AUGMENTED REFLECTION TECHNOLOGY … · Motor Assessment Scale (Upper arm)/6 5 0 0 0 6 Motor...
Transcript of AUGMENTED REFLECTION TECHNOLOGY … · Motor Assessment Scale (Upper arm)/6 5 0 0 0 6 Motor...
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Simon Hoermann September 2012 ART for Rehabilitation
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INFORMATION SCIENCE
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Simon Hoermann
AUGMENTED REFLECTION
TECHNOLOGY
Feasibility Evaluation for Stroke
Rehabilitation
with
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
Motor Assessment Scale
(Hand)/6 3 0 0 0 5
Motor Assessment Scale
(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
time
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
Motor Assessment Scale
(Upper arm)/6 +1 0 0 0 0
Motor Assessment Scale
(Hand)/6 +1 0 0 0 0
Motor Assessment Scale
(Advanced hand)/6 0 0 0 0 0
Nine Hole Peg Test
(remove pegs) ~120 sec NA* NA* NA*
33 sec
(+11)
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
Leigh Hale
Assoc. Prof. PT
Stanley J. Winser
MSc PT
Holger Regenbrecht
Assoc. Prof. InfoSci
.nz
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