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Patient-Tailored Augmented Reality Games for Assessing Upper Extremity Motor Impairments in Parkinson's Disease and Stroke.

ABSTRACT: In clinical practice, upper extremity motor impairments are commonly assessed with disease-specific, subjectively scored and low-resolution rating scales that often do not consider the variations in tasks and environment that are essential aspects of daily life. Augmented reality (AR) systems with contactless tracking of the hand and upper body offer opportunities for objective quantification of motor (dys)function in a challenging, engaging and patient-tailored environment. In this study, we explore the potential of AR for evaluating 1) speed and goal-directedness of movements within the individually determined interaction space, 2) adaptation of hand opening to objects of different sizes, and 3) obstacle avoidance in healthy individuals (N?=?10) and two highly prevalent neurological conditions (N?=?10 patients with Parkinson's Disease and N?=?10 stroke patients). We successfully implemented three AR games to evaluate these key aspects of motor function. As expected, PD patients moved slower than controls and needed more time for task completion. No differences were observed between stroke patients and controls, perhaps because motor impairments in this patient group were relatively mild. Importantly, usability of our AR system was good and considerably improved compared to our previous study due to more natural and patient-tailored interaction. Although our findings testify to the potential of AR for assessing motor impairments in patients with neurological conditions and provide starting points for further improvement, there are still many steps to be taken towards application in clinical practice.

SUBMITTER: Bank PJM

PROVIDER: S-EPMC6208648 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Patient-Tailored Augmented Reality Games for Assessing Upper Extremity Motor Impairments in Parkinson's Disease and Stroke.

Bank Paulina J M PJM Cidota Marina A MA Ouwehand P Elma W PEW Lukosch Stephan G SG

Journal of medical systems 20181030 12

In clinical practice, upper extremity motor impairments are commonly assessed with disease-specific, subjectively scored and low-resolution rating scales that often do not consider the variations in tasks and environment that are essential aspects of daily life. Augmented reality (AR) systems with contactless tracking of the hand and upper body offer opportunities for objective quantification of motor (dys)function in a challenging, engaging and patient-tailored environment. In this study, we ex ...[more]

PMID: 30374695

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Project description:BackgroundGait and balance impairments are common in neurological diseases, including stroke, and negatively affect patients' quality of life. Improving balance and gait are among the main goals of rehabilitation. Rehabilitation is mainly performed in clinics, which lack context specificity; therefore, training in the patient's home environment is preferable. In the last decade, developed rehabilitation technologies such as virtual reality and augmented reality (AR) have enabled gait and balance training outside clinics. Here, we propose a new method for gait rehabilitation in persons who have had a stroke in which mobile AR technology and a sensor-based motion capture system are combined to provide fine-grained feedback on gait performance in real time.ObjectiveThe aims of this study were (1) to investigate manipulation of the gait pattern of persons who have had a stroke based on virtual augmentation during overground walking compared to walking without AR performance feedback and (2) to investigate the usability of the AR system.MethodsWe developed the ARISE (Augmented Reality for gait Impairments after StrokE) system, in which we combined a development version of HoloLens 2 smart glasses (Microsoft Corporation) with a sensor-based motion capture system. One patient with chronic minor gait impairment poststroke completed clinical gait assessments and an AR parkour course with patient-centered performance gait feedback. The movement kinematics during gait as well as the usability and safety of the system were evaluated.ResultsThe patient changed his gait pattern during AR parkour compared to the pattern observed during the clinical gait assessments. He recognized the virtual objects and ranked the usability of the ARISE system as excellent. In addition, the patient stated that the system would complement his standard gait therapy. Except for the symptom of exhilaration, no adverse events occurred.ConclusionsThis project provided the first evidence of gait adaptation during overground walking based on real-time feedback through visual and auditory augmentation. The system has potential to provide gait and balance rehabilitation outside the clinic. This initial investigation of AR rehabilitation may aid the development and investigation of new gait and balance therapies.

Project description:ObjectiveTo determine the effects of augmented reality (AR) interventions on the function of the upper extremity (UE) and balance in children with spastic hemiplegic cerebral palsy (SHCP).MethodsIn total, 30 children with SHCP, aged 6 to 12 years, were randomly divided into three interventional groups. Each group received an AR game, i.e., Balance It, Bubble Pop, or Scoop'd (WonderTree, Pakistan). The UE function and balance were assessed at the baseline and after 8 weeks of intervention through the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and Pediatric Balance Scale (PBS), respectively. The mixed ANOVA was used to determine the combined with-in and between-the-groups differences in the function of the upper extremity. The Wilcoxon sign ranked test was used for with-in group changes, while the Kruskal Wallis test with the bonferroni correction post-hoc analysis was used to compare the groups in terms of balance. The data were analyzed by using SPSS version 21 and the level of significance was set at p < 0.05. Paired sample t-test and Wilcoxon signed-rank test was used for analyzing the changes in the total DASH and PBS scores within the groups, respectively. One-way ANOVA was used to determine the differences between the groups in the total DASH and PBS scores, while the Kruskal Wallis test was used for the differences between the groups in the PBS items. The data were analyzed by using SPSS version 21.ResultsAll the groups improved significantly in the total DASH and PBS scores post-intervention. A significant difference was determined in standing with one foot in front between Bubble Pop and Balance It groups (p = 0.03). The total score of PBS also showed a significant difference between Bubble Pop and Balance It groups (p = 0.02).ConclusionThe AR interventions used in this study were found to be effective in improving the UE function and balance of children with SHCP. The Balance It game showed more promising results in improving the balance as compared with the other games, however, no significant difference was determined between the three AR games in terms of the UE function of the participants.

