extension, to train upper limb motor function), in third-person.
Our initial goal was to map a basic and comfortable setup of equipment in order to adopt later with post-stroke patients. Therefore, we defined a study using two different visualization devices: Smart TV 3D and HMD. We assumed that if
Discussions
We identified that 20% (four participants) presented some difficulties in terms of spatial orientation. They did not capture the objects proposed during the task because they did not perceive that it was necessary to open their arms in a slightly larger angle (physically) to reach the objects. Another 20% (four participants) presented this same difficult in the beginning of the interaction process – but, along of the experiment they perceived what should be done and they were able to execute
Conclusions
Exergames are increasingly gaining space in medical area, especially with the help of gesture and motion sensing devices and immersive interfaces. Motion Rehab AVE 3D is presented as a new tool for motor and balance rehabilitation. It will be used to help physiotherapists in the motivation of patients during rehabilitation sessions.
Regarding the pilot study, all participant classified as an interesting and excellent experience for elderly age. We also suggested to use the game in sessions with
Conflicts of interest
None declared.
Acknowledgments
The authors are grateful to Brazilian National Council for Scientific and Technological Development for their support.
References (30)
Stroke, Cerebrovascular accident: health topics
Geneva
(2013)- WSO - World Stroke Organization. “The Facts Behind 1 in 6". (2012). [Online]. Available:...
- et al.
Recuperação após acidente vascular cerebral em adulto jovem submetido à fisioterapia alternativa
Revista Interfaces: Saúde, Humanas e Tecnologia
(2015) Qualidade de vida em Indivíduos com Sequelas de Acidente Vascular Cerebral (AVC)
Vila Nova de Gaia: Escola Superior De Tecnologias da Saúde do Porto
(2011)- et al.
Predictors of upper limb recovery after stroke: a systematic review and meta-analysis
Clin. Rehabil.
(2012) - et al.
Efeito da fisioterapia convencional e do feedback eletromiográfico associados ao treino de tarefas específicas na recuperação motora de membro superior após acidente vascular encefálico.
Motricidade
(2013) - et al.
A feasibility study using interactive commercial off-theshelf computer gaming in upper limb rehabilitation in patients after stroke
J. Rehabil. Med.
(2010) - et al.
Efeitos da Realidade Virtual em Hemiparéticos Crônicos Pós- Acidente Vascular Encefálico
Revista Brasileira de Ciências da Saúde. São Caetano do Sul
(2012) - et al.
O ambiente virtual como interface na reabilitação pós-AVE: relato de caso.
Fisioterapia em Movimento.
(2013) - et al.
Breve estudo do estado da arte sobre acidente vascular cerebral e serious games para aplicação no projeto “AVC” do núcleo de tecnologia assistiva da UFS.
Revista GEINTEC
(2012)
Video game based coordinative training improves ataxia in children with degenerative ataxia
Neurology.
Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training.
J. NeuroEng. Rehabil.
Comparing the energy expenditure of WiiFitbased therapy with that of traditional physiotherapy in an older adult population
J. Am. Geriatrics Soc.
Increasing motivation in robotaided arm rehabilitation with competitive and cooperative gameplay
J. NeuroEng. Rehabil.
On complexity modeling of H.264/AVC video decoding and its application for energy efficient decoding
IEEE Trans. Multimedia
Cited by (87)
Exergames for hand rehabilitation in elders using Leap Motion Controller: A feasibility pilot study
2023, International Journal of Human Computer StudiesVR educational game in public awareness campaign preventing the spread of COVID-19 - a pilot study
2023, Procedia Computer ScienceDesign recommendations for XR-based motor rehabilitation exergames at home
2024, Frontiers in Virtual RealityVirtual reality interventions to improve function after stroke
2023, Handbook of Research on Advances in Digital Technologies to Promote Rehabilitation and Community ParticipationA new adaptive VR-based exergame for hand rehabilitation after stroke
2023, Multimedia Systems