Jonathan Duckworth

Upper limb virtual rehabilitation for traumatic brain injury: Initial evaluation of the elements system

Primary objective: To evaluate the effectiveness of a tabletop virtual-reality (VR) based upper-limb rehabilitation system (called Elements) for promoting movement skill in patients with TBI. Research design: An ABA case study design with multiple baselines was employed. Baseline performance in this design is contrasted against the results during the treatment phase. Research methods: Three patients with TBI participated in 12 1-hour sessions of VR-based training. The VR system consisted of a 42-inch tabletop LCD, camera tracking system and tangible user interface. The system requires participants to move an object to cued locations while receiving augmented movement feedback to reinforce speed, trajectory and placement. Upper limb performance was assessed using these three system-measured variables and standardized tests. Trends in the time-sequence plots for each patient were assessed by sight inspection of smoothed data and then by statistical analyses. Results: Participants demonstrated improvements on movement accuracy, efficiency and bimanual dexterity and mixed improvement on speed and other measures of movement skill. Conclusion: Taken together, the findings demonstrate that the Elements system shows promise in facilitating motor learning in these TBI patients. Larger scale trials are now deemed a viable step in further validating the system.

A virtual tabletop workspace for the assessment of upper limb function in Traumatic Brain Injury (TBI)

Traditional methods of movement assessment in clinical rehab are often labor intensive and provide a limited number of outcome variables for tracking recovery. Entry level virtual reality (VR) systems afford new possibilities for systematic assessment and treatment. This paper describes the development of a virtual tabletop environment for the assessment of upper limb function in Traumatic Brain Injury (TBI). The system is designed to present realistic virtual workspaces and to measure performance at both a functional and kinematic level. In addition, we incorporate the use of Tangible User Interfaces (TUIs) as a means of integrating performance with the workspace. Unlike top-end movement analysis systems, the experimental system utilizes readily available computing technologies: mid-range PC, LCD panels, stereo camera, Virtools software, and TUI enabled by Wii Remote, Wii Sensor Bar (Nintendo¿) and passive markers. The combination of vision-based marker tracking with a low cost game controller (viz Wii system) provides a stable and accurate means of tracking the TUI on the virtual workspace, and for interactivity within this space. The system provides a compelling sense of realism for the performer and an innovative means of assessing movement capabilities over time.

Ambient Protection of Few-Layer Black Phosphorus via Sequestration of Reactive Oxygen Species.

Few-layer black phosphorous (BP) has emerged as a promising candidate for next-generation nanophotonic and nanoelectronic devices. However, rapid ambient degradation of mechanically exfoliated BP poses challenges in its practical deployment in scalable devices. To date, the strategies employed to protect BP have relied upon preventing its exposure to atmospheric conditions. Here, an approach that allows this sensitive material to remain stable without requiring its isolation from the ambient environment is reported. The method draws inspiration from the unique ability of biological systems to avoid photo-oxidative damage caused by reactive oxygen species. Since BP undergoes similar photo-oxidative degradation, imidazolium-based ionic liquids are employed as quenchers of these damaging species on the BP surface. This chemical sequestration strategy allows BP to remain stable for over 13 weeks, while retaining its key electronic characteristics. This study opens opportunities to practically implement BP and other environmentally sensitive 2D materials for electronic applications.

Upper-limb virtual rehabilitation for traumatic brain injury: A preliminary within-group evaluation of the elements system

Aim: The aim of this study was to assess the efficacy of the Elements virtual reality (VR) system for rehabilitation of upper-limb function in patients with traumatic brain injury (TBI). Methods: Using a within-group design, patients were tested three times, each 4 weeks apart: Pre-intervention 1 and 2 and Post-intervention. During intervention, participants received 12 1-hour training sessions over 4 weeks in addition to their usual care. Five males and four females aged 18–48 years with severe TBI were recruited. The Elements system consisted of a 100-cm tabletop LCD, camera tracking system, tangible user interfaces (i.e. graspable objects of basic shape) and software. The system provided two modes of interaction with augmented feedback: goal-directed and exploratory. Upper-limb performance was assessed using system-rated measures (movement speed, accuracy and efficiency) and standardized tests. Results: Planned comparisons revealed little change in performance over the pre-test period apart from an increase in movement speed. There were significant training effects, with large effect sizes on all measures except the nuts-and-bolts task. Conclusions: These preliminary findings support the results of an early case study of the Elements system, further demonstrating that VR training is a viable adjunct to conventional physical therapy in facilitating motor learning in patients with TBI.

