Ioannis Paraskevopoulos

Fall prevention intervention technologies

In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.

Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence – key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.

Use of gaming sensors and customised exergames for parkinson's disease rehabilitation: A proposed virtual reality framework

The research in-progress presented in this paper proposes the use of a low-cost, customized and off-the-shelf motion capture system (employing commercial game controllers) with bespoke video games tailored to suit the requirements of Parkinsons Disease (PD) rehabilitation protocol. The proposed system is designed to capture various movements of the upper limbs, unilateral or bilateral, and the motion captured is represented one-to-one in the virtual world of the video game. Furthermore, the captured data is fed online to a Virtual Reality (VR) instructor platform to realize the potential of live biofeedback and game difficulty adjustment by the clinician. The pilot study design for evaluating the proposed platform is also presented.

Wii YOUR HEALTH: A LOW-COST WIRELESS SYSTEM FOR HOME REHABILITATION AFTER STROKE USING Wii REMOTES WITH ITS EXPANSIONS AND BLENDER

Full body motion capture via the Wiimote and the new Wii MotionPlus sensor has yet to be investigated or developed. In addition, the mapping of the Wiimotecaptured motion data to a computer generated 3D model inside an open source professional 3D animation tool has yet to be attempted. Within this paper the authors initiate a new study into full markerless human body motion tracking for physical rehabilitation. In particular, it includes the investigation and development of the first phase of a system that is able to capture full human body motion data by a set-up of several Wiimotes placed on different human body segments. This will allow the development of an affordable store and forward treatment option that would enable and motivate physical rehabilitation patients and in particular stroke patients, to conduct physical therapy from home. Finally, by extending a professional 3D animation software tool (Blender), motion data captured through the new system can be mapped onto a virtual 3-D human model in real time, thereby making it possible to have a strong correlation between the physical human and a virtual character to enhance the clinical utility of this innovative technology.

The Use of the Nintendo Wii in Motor Rehabilitation for Virtual Reality Interventions: A Literature Review

Several review articles have been published on the use of Virtual Reality (VR) in motor rehabilitation. The majority of these focus on the effectiveness of VR on improving motor function using relatively expensive commercial tools and technologies including robotics, cybergloves, cybergrasps, joysticks, force sensors and motion capture systems. However, we present the case in this chapter that game sensors and VR technologies which can be customized and reconfigured, such as the Nintendo Wii, provide an alternative and affordable VR intervention for rehabilitation. While the performance of many of the Wii based interventions in motor rehabilitation are currently the focus of investigation by researchers, an extensive and holistic discussion on this subject does not yet exist. As such, the purpose of this chapter is to provide readers with an understanding of the advantages and limitations of the Nintendo Wii game sensor device (and its associated accessories) for motor rehabilitation and in addition, to outline the potential for incorporating these into clinical interventions for the benefit of patients and therapists.

Virtual Reality-Based Holistic Framework: A Tool for Participatory Development of Customised Playful Therapy Sessions for Motor Rehabilitation

The research in-progress presented in this paper proposes a holistic VR-based framework for participatory design of Serious Games for motor rehabilitation. The proposed framework is devised in layers that facilitate the mapping of game mechanics to playful therapeutic exercise games. The framework proposed can be disease agnostic and applies to a wider range of service users, regardless of their condition and motor functional capacity. The pilot study design for evaluating the proposed solution is also presented.

Measuring standing balance in multiple sclerosis: Further progress towards an automatic and reliable method in clinical practice

BACKGROUND Balance deficits in multiple sclerosis (MS) are often monitored by means of observer-rated tests. These may provide reliable data, but may also be time-consuming, subject to inter-rater variability, and potentially insensitive to mild fluctuations throughout the clinical course. On the other hand, laboratory assessments are often not available. The Nintendo Wii Balance Board (WBB) may represent a low-cost solution. The purpose of the current study was to examine the methodological quality of WBB data in MS (internal consistency, test-retest reliability), convergent validity with observer-rated tests (Berg Balance Scale, BBS; Timed-Up and Go Test, TUG), and discriminative validity concerning clinical status (Expanded Disability Status Scale, EDSS). METHODS Standing balance was assessed with the WBB for 4min in 63 MS patients at two assessment points, four months apart. Additionally, patients were examined with the BBS, TUG and the EDSS. RESULTS A period of 4min on the WBB provided data characterized by excellent internal consistency and test-retest reliability. Significant correlations between WBB data and results of the BBS and TUG were obtained after merely 2min on the board. An EDSS median-split revealed that higher EDSS values (>3) were associated with significantly increased postural sway on the WBB. CONCLUSIONS WBB measures reflecting postural sway are methodologically robust in MS, involving excellent internal consistency and test-retest reliability. They are also characterized by convergent validity with other considerably lengthier observer-rated balance measures (BBS) and sensitive to broader clinical characteristics (EDSS). The WBB may hence represent an effective, easy-to-use monitoring tool for MS patients in clinical practice.

Swarm intelligence for autonomous cooperative agents in battles for real-time strategy games

This paper investigates the use the swarm intelligence of honey bees to create groups of co-operative AI for an RTS game in order to create and re-enact battle simulations. The behaviour of the agents are based on the foraging and defensive behaviours of honey bees, adapted to a human environment. The groups consist of multiple model-based reflex agents, with individual blackboards for working memory, with a colony level blackboard to mimic the foraging patterns. An agent architecture and environment is proposed that allows for creation of autonomous cooperative agents. The behaviour of agents is then evaluated and their intelligence is tested using an adaptation of Anytime Universal Intelligence Test.

The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study

Abstract Purpose: To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors. Method: Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14–25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl–Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings. Results: Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p < 0.05 for all measures). Conclusions: Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability. Implications for rehabilitation To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation. Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment. Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

Integratingfall-risk assessments within a simple balance exergame

Computer-based exercise games (or “exergames”) are a common platform for balance interventions in older adults. Traditionaiy, interventions segregate assessments and training activities into different tasks. In this study, we investigate whether it is possible to embed clinically relevant assessments of balance within a bespoke Wii-Balance Board exergame designed to train older adult functional balance. Twenty-seven older adults participated in a single session of exer-gameplay. Results demonstrated that within-game scores correlated with relevant clinical measures of functional balance. These findings suggest that it is possible to objectively evaluate clinically relevant measures of functional balance during exer-gameplay.