Renato Mainetti

Duckneglect: Video-games based neglect rehabilitation

BACKGROUND Video-games are becoming a common tool to guide patients through rehabilitation because of their power of motivating and engaging their users. Video-games may also be integrated into an infrastructure that allows patients, discharged from the hospital, to continue intensive rehabilitation at home under remote monitoring by the hospital itself, as suggested by the recently funded Rewire project. OBJECTIVE Goal of this work is to describe a novel low cost platform, based on video-games, targeted to neglect rehabilitation. METHODS The patient is guided to explore his neglected hemispace by a set of specifically designed games that ask him to reach targets, with an increasing level of difficulties. Visual and auditory cues helped the patient in the task and are progressively removed. A controlled randomization of scenarios, targets and distractors, a balanced reward system and music played in the background, all contribute to make rehabilitation more attractive, thus enabling intensive prolonged treatment. RESULTS Results from our first patient, who underwent rehabilitation for half an hour, for five days a week for one month, showed on one side a very positive attitude of the patient towards the platform for the whole period, on the other side a significant improvement was obtained. Importantly, this amelioration was confirmed at a follow up evaluation five months after the last rehabilitation session and generalized to everyday life activities. CONCLUSIONS Such a system could well be integrated into a home based rehabilitation system.

An integrated low-cost system for at-home rehabilitation

We show here how integrating novel natural user interfaces, like Microsoft Kinect, with a fully adappatients current statustive game engine, a system that can be used for rehabilitation at home can be built. A wide variety of game scenarios, a balanced scoring system, quantitative and qualitative exercise evaluation, automatic gameplay level adaptation to patients current status, and audiovisual feed-back are all implemented inside the Intelligent Game Engine for Rehabilitation here introduced, and are aimed at maximizing patients motivation and rehabilitation effectiveness. The system is integrated into a multi-level platform that provides continuous monitoring by the hospital and it has been developed inside the framework of the EU funded Rewire project.

Exergaming and rehabilitation: A methodology for the design of effective and safe therapeutic exergames☆

Abstract We present here a comprehensive definition of therapeutic exergames from which a methodology to create safe exergames for real therapy pathways is derived. Three main steps are identified. (I) A clear identification of all the exercise requirements, not only in terms of goals of the therapy, but also in terms of additional constraints. Characteristic parameters for determining the challenge level and to assess progression are also defined in this phase. (II) The exercise is transformed into a Virtual Exercise, in which all the exercise elements are implemented inside a simple virtual environment. In this step the discussion between clinical and ICT teams allows maximizing the effectiveness of exergames implementation. (III) The final exergame is realized by introducing on top of the exercise all the game elements suggested by good game design to maximize entertainment. A clear line between exercises and games is drawn here. We illustrate the methodology with exergames designed for (1) balance and posture and (2) neglect rehabilitation, implemented and tested with post-stroke patients training autonomously at home. The methodology can have a broader impact as it can be applied also in other gaming fields in which the requirements go beyond entertainment.

An intelligent game engine for the at-home rehabilitation of stroke patients

The recent availability of advanced video game interfaces (such as the Microsoft Kinect, the Nintendo WiiMote and Balance Board) is creating interesting opportunities to provide low-cost rehabilitation at-home for patients. In this context, video games are rising as promising tools to guide patients through their recovery experience and to increase their motivation throughout the rehabilitation path. However, to be applied to clinical scenarios, video games must be designed to adhere to the clinical requirements and to meet doctors/patients expectations. They also need to be integrated within multi-level platforms that can allow different levels of monitoring, e.g., at a personal level by the therapist, at the hospital level by the doctors, and at the regional level by the government agencies. In this paper, we overview an intelligent game engine for the at-home rehabilitation of stroke patients The engine provides several games that implement actual rehabilitation exercises and have been developed in strict collaboration with therapists. It is integrated in a patient station that provides several types of monitoring and feedback using virtual and/or human therapists.

IGER: A Game Engine Specifically Tailored to Rehabilitation

Exergames for rehabilitation, both in the physical and cognitive fields, have been the target of much research in the last years. Such exergames, however, are often created for a specific impairment and cannot be generalized to other domains. More generally speaking, the lack of shared design and development guidelines for rehabilitation games can be highlighted. The Intelligent Game Engine for Rehabilitation (IGER) described here has been developed with the intent to provide a framework for building rehabilitation exergames that are functional, accessible and entertaining. Several features, mandatory for rehabilitation, have been incorporated: configuration, adaptation, monitoring, data logging and feedback through a virtual therapist. Besides describing how these features have been implemented in IGER, we describe here also a few games we created with it and their rationale.

