Motion Rehab AVE 3D: A VR-based exergame for post-stroke rehabilitation

https://doi.org/10.1016/j.cmpb.2017.08.008Get rights and content

Highlights

  • A new serious game for post-stroke rehabilitation with six different levels of exercises.

  • This solution allows to assist the traditional therapy and motivate the patient to execute his/her rehabilitation program, under health professional supervision.

  • A preliminary study show good results in user preferences.

  • This approach supports first- and third-person point of views and virtual reality devices, like head-mounted displays and motion sensors.

Abstract

Background and objective

Recent researches about games for post-stroke rehabilitation have been increasing, focusing in upper limb, lower limb and balance situations, and showing good experiences and results. With this in mind, this paper presents Motion Rehab AVE 3D, a serious game for post-stroke rehabilitation of patients with mild stroke. The aim is offer a new technology in order to assist the traditional therapy and motivate the patient to execute his/her rehabilitation program, under health professional supervision.

Methods

The game was developed with Unity game engine, supporting Kinect motion sensing input device and display devices like Smart TV 3D and Oculus Rift. It contemplates six activities considering exercises in a tridimensional space: flexion, abduction, shoulder adduction, horizontal shoulder adduction and abduction, elbow extension, wrist extension, knee flexion, and hip flexion and abduction. Motion Rehab AVE 3D also report about hits and errors to the physiotherapist evaluate the patient's progress.

Results

A pilot study with 10 healthy participants (61–75 years old) tested one of the game levels. They experienced the 3D user interface in third-person. Our initial goal was to map a basic and comfortable setup of equipment in order to adopt later. All the participants (100%) classified the interaction process as interesting and amazing for the age, presenting a good acceptance.

Conclusions

Our evaluation showed that the game could be used as a useful tool to motivate the patients during rehabilitation sessions. Next step is to evaluate its effectiveness for stroke patients, in order to verify if the interface and game exercises contribute into the motor rehabilitation treatment progress.

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.

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