A virtual tabletop workspace for upper-limb rehabilitation in Traumatic Brain Injury (TBI): A multiple case study evaluation

Deficits in upper limb function are common among patients with traumatic brain injury (TBI). Accordingly, new technologies, such as virtual reality (VR), are being developed to further upper limb rehabilitation. The study described here successfully trialed a table-top VR-based system (called Elements). Two patients with TBI participated in case-studies using a multiple-baseline, AB time-sequence design; the intervention consisted of 12 1-hour sessions. Performance was measured on both system-rated measures and standardized tests of functional skill. Time-sequence plots for each patient were first sight inspected for trends; this was followed by split-middle trend analysis. Participants demonstrated significant improvements in their movement accuracy, efficiency, and bimanual dexterity; and mixed improvement on speed and other measures of movement skill. Taken together, these findings demonstrate that the Elements system facilitated motor learning in both TBI patients. Larger scale clinical trials are now deemed a viable step in further validating the system.

Life Tree: Understanding the Design of Breathing Exercise Games

Regular breathing exercises can be a beneficial part of leading a healthy life. Digital games may have the potential to help people practice breathing exercises in an engaging way, however designing breathing exercise games is not well understood. To contribute to such an understanding, we created Life Tree as the culmination of three prototypal breathing games. Life Tree is a virtual reality (VR) game in which a player controls the growth of a tree by practicing pursed-lip breathing. We selected VR head-mounted display technology because it allows players to focus and limit external distractions, which is beneficial for breathing exercises. 32 participants played Life Tree and analysis of the collected data identified four key themes: 1) Designing Breathing Feedback; 2) Increasing Self-Awareness of Breathing and Body; 3) Facilitating Focused Immersion; and, 4) Engagement with Breathing Hardware. We used these themes to articulate a set of breathing exercise game design strategies that future game designers may consider to develop engaging breathing exercise games.

Resonance: An Interactive Tabletop Artwork for Co-located Group Rehabilitation and Play

In this paper we describe the design and development of Resonance, an interactive tabletop artwork that targets upper-limb movement rehabilitation for patients with an acquired brain injury. The artwork consists of several interactive game environments, which enable artistic expression, exploration and play. Each environment aims to encourage collaborative, cooperative, and competitive modes of interaction for small groups (2-4) of co-located participants. We discuss how participants can perform movement tasks face-to-face with others using tangible user interfaces in creative and engaging activities. We pay particular attention to design elements that support multiple users and discuss preliminary user evaluation of the system. Our research indicates that group based rehabilitation using Resonance has the potential to stimulate a high level of interest and enjoyment in patients; facilitates social interaction, complements conventional therapy; and is intrinsically motivating.

Designing co-located tabletop interaction for rehabilitation of brain injury

This paper surveys emerging design research on co-located group interaction with tabletop displays as an approach toward developing an upper-limb movement rehabilitation system for acquired brain injury (ABI). Traditional approaches and newer virtual reality interventions for physical therapy tend to focus on individuals interacting one-on-one with a therapist in a clinical space --- this is both labor intensive and costly. Co-located tabletop environments have been shown to enhance the engagement of users, translating to skill acquisition. We describe the principles of group interaction that inform our understanding of motor rehabilitation using interactive media; explore four constructs from interactive tabletop research that may influence the design of co-located systems for rehabilitation: 1) physical space, 2) group awareness, 3) territoriality, and 4) interaction simultaneity; and consider how each construct can be expressed in particular design solutions for rehabilitation of ABI.

Tabletop Computer Game Mechanics for Group Rehabilitation of Individuals with Brain Injury

In this paper we provide a rationale for using tabletop displays for the upper-limb movement rehabilitation of individuals with brain injury. We consider how computer game mechanics may leverage this technology to increase patient engagement and social interaction, and subsequently enhance prescribed training. In recent years there has been a growing interest among health professionals in the use of computer games and interactive technology for rehabilitation. Research indicates that games have the potential to stimulate a high level of interest and enjoyment in patients; enhance learning; provide safe task conditions; complement conventional therapy; and become intrinsically motivating. We explore how game mechanics that include reward structures, game challenges and augmented audiovisual feedback may enhance a goal-orientated rehabilitation learning space for individuals with brain injury. We pay particular attention to game design elements that support multiple players and show how these might be designed for interactive tabletop display systems in group rehabilitation.

Re-sensitising the body: interactive art and the Feldenkrais method

This article describes interdisciplinary research undertaken by a group of artists, designers, curators and somatic bodywork practitioners to explore a human-centred approach to the potential of touch, movement, balance and proprioception as modalities for interactive art. Somatic bodywork methodologies such as the Feldenkrais method provide highly developed frameworks for attending to these very phenomena. Re-sensitising the body through somatic investigations allowed us as makers of body-focussed interactive art to translate the subtle shifts in attention and nuances of felt sensation into the audience experience of sensor-based interactive artworks. We describe the results of a yearlong project through our experience of the making of one specific experimental artwork, surging verticality. We reflect on the conditions for audience engagement and the profound connections we experienced between Feldenkrais somatic bodywork and art practice as modes of enquiry into the world.