1. Virtual Rehabilitation in Neurological Rehabilitation Ksenia Ustinova, PhD

2. VR – rehabilitation via interaction with different types of computer-generated (virtual) environments – full or partial immersion WHAT IS VIRTUAL REHABILITATION (VR)? HMD PROJECTION TV PROJECTION

3. –entire body or segment representation (avatar) –2D or 3D projection, first- or third-person view –combination with haptic devices –motion sensors WHAT IS VIRTUAL REHABILITATION (VR)? VIVID GT: IREX CYBERGLOVE APPLICATION CAVE

4. VR is task-oriented therapeutic approach Creates real-life scenarios and tasks Provides practice in safe environment Allows manipulating feedback Motivating and fun! Shown to be effective in many patient populations WHY VIRTUAL REHABILITATION…?

5. Patients with Parkinson Disease (PD) have difficulties initiating gait Vision influence multiple gait parameters via optic flow - pattern of visual image, projected on the eye retina (Gibson 1966) This implies that by artificially changing the optic flow one can influence the gait initiation in patients with PD Hypothesis was tested by analyzing the gait initiation in response to changing the optic flow from a stationary to a moving pattern. EFFECT OF OPTIC FLOW ON GAIT INITIATION IN PATIENTS WITH PD

6. Walking 2 steps forward EXPERIMENTAL DESIGN Expansion or compression of the VR hallway at speeds ranged from 0.5 to 8 m/s Adapted from the library of VRCO Inc. by L. Hughey

7. PARTICIPANTS Seven patients with rigidity predominant form of Parkinson Disease Age 61±8 yr Hoehn & Yahr stage II-III (V bedridden) UPDRS motor section 46±11 pts (108 pts severe impairments) DATA ANALYSIS From knee markers displacement - the latency, duration of unloading phase, and temporal characteristics of the first step were analyzed

8. RESULTS latency unloading first step

9. RESULTS LATENT PERIOD M±SD (s) DURATION OF UNLOADING PHASE M±SD (s)

10. RESULTS

11. DISCUSSION & CONCLUSION Results show that the optic flow rate influences not only the latency, but also kinematic characteristics of gait initiation. Results may be used in rehabilitation to facilitate gait initiation in patients with Parkinson Disease.

12. VR GAMES FOR PATIENTS WITH TBI Traumatic brain injury (TBI) disrupts the central and executive mechanisms underlying motor coordination Customized 3D immersive videogame was developed to address coordination deficit Effect of a short-term gaming practice on the arm and postural coordination of patients with TBI was analyzed

13. The Octopus game Task – pop as many bubbles as possible 90 s, ~20-25 reach-to- pop movements GAME DESIGN Practice 10 trials during a single session 30-min break 2 trials retention test

14. PARTICIPANTS Nine patients with mild-to-moderate manifestations of TBI Ataxia Score according to Klockgether 12±7 pts (35 pts severe ataxia) Age 36±5 yrs No severe visual perception deficits No severe cognitive deficits

15. DATA COLLECTION & ANALYSIS Parameters analyzed (for the bubble in strictly sagittal plane) Arm movement time Trajectory curvature – ratio of actual trajectory length to the shortest distance to target Arm-postural coordination – Principal Component Analysis (PCA) Strength of multi-segment coupling (PC1: percent variance 0% to 100%) Contribution of each segment into task performance (loadings: significant when > 0.7)

16. Trajectories of the arm (hand), trunk (C7), and legs (hip) in sagittal plane during the first (A) and ninth (B) gaming trials in a representative participant. RESULTS

17. As a result of short-term practice: –Arm movement time decreased (A) –Trajectory curvature decreased (B) –Coordination improved (C ) RESULTS

18. As a result of short-term practice: –Contribution of postural segments into task performance was increased

19. DISCUSSION & CONCLUSION The result confirmed the feasibility of this type of videogame in patients with TBI. These games potentially can be used to regain arm-postural control and to encourage maximal use of available coordination strategies.

20. FUTURE APPLICATION VR game-based telerehabilitation PARTICIPANT IN-HOME TV Xbox MOTION SENSOR IN-HOME LAPTOP CMU TELE-THERAPIST We are open for collaboration!!!!!

21. ACKNOWLEDGEMENTS The US Department of Defense for sponsoring the project Collaborators: Anatol G. Feldman Wesley Leonard Lisette Tamkei Jan Perkins

22. HOUSE LARGE TREE CORNER TREE BURNING BUSHES EVERGREENS