Project description:ImportanceAffordable, quantitative methods to screen children for developmental delays are needed. Motor milestones can be an indicator of developmental delay and may be used to track developmental progress. Accelerometry offers a way to gather real-world information about pediatric motor behavior.ObjectiveTo develop a referent cohort of pediatric accelerometry from bilateral upper extremities (UEs) and determine whether movement can accurately distinguish those with and without motor deficits.Design, setting, and participantsChildren aged 0 to 17 years participated in a prospective cohort from December 8, 2014, to December 29, 2017. Children were recruited from Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, and Washington University School of Medicine in St Louis, St Louis, Missouri. Typically developing children were included as a referent cohort if they had no history of motor or neurological deficit; consecutive sampling and matching ensured equal representation of sex and age. Children with diagnosed asymmetric motor deficits were included in the motor impaired cohort.ExposuresBilateral UE motor activity was measured using wrist-worn accelerometers for a total of 100 hours in 25-hour increments.Main outcomes and measuresTo characterize bilateral UE motor activity in a referent cohort for the purpose of detecting irregularities in the future, total activity and the use ratio between UEs were used to describe typically developing children. Asymmetric impairment was classified using the mono-arm use index (MAUI) and bilateral-arm use index (BAUI) to quantify the acceleration of unilateral movements.ResultsA total of 216 children enrolled, and 185 children were included in analysis. Of these, 156 were typically developing, with mean (SD) age 9.1 (5.1) years and 81 boys (52.0%). There were 29 children in the motor impaired cohort, with mean (SD) age 7.4 (4.4) years and 16 boys (55.2%). The combined MAUI and BAUI (mean [SD], 0.86 [0.005] and use ratio (mean [SD], 0.90 [0.008]) had similar F1 values. The area under the curve was also similar between the combined MAUI and BAUI (mean [SD], 0.98 [0.004]) and the use ratio (mean [SD], 0.98 [0.004]).Conclusions and relevanceBilateral UE movement as measured with accelerometry may provide a meaningful metric of real-world motor behavior across childhood. Screening in early childhood remains a challenge; MAUI may provide an effective method for clinicians to measure and visualize real-world motor behavior in children at risk for asymmetrical deficits.

Project description:Simulations of visual impairment are used to educate and inform the public. However, evidence regarding their accuracy remains lacking. Here we evaluated the effectiveness of modern digital technologies to simulate the everyday difficulties caused by glaucoma. 23 normally sighted adults performed two everyday tasks that glaucoma patients often report difficulties with: a visual search task in which participants attempted to locate a mobile phone in virtual domestic environments (virtual reality (VR)), and a visual mobility task in which participants navigated a physical, room-scale environment, while impairments were overlaid using augmented reality (AR). On some trials, a gaze-contingent simulated scotoma-generated using perimetric data from a real patient with advanced glaucoma-was presented in either the superior or inferior hemifield. The main outcome measure was task completion time. Eye and head movements were also tracked and used to assess individual differences in looking behaviors. The results showed that the simulated impairments substantially impaired performance in both the VR (visual search) and AR (visual mobility) tasks (both P < 0.001). Furthermore, and in line with previous patient data: impairments were greatest when the simulated Visual Field Loss (VFL) was inferior versus superior (P < 0.001), participants made more eye and head movements in the inferior VFL condition (P < 0.001), and participants rated the inferior VFL condition as more difficult (P < 0.001). Notably, the difference in performance between the inferior and superior conditions was almost as great as the difference between a superior VFL and no impairment at all (VR: 71%; AR: 70%). We conclude that modern digital simulators are able to replicate and objectively quantify some of the key everyday difficulties associated with visual impairments. Advantages, limitations, and possible applications of current technologies are discussed. Instructions are also given for how to freely obtain the software described (OpenVisSim).

Dataset Information

Patient-Tailored Augmented Reality Games for Assessing Upper Extremity Motor Impairments in Parkinson's Disease and Stroke.

Publications

Patient-Tailored Augmented Reality Games for Assessing Upper Extremity Motor Impairments in Parkinson's Disease and Stroke.

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