Shih-Ching Yeh

Intervention to enhance skilled arm and hand movements after stroke: A feasibility study using a new virtual reality system

BackgroundRehabilitation programs designed to develop skill in upper extremity (UE) function after stroke require progressive practice that engage and challenge the learner. Virtual realty (VR) provides a unique environment where the presentation of stimuli can be controlled systematically for optimal challenge by adapting task difficulty as performance improves. We describe four VR tasks that were developed and tested to improve arm and hand movement skills for individuals with hemiparesis.MethodsTwo participants with chronic post-stroke paresis and different levels of motor severity attended 12 training sessions lasting 1 to 2 hours each over a 3-week period. Behavior measures and questionnaires were administered pre-, mid-, and post-training.ResultsBoth participants improved VR task performance across sessions. The less impaired participant averaged more time on task, practiced a greater number of blocks per session, and progressed at a faster rate over sessions than the more impaired participant. Impairment level did not change but both participants improved functional ability after training. The less impaired participant increased the number of blocks moved on the Box & Blocks test while the more impaired participant achieved 4 more items on the Functional Test of the Hemiparetic UE.ConclusionTwo participants with differing motor severity were able to engage in VR based practice and improve performance over 12 training sessions. We were able to successfully provide individualized, progressive practice based on each participants level of movement ability and rate of performance improvement.

An integrated system: virtual reality, haptics and modern sensing technique (VHS) for post-stroke rehabilitation

In this paper, we introduce an interdisciplinary project, involving researchers from the fields of Physical Therapy, Computer Science, Psychology, Communication and Cell Neurobiology, to develop an integrated virtual reality, haptics and modern sensing technique system for post-stroke rehabilitation. The methodology to develop the system includes identification of movement pattern, development of simulated task and diagnostics. Each part of the methodology can be achieved through several sub-steps that are described in detail in this paper. The system is designed from Physical Therapy perspective that can address the motor rehabilitation needs of stroke patients. The system is implemented through stereoscopic displays, force feedback devices and modern sensing techniques that have game-like features and can capture accurate data for further analysis. Diagnostics and evaluation can be made through an Artificial Intelligence based model using collected data and clinical tests have been conducted.

Evaluation of a haptics-based virtual reality temporal bone simulator for anatomy and surgery training

INTRODUCTION Virtual reality simulation training may improve knowledge of anatomy and surgical skills. We evaluated a 3-dimensional, haptic, virtual reality temporal bone simulator for dissection training. METHODS The subjects were 7 otolaryngology residents (3 training sessions each) and 7 medical students (1 training session each). The virtual reality temporal bone simulation station included a computer with software that was linked to a force-feedback hand stylus, and the system recorded performance and collisions with vital anatomic structures. Subjects performed virtual reality dissections and completed questionnaires after the training sessions. RESULTS Residents and students had favorable responses to most questions of the technology acceptance model (TAM) questionnaire. The average TAM scores were above neutral for residents and medical students in all domains, and the average TAM score for residents was significantly higher for the usefulness domain and lower for the playful domain than students. The average satisfaction questionnaire for residents showed that residents had greater overall satisfaction with cadaver temporal bone dissection training