9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Upper-Body Interactive Rehabilitation System for Children with Cerebral Palsy: The Effect of Control/Display Ratios Takehiko Yamaguchi1, Paul Richard2, Fabienne Veaux3, Mickaël Dinomais4, Sylvie Nguyen5 1,2,3,4,5Laboratoire d'Ingénierie des Systèmes Automatisés, Université d’Angers, Angers, France 3,4Centre les Capucins, Département de Médecine Physique et de Rééducation Pédiatrique, Angers, France 4Faculté de Médecine; Département de Médecine Physique et de Réadaptation Pédiatrique, Université d’Angers, Angers, France

Introduction Related Studies Proposed System System Evaluation 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Related Studies Proposed System System Evaluation Results and Discussion Conclusion

9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Cerebral palsy (CP): various motor impairments caused by damage to the central nervous system during foetal development It affects about 0.3% of births (Krageloh-Mann, and Cans, 2009) It often manifests itself during childhood Physical therapy is need; - Improve their movement patterns. - Maintain the range of the affected arm/leg joints. Constraint-induced movement therapy (CIMT) It encourages the use of the affected hand by restricting the unaffected hand and asking for intensive movement with the impaired upper limb Having the "good" arm blocked for long periods of time can generate frustration in the child More "child-friendly" approaches are needed

9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Traditional CP Therapy: is often of little interest to a child, affecting his motivation to continue such therapeutic activities (Schmidt, and Lee, 2005) Traditional CP Therapy is not motivating and entertaining for child Virtual Reality (VR): systems offer the capability to achieve rehabilitative goals through the use of real-time feedback and adaptive strategy/difficulty (Le Gal et al., 2008) VR remains motivating and entertaining Goal of project: is to develop a “child-friendly, motivating, and entertaining” rehabilitation system for children with CP

Motion capture based VR rehabilitation system using Kinect sensor 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Traditional CP Therapy: is often of little interest to a child, affecting his motivation to continue such therapeutic activities (Schmidt, and Lee, 2005) Traditional CP Therapy is not motivating and entertaining for child Virtual Reality (VR): systems offer the capability to achieve rehabilitative goals through the use of real-time feedback and adaptive strategy/difficulty (Le Gal et al., 2008) VR remains motivating and entertaining Motion capture based VR rehabilitation system using Kinect sensor

Related Studies Introduction Proposed System System Evaluation 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Related Studies Proposed System System Evaluation Results and Discussion Conclusion

9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, FranceS eptember 10–12, 2012 Related Studies IREX EyeToy Cybex Trazer VR Rehabilitation ： Using full-body interaction via a tracking device Working Space of Previous Systems： Visually limited since the user’s movement is directly projected on a screen via a tracking system Limited working space could generate frustration on children’s motivation Limit system capability: task variation, and interaction techniques for the rehabilitation task. Concept of our system: Assist children with CP in a full-range of avatar movements to adapt the Control/Display (C/D) ratio of limb positions

9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Related Studies VR Rehabilitation ： Using full-body interaction via a tracking device IREX EyeToy Cybex Trazer Working Space of Previous Systems： Visually limited since the user’s movement is directly projected on a screen via a tracking system Limited working space could generate frustration on children’s motivation Limit system capability: task variation, and interaction techniques for the rehabilitation task. Aim of this study: Explore the effectiveness of C/D ratios to analyze user performance, work load, and user enjoyment

Proposed System Introduction Related Studies System Evaluation 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Related Studies Proposed System System Evaluation Results and Discussion Conclusion

Proposed System System Configuration A 60” TV monitor, A laptop 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Proposed System System Configuration A 60” TV monitor, A laptop A Microsoft Kinect sensor A rehabilitation application running on the laptop The application renders a visually-realistic 3D environment.

Proposed System VR Rehabilitation Application 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Proposed System VR Rehabilitation Application

System Evaluation Introduction Related Studies Proposed system 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Related Studies Proposed system System Evaluation Results and Discussion Conclusion

System Evaluation Participants Apparatus 12 university students: 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 System Evaluation Participants 12 university students: 9 male and 3 female, between 19 and 30 years (M = 24.3, SD = 3.3 years) Dominant hand: All participants were right-handed Health: in good health, Kinect experience: had not used a game using Kinect All subjects were at a distance of about 3 meters from the Kinect sensor. Apparatus Kinect: one Kinect was used for training exercises and experimental tasks FPS: Kinect was updated to about 20Hz Platform: The Unity3D platform was used for graphic rendering Monitor: 60 inch LG PC: TOSHIBA laptop OS: Windows 7 CPU: Intel Core i7 720QM processor RAM: 4GB of memory

System Evaluation Task Procedure 1 session x 3 times 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 System Evaluation Task Procedure Training Trial Questionnaire x 3 times 1 session Independent variable: C/D ratio Level: ratio 1.0, ratio 1.5, ratio 2.0

