Applied Computer Simulation Labs

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VR Meets Physical Therapy

Tim Bowman

If you've ever needed physical therapy, you know the process is at best repetitive, and at worst, painful and boring. Imagine the challenges if you were partially paralyzed by a stroke and facing months of repetitious exercises and therapy.

What if you could perform your physical therapy with an engaging game or VR simulation? What if you could become totally involved in your own therapy and could "see" your own progress with the help of new technology?

Picture of a Physical Therapist working with a child with the VR wheelchair training system.

Figure 1. Experiencing virtual worlds with the help of a physical therapist.

In late 1995. We began exploring, developing, and offering Advanced Rehabilitation Therapies (ART) as part of an innovative environment where patients can experience cutting-edge technology applications such as wheelchair mobility training through VR as well as new uses of biofeedback therapy. ART is a part of the next generation of tools that will increase the independence level of disabled individuals and employ products never before used in a medical or nonmedical setting.

Current ART products were developed by two nationally recognized leaders in the medical and rehabilitative markets of VR, Dean Inman and David Warner. Warner, from the Institute for Interventional Informatics, designed an Enhanced Sensory Feedback Device (LSFD). The goal of the product is to offer muscle reeducation for strengthening and coordination, as well as presenting cognitive retraining through the use of simple computer games, and an electronic remote controlled car. The device is very feedback oriented and offers patients a motivating, positive, and interesting rehabilitation experience.

A stroke patient using ESFD said this: "When I came for therapy, my therapist worked on my knee and ankle muscles to see the range of movement and strength I had. I showed improvement after being on the machine a week. The Sega program showed me what I could do, and after I went home, I was able to use the muscles and movements better than I had before. I could twist my toes, stand on my tiptoes, and twist my foot right and left to actuate the muscles in my leg."

Inman, founder of the Oregon Research Institute, developed the wheelchair platform, a VR product that is totally immersive and three-dimensional (see the article by Inman et al. in this section). Although it was initially created to assist children who have cere-bral palsy in learning how to use and control a power wheelchair, the product has applications for a wide variety of users. The patient sits in a wheelchair on a roller system that allows the chair's wheels to spin while the chair remains stationary. The patient uses the joystick to move through different environments experienced through the 3D headset. A monitor enables the therapist to view patients' progress as they navigate through different VR worlds.

Picture of a physically disabled man controlling a computer game with muscle sensors.

Figure 2. The enhanced sensory feedback device.

A patient who used the VR platform reported: "Left neglect [failure to look left] was a real problem with me, and just a couple of sessions on the VR machine seemed to help me considerably. It was just a fun way to make the point of 'be sure you look left, too.

Approximately l3% to 16% of our patients have used the ESFD and/or the wheelchair platform. On average, these patients used the applications live to six times before discharge, and in some cases, they are still involved on an outpatient basis.

The ultimate goal of any therapy plan is to restore as much functionality for the patient as possible. Some of the major deterrents to achieving this goal are not necessarily physiological, but rather psychologi-cal. The use of ART seeks to overcome these deter-rents by making the entire rehabilitation process more enjoyable, motivating, and interesting.

These new technology applications are sensitive and responsive to improvements in patients' condi-tions and offer more immediate feedback than the tra-ditional assistive devices. We believe using these products in the rehabilita-tion process can lower healthcare costs, shorten hospital stays, and return people to work faster. Currently, most of the products available to phys-ical and occupational ther-apists are nontechnical in nature and offer only sub-jective measures of out-come. ART will not replace all traditional reha-bilitative methods. How-ever, use of these products has the potential to trans-form the way in which physicians, therapists, and providers consider patient outcomes and treatment cost issues.

Warner envisions developing a Windows version of the FSFD to allow for distance therapy through the World-Wide Web. This would facilitate home-based therapy.

Inman is interested in developing a program for post-stroke patients to help them re-establish sitting, standing, and walking. Inman hopes to conduct four research projects concurrently to help stroke patients achieve these skills.

Assistive devices and other technologies discussed in this article (and in this special section) may be effective methods to help minimize rehabilitative costs while increasing patients' independence levels. These products help patients increase their confidence and motivation levels, which, in turn, can lead to more beneficial and cost-effective treatment. Although it is too early to determine the exact level of improvement, patients have found these treatments engaging and motivating, while therapists have been able to document specific functional gains.

Tim Bowman is the project director of advanced rehabilitative technologies at Sister Kenny Institute, Minneapolis, Minn.

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August 1997/Vol.40, No.8 COMMUNICATIONS OF THE ACM