Using Virtual Reality to Rehabilitate Neglect

Purpose: Virtual Reality (VR) platforms gained a lot of attention in the rehabilitation field due to their ability to engage patients and the opportunity they offer to use real world scenarios. As neglect is characterized by an impairment in exploring space that greatly affects daily living, VR could be a powerful tool compared to classical paper and pencil tasks and computer training. Nevertheless, available platforms are costly and obstructive. Here we describe a low cost platform for neglect rehabilitation, that using consumer equipments allows the patient to train at home in an intensive fashion. Method: We tested the platform on IB, a chronic neglect patient, who did not benefit from classical rehabilitation. Results: Our results show that IB improved both in terms of neglect and attention. Importantly, these ameliorations lasted at a follow up evaluation 5 months after the last treatment session and generalized to everyday life activities. Conclusions: VR platforms built using equipment technology and following theoretical principles on brain functioning may induce greater ameliorations in visuo-spatial deficits than classical paradigms possibly thanks to the real world scenarios in association with the “visual feedback” of the patient’s own body operating in the virtual environment.

Intelligent Game Engine for Rehabilitation (IGER)

Computer games are a promising tool to support intensive rehabilitation. However, at present, they do not incorporate the supervision provided by a real therapist and do not allow safe and effective use at a patients home. We show how specifically tailored computational intelligence based techniques allow extending exergames with functionalities that make rehabilitation at home effective and safe. The main function is in monitoring the correctness of motion, which is fundamental in avoiding developing wrong motion patterns, making rehabilitation more harmful than effective. Fuzzy systems enable us to capture the knowledge of the therapist and to provide real-time feedback of the patients motion quality with a novel informative color coding applied to the patients avatar. This feedback is complemented with a therapist avatar that, in extreme cases, explains the correct way to carry out the movements required by the exergames. The avatar also welcomes the patient and summarizes the therapy results to him/her. Text to speech and simple animation improve the engagement. Another important element is adaptation. Only the proper level of challenge exercises can be both effective and safe. For this reason exergames can be fully configured by therapists in terms of speed, range of motion, or accuracy. These parameters are then tuned during exercise to the patients performance through a Bayesian framework that also takes into account input from the therapist. A log of all the interaction data is stored for clinicians to assess and tune the therapy, and to advise patients. All this functionality has been added to a classical game engine that is extended to embody a virtual therapist aimed at supervising the motion, which is the final goal of the exergames for rehabilitation. This approach can be of broad interest in the serious games domain. Preliminary results with patients and therapists suggest that the approach can maintain a proper challenge level while keeping the patient motivated, safe, and supervised.

The design of a comprehensive game engine for rehabilitation

Physical and cognitive rehabilitation under the form of therapeutic videogames has been growing in popularity over the last years. Many rehabilitation games (or exergames) have been created with the intent to promote functional rehabilitation in a highly motivational environment. However, such exergames are often created as standalone products typically designed to target a specific exercise. Accordingly, they are usually difficult to integrate in a more structured therapy and also have very different and varied features. There is therefore a need in this area for a more holistic approach with game engines specifically designed for rehabilitation that would represent the next step in this field to guarantee efficacy, accessibility and motivational factors of exergames. In this paper, we present our Intelligent Game Engine for Rehabilitation (IGER) that tries to address these issues; we highlight the features it supports, we present some of the games we created with it, and the initial results we achieved so far.

Algorithms Based on Computational Intelligence for Autonomous Physical Rehabilitation at Home

Exergames provide efficient and motivating training mechanisms to support physical rehabilitation at home. Nonetheless, current exergame examples lack some important aspects which cannot be disregarded in rehabilitation. Exergames should: (i) modify the game difficulty adapting to patient’s gameplay performance, (ii) monitor if the exercise is correctly executed, and (iii) provide continuous motivation. In this study, we present a game engine which implements computer intelligence-based solutions to provide real-time adaptation, on-line monitoring and an engaging gameplay experience. The game engine applies real-time adaptation using the Quest Bayesian approach to modify the game difficulty according to the patient’s performance. Besides, it employs a fuzzy system to monitor the execution of the exercises according to the parameters set by the therapists and provides on-line feedback to guide the patient during the execution of the exercise. Finally, a motivating game experience is provided using rewards and adding random enrichments during the game.

IGER: An Intelligent Game Engine for Rehabilitation *

We present here a novel game engine, designed specifically to guide rehabilitation at home. Besides the classical functionalities: animation, rendering, collision detection and so forth, adaptation to the patient status and monitoring are embedded inside the engine. Moreover, a virtual therapist is also provided that can advice and support the patient throughout the rehabilitation sessions. Some game examples built on this engine are described.