System Evaluation Task Procedure 1 session x 3 times Training 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 System Evaluation Task Procedure Training Trial Questionnaire x 3 times Independent variable: C/D ratio Level: ratio 1.0, ratio 1.5, ratio 2.0 1 session Training 20 – 40 objects were applied every 2 seconds Randomly between 0 -180 °

System Evaluation Task Procedure 1 session x 3 times Trial 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 System Evaluation Task Procedure Training Trial Questionnaire x 3 times 1 session Independent variable: C/D ratio Level: ratio 1.0, ratio 1.5, ratio 2.0 Trial 60 objects The applied direction : randomly selected out of 3 angles 60° -5° -40° C/D 1.0

System Evaluation Task Procedure 1 session x 3 times Trial 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 System Evaluation Task Procedure Training Trial Questionnaire x 3 times 1 session Independent variable: C/D ratio Level: ratio 1.0, ratio 1.5, ratio 2.0 Trial 60 objects The applied direction : randomly selected out of 3 angles 60° -5° -40° C/D 1.0 27.5° 125° -25° C/D 1.5 190° -10° 60° C/D 2.0

System Evaluation Task Procedure 1 session x 3 times Questionnaire 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 System Evaluation Task Procedure Training Trial Questionnaire x 3 times 1 session Independent variable: C/D ratio Level: ratio 1.0, ratio 1.5, ratio 2.0 Questionnaire Nasa TLX for workload Physical Activity Enjoyment Scale (PACES) for Enjoyment of the training

Results and Discussion 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Related Studies Proposed system System evaluation Results and Discussion Conclusion

Results and Discussion 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Results and Discussion Dependent variables Performance data: Take success rate Subjective data: Nasa TLX Physical Activity Enjoyment Scale

Results and Discussion 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Results and Discussion Task success rate C/D 1.0 (M = 99.72% , SD = 0.96%) > C/D 2.0 (M = 90.28% , SD = 10.77%) C/D 1.5 (M = 97.50% , SD = 3.51% ) > C/D 2.0 (M = 90.28% , SD = 10.77%) C/D ratio was related to task difficulty 190° -5° -40° 60° 125° -10° -25° 27.5° User comments

Results and Discussion 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Results and Discussion Task success rate C/D 1.0 (M = 99.72% , SD = 0.96%) > C/D 2.0 (M = 90.28% , SD = 10.77%) C/D 1.5 (M = 97.50% , SD = 3.51% ) > C/D 2.0 (M = 90.28% , SD = 10.77%) C/D ratio was related to task difficulty User comments 60° 190° 60° 125° 27.5° -5° -10° -25° -40° The user’s movement strategy for the task could be changed

Results and Discussion 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Results and Discussion Nasa TLX Temporal Demand (Significant trend): C/D 2.0 (M = 3.67 , SD = 1.15) > C/D 1.0 (M = 2.67 , SD = 0.98) Effort (Significant effect): C/D 2.0 (M = 3.41 , SD = 1.24) > C/D 1.0 (M = 2.08, SD = 0.67) Required to make an effort to complete a task with a C/D 2.0 ratio There was time pressure with C/D 2.0 ratio Concerning frustration: Expected Result : Felt stress for avatar operations in C/D 1.5 and 2.0 ratio conditions Result : No significant effect comfortable operation for the C/D 2.0 ratio because of the speed of the avatar's movement. uncomfortable operation for C/D 1.0 because the avatar’s movement was slow. User comments

Results and Discussion 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Results and Discussion Enjoyment No significant effect C/D 1.5 and 2.0 : Could be challenged, excited, and motivated to perform the task C/D 1.0 condition : no excited, and no challenged , but the movement was realistic, natural, simulated User comments User motivation can be changed with different C/D ratios.

Conclusion Introduction Related Studies Proposed system 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Introduction Related Studies Proposed system System evaluation Results and Discussion Conclusion

Conclusion Aim of this study Method Findings Future works 9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Conclusion Aim of this study Explored the effectiveness of C/D ratios in our prototype application - Applied the object catching task with 3 kinds of C/D ratio to analyze user performance, work load, and user enjoyment with university students without motor impairments Method Performance data - Success rate: C/D ratio was related to task difficulty The user’s movement strategy for the task could be changed Subjective data - Workload: High C/D ratio could make an effort, and time pressure High C/D ratio could make it comfortable on avatar movement Low C/D ratio could make it uncomfortable on avatar movement Subjective data - Enjoyment: User motivation could be changed with different C/D ratios. Findings Different kinds of C/D ratios will be designed to better understand their effectiveness. Other kinds of interaction techniques we have developed will be investigated using patients with impaired motor function. Future works

9th International Conference on Disability, Virtual Reality and Associated Technologies Laval, France September 10–12, 2012 Any questions?