AUGMENTED REFLECTION TECHNOLOGY … · Motor Assessment Scale (Upper arm)/6 5 0 0 0 6 Motor...

Simon Hoermann September 2012 ART for Rehabilitation

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Simon Hoermann

AUGMENTED REFLECTION

TECHNOLOGY

Feasibility Evaluation for Stroke

Rehabilitation

Leigh Hale, Stanley J. Winser and Holger T. Regenbrecht

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Outline

Augmented Reflection

Technology (ART)

TheraMem

Rehabilitation Game

Clinical Feasibility Study

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Augmented Reflection Technology (ART)

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Augmented Reflection Technology

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3D Scene Construction

Client’s View

3D Scene View

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Mirroring

Size and Position

3D models

2D Backgrounds

Colour etc.

Augmented Reflection Technology - Settings

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Movement Amplification

Camera Video Stream (original movement)

User’s View (left hand with

amplified movement)

1cm 3cm

• e.g. factor 2.0 [snew = sori * (f+1)] =

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TheraMem – Rehabilitation Game

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TheraMem Game

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ART::TheraMem Software Architecture (simplified)

Video Left Video Right

Bgr Subtraction Bgr Subtraction

Fingertracking Fingertracking

Amplification Ctrl Amplification Ctrl

3D Scene

Render Left Render Right 3D environment

3D objects (plants)

Interaction/Logic

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Hypotheses

a) The system can be used for physical rehabilitation, in particular for after-stroke therapy in a clinical setting

b) Using a casual computer game approach engages the patients and might distract them from pain or discomfort while moving their impaired upper limb (arm/hand)

c) A controlled amplification of the movement of the impaired limb will help patients to exercise with the game

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ART System Configuration

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Utility Evaluation

• Post-stroke rehabilitation lab week for about 100 third year physiotherapy students: 8 different hands-on stations: TheraMem one of those

• groups of 3-5 • act as client, operator,

observers • Fill-in questionnaires on:

• Explain system to peers • Use for motor rehab • Therapy outcome

Student Evaluations

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Utility Evaluation

• “Best neuro lab ever!” • “It is so cool” • “Great fun.” • “It’s fun! Not boring like most exercises we give patients.”

Student Evaluations

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Clinical Feasibility

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Clinical Environment

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Clinical Setting

(b) User screen

(a) Operator screen

(b) ART boxes

(d) Physiotherapist

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Preliminary Study with subject-matter experts for protocol refinement

Evaluation of protocol and refinement with two healthy

participants:

• One participant with a expertise in HCI and technology

• One participant with proficiency in physiotherapy

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Clinical Protocol Outline

4 sessions of 1h

First session:

Assessment of patient’s motor capabilities

Orientation of patient to the ART

Second & Third Session:

3- 5 patient tailored exercises based on the outcomes of

assessment

Fourth Session

Exercises

Reassessment of patient’s motor capabilities

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Patients

5 chronic stroke patients:

• stable motor deficits (> 5

years since stroke)

• different impairment severity

(2 dependent, 3

independent)

• different range of

impairments

• all having motor-deficits in

their upper limb

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Initial Assessment

Assessment item PT0 PT1 PT2 PT3 PT4

Fugl-Meyer measure

(Wrist)/10 5 0 0 0 7

Fugl-Meyer measure

(Hand)/14 4 0 0 0 11

Motor Assessment Scale

(Upper arm)/6 5 0 0 0 6

(Hand)/6 3 0 0 0 5

(Advanced hand)/6 6 0 0 0 6

Nine Hole Peg Test

(remove pegs) NA* NA* NA* NA* 22 sec

Nine Hole Peg Test

(remove pegs using ART) NA* NA* NA* NA* 49 sec

Modified Ashworth Scale

1+ 4 2 2 1+

Sensory assessment of hand

Light touch / 2 2 2 2 2 2

Pain / 2 2 2 2 2 2

Proprioception / 2 2 2 2 2 2

*NA.. Not assessed or stopped on patients request

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TheraMem questionnaire slightly modified

Tries & Time

Difficulty to play the game Unusable - Very easy to use

Difficulty to reach tiles (squares) Very difficult - Very easy to reach

Difficulty of tile (square) selection

Very difficult - Very easy to select

How fast did you perceive your (impaired) hand to move

Much slower than normal – Much faster than normal

Did you have any discomfort in your (impaired) hand

No discomfort – A lot of discomfort (pain)

Enjoyment / fun to perform the exercise

Not enjoying it - Very enjoyable

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Patients’ engagement

Patient’s:

1. Understanding of instructions.

2. Performance in exercises

3. Active participation in the exercise

4. Maximum effort to complete exercises.

5. Expressed positive attitude towards exercise

6. Acknowledged need and potential benefit of exercise

Rating of therapeutic value of exercise for patient

Comments / Suggestions / Additional Observations

1 2 3 4 5 6

Never Seldom Some of

the time

Most of the

Nearly

Always Always

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Final Semi-structure Interview

How would you describe your experience with this therapeutic

system?

What were your difficulties/expectations/motivations?

Do you have improvement suggestions for the device? Any

problems you experienced?

What did you think of the location / room / setting and seating

positions?

Did you feel Security/Safety during the therapy?

Did you have the perception that you improved you condition, was

there any change in your arm?

Would you suggest (to other stroke patients) to use this system?

When do you think would be a good time to start using the system?

Could you imagine using the system without the (permanent)

presence of a physiotherapist?

Would you use the system at home?

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TheraMem - Completion

44 games of TheraMem were played by patients

of which 42 were successfully completed

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Support Device: Elbow-splint

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Support Device: Pointing-Stick

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Use of Support Devices

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Average Time for Completion

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Average Tries for Completion

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Patients’ Engagement

PT0 PT1 PT2 PT3 PT4

1. Understanding of instructions 6.0 6.0 4.0 6.0 6.0

2. Performance.in exercises 6.0 4.7 4.0 4.7 6.0

3. Active participation in the exercise 4.7 5.0 3.0 6.0 6.0

4. Maximum effort to complete

exercises 6.0 6.0 4.0 6.0 6.0

5. Expressed positive attitude

towards exercise 4.7 5.0 3.0 6.0 6.0

6. Acknowledged need and potential

benefit of exercise 4.7 4.7 3.0 6.0 6.0

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Patients’ rating for TheraMem

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Equipment (ART) Physiotherapist’s rating

Equipment feasibility for clinical usage: 7

Therapeutic value: 8

Diagnostic value: 0

How interesting are the tasks: 10

Degree of motivation for the patient 10

Ease of administering tasks (by PT) 7

(0- not at all useful to 10- very useful)

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TheraMem only (Physiotherapist’s rating)

Equipment feasibility for clinical usage: 10

Therapeutic value: 8

Diagnostic value: 0

How interesting is the task: 8*

Degree of motivation for the patient 10*

Ease of administering tasks (by PT) 10

(0- not at all useful to 10- very useful)

* Fades away with repetition of task

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Changes from Initial to Final Assessment

Assessment item PT0 PT1 PT2 PT3 PT4

Fugl-Meyer measure

(Wrist)/10 0 0 0 0 +1

Fugl-Meyer measure

(Hand)/14 +4 0 0 0 0

(Upper arm)/6 +1 0 0 0 0

(Hand)/6 +1 0 0 0 0

(Advanced hand)/6 0 0 0 0 0

Nine Hole Peg Test

(remove pegs) ~120 sec NA* NA* NA*

33 sec

Nine Hole Peg Test

(remove pegs using ART) NA* NA* NA* NA*

26 sec

(-23) Modified Ashworth Scale

0 0 0 0 0

Sensory assessment of hand

Light touch / 2 0 0 0 0 0

Pain / 2 0 0 0 0 0

Proprioception / 2 0 0 0 0 0

*NA.. Not assessed or stopped on patients request

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Conclusion

• The ART system is feasible for the use in clinical physiotherapeutic settings

• Patients are able to successful complete TheraMem • Assistive devices might be required for patients with

severe motor-impairments

• Patients were highly engaged in the exercises

• Patients liked the system and suggested it for further use

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Thank you for your attention!

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Contact & Acknowledgements

Simon Hoermann

shoermann@infoscience.otago.ac.nz

Leigh Hale

Assoc. Prof. PT

Stanley J. Winser

MSc PT

Holger Regenbrecht

Assoc. Prof. InfoSci

Leigh.hale@otago.ac

Stanley.winser@otag

o.ac.nz

Holger@infoscience.

otago.ac.nz

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Whereto from here?

• More Clinical Case Studies

• Further developments

• Sub-Acute Stroke Rehabilitation Feasibility Study

• Randomized Controlled Trial

• Deployment

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References

Paper about the original concept of ART - AMB:

Regenbrecht, H. T., Franz, E. A., McGregor, G., Dixon, B. G., & Hoermann,

S. (2011). Beyond the Looking Glass: Fooling the Brain with the

Augmented Mirror Box. Presence: Teleoperators and Virtual

Environments, 20(6), 559–576. doi:10.1162/PRES_a_00082

ISMAR – TheraMem Paper:

Regenbrecht, H., McGregor, G., Ott, C., Hoermann, S., Schubert, T., Hale,

L., Hoermann, J., et al. (2011). Out of reach? — A novel AR interface

approach for motor rehabilitation. Mixed and Augmented Reality

(ISMAR), 2011 10th IEEE International Symposium on (pp. 219–228).

Presented at the Mixed and Augmented Reality (ISMAR), 2011 10th

IEEE International Symposium on. doi:10.1109/ISMAR.2011.6092389

Technological Paper on ART & TheraMem (accepted manuscript):

Regenbrecht, H., Hoermann, S., McGregor, G., Dixon, B., Franz, E., Ott, C.,

Hale, L., et al. (2012). Visual Manipulations for Motor Rehabilitation.

Computers & Graphics, (0). doi:10.1016/j.cag.2012.04.012

AUGMENTED REFLECTION TECHNOLOGY … · Motor Assessment Scale (Upper arm)/6 5 0 0 0 6 Motor...

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