VirtRehab 2013 Abstracts

Full Papers
Paper Nr: 1

Virtual Arm Representation and Multimodal Monitoring for the Upper Limb Robot Assisted Teletherapy


Gorka Epelde, Xabier Valencia, Aitor Ardanza, Elsa Fanchon, Alessandro De Mauro, Francisco Molina Rueda, Eduardo Carrasco and Shabs Rajasekharan

Abstract: The use of technology in rehabilitation therapies targets the sustainability of health systems and the improvement of quality of life of the user (therapists, patients and informal carers). Robot or exoskeleton assisted rehabilitation systems, which are based on neurorehabilitation principles, are tools that not only help patients move the arm with precision; they also help reduce the fatigue of the therapist during the process. One of the challenges of the virtual reality based robot assisted upper limb rehabilitation is patients’ immersion within the therapy to achieve an improved progress of the rehabilitation. This paper, presents a new virtual reality therapy that has been created using the Armeo Spring exoskeleton. A 3D representation of the arm serves as an interaction mechanism with the virtual world. This makes the user more aware of the movements that he/she is making and improves the rehabilitation outcomes. It also encourages the user motivation and engagement to the therapy. Additionally, an application for the multimodal monitoring of the patient has been developed, together with tools for the online assessment of patients. These developments allow the physician to review the therapy without being in the same place and time, optimizing the use of hospital’s human resources.

Paper Nr: 2

Clinical, Functional and Kinematic Correlations using the Virtual Reality System Toyra® as Upper Limb Rehabilitation Tool in People with Spinal Cord Injury


Iris Dimbwadyo-Terrer, Fernando Trincado-Alonso, Ana de los Reyes-Guzmán, Alberto Bernal-Sahún, Patricia López-Monteagudo, Begoña Polonio-López and Ángel Gil-Agudo

Abstract: The aim of this study was to prove the validity and efficacy of the Virtual Reality (VR) System Toyra® as an assessment and rehabilitation tool for people with tetraplegia. We analysed the correlation between clinical and functional parameters with kinematic variables of upper limbs during a training protocol using Toyra®. Eighteen patients with cervical spinal cord injury (SCI) were selected to perform the study by comparing 2 treatments: patients in an intervention group (IG) conducted a program that included 12 sessions with Toyra® Activities of Daily Living (ADLs) module for 3 weeks, while a control group (CG) only had the traditional rehabilitation. Kinematic variables (shoulder, elbow and hand joint range of motion) were correlated to clinical [Motor Index (MI), Muscle Balance (MB)] and functional [Functional Independence Measure (FIM), Spinal Cord Independence Measure II (SCIM II), Barthel Index (BI)] evaluation scores. The results of the study showed a high correlation between these variables and also statistically significant differences (p=0.039) in a kinematic parameter (wrist extension), after treatment and in the follow-up evaluation. Toyra® system has been validated as upper limb assess and rehabilitation tool in people with SCI, to measure the patient´s functional evolution and improve the movement in upper limbs.

Paper Nr: 4

Rehabilitation for Children while Playing with a Robotic Assistant in a Serious Game


L. V. Calderita, P. Bustos, C. Suárez Mejías, B. Ferrer González and A. Bandera

Abstract: Traditional neuro-rehabilitation therapies are usually repetitive and lengthy, reducing motivation and adherence to the treatment and thus limiting the benefits for the patients. Moreover, exercises are usually not customizable for the patients, further increasing their disengagement with the treatment. The outcome is then a boring session day after day. This is more pronounced when the patient is a child. However, the execution of these repetitive movements is really needed, as it alters the properties of our neurons, including their pattern of connectivity. Correctly driven, this process finally allows to improve the neural functionality. The question is then: how can we improve the motivation and immersion of the patients into the therapy? We could try to convert the boring therapy into a funny one. This will help to the patients, but also to the practitioner. For this end, computer-assisted technologies have been extensively employed in the last years. Within this research field, this paper proposes to engage the child to the therapy by immersing her into an augmented reality scenario, where it will play several serious games. The adherence to the session will be further increased by incorporating a social robot as a playmate. This robot will be a personal trainer, that will perform the session in the real world with the patient. Additionally, the robot will be able to record the data for each session. This data could be subsequently used by the rehabilitation specialists for monitoring and/or adapting the therapy to the patient’s needs.

Short Papers
Paper Nr: 5

Illusion Approach for Upper Limb Motor Rehabilitation


Yee Mon Aung and Adel Al-Jumaily

Abstract: Taking the advantage of human brain plasticity nature, Augmented Reality (AR) based Illusion System (ARIS) for upper limb rehabilitation has developed. The ARIS aims to restore the lost functions of upper limb due to various motor injuries. It incorporates with AR technology to build up the upper limb rehabilitation exercise and computer vision with color recognition technique to comply “Fool-the-Brain” concept for fast recovery of neural impairments. The upper limb exercise that developed in ARIS is to promote the impaired arm range of motion by moving along the predefined trajectory of the AR based exercise. In ARIS, the real impaired arm will be overlapped by the virtual arm throughout the rehabilitation exercise to create the illusion scene. In the case of real arm cannot perform the required task, virtual arm will take over the job of real one and will let the user to perceive the sense that he/she is still able to perform the reaching movement by own effort to the destination point which is the main idea of ARIS. The validation of ARIS was conducted as a preliminary stage and the outcome are discussed.

Paper Nr: 7

New Developments in the Gesture Therapy Platform - Past, Present and Future of our Research


Felipe Orihuela-Espina, Paloma Álvarez-Cardenas, Lorena Palafox, Israel Sánchez-Villavicencio, Alberto L. Morán, Jorge Hérnandez-Franco and Luis Enrique Sucar

Abstract: Gesture Therapy (GT) is a virtual rehabilitation tool for the upper arm that has been in the making since 2008, and by now has successfully demonstrated therapeutic validity in two small clinical trials for stroke survivors. During this time, our group has published a number of contributions regarding different aspects of this platform ranging from hardware controllers to artificial intelligence algorithms guiding different aspects of the serious games behaviour, and clinical trial data from observable improvements in dexterity to changes in functional neuroreorganization. As we continue our research efforts in virtual rehabilitation and realising this knowledge in the GT platform, this paper presents an overview of the latest developments as well as a roadmap for future research.

Paper Nr: 6

Hand Functional Recovery in Sub-acute Brain Injury Stage Patients using AMADEO® Robotic-assisted Therapy - A Pilot Clinical Study with Apraxic and Neglect Patients


Pedro A. Serrano López-Terradas, Diana Moya Rosendo and Marcos Ríos Lago

Abstract: INTRODUCTION: Repeated and intensive exercise with AMADEO® Robot-Assisted Therapies (RAT) has been found useful in restoring functions of hand paresis in some brain-injured patients. OBJECTIVES: Evaluate the effects of RAT using AMADEO® device in combination with Conventional Neuro-rehabilitation Therapy (CNT) for the hand functional recovery in post-acute phase patients and to identify differences in the hand outcome trends among infants and adults with different recovery potential. METHODS: 12 adults and 3 infants with neglect or apraxia and hemi-paresis of the upper limb were enrolled in this prospective randomized pre-post pilot clinical study. They were assigned a priori to positive (PF+) or negative (PF-) prognostic factor groups. All subjects followed the same standardized protocol with AMADEO® and CNT. The outcome measures selected were: ARAT, MAS, COTNAB (subtest III), RASP, RPAB, and AMADEO® ROM and Strength Assessment Tools. RESULTS: Statistical analysis showed important differences between PF+ and PF- groups in hand function outcome measurements. Similar improved trends were found between PF+ and the group of infants. Both groups improved in extension variables, total score, level of difficulty, and speed in performing robot-graded tasks. They also showed more strength and motor control. Patients in the PF- group showed only hand recovery in flexion and ROM variables after using the robotic device. Positive intra- and intersession effects were found in all patients. DISCUSSION: The results suggest that finger motor activation and less somato-sensorial impairments in pre-test could be a better sign for the prognosis of hand recovery and for the decision to apply Amadeo® in opposite to the presence or absence of apraxic or neglect symptoms, which have been referred as contraindications. Amadeo® was a valuable tool, easy to use, safe and useful to monitor hand recovery and improve grip and finger motor function in spite of the presence of other cognitive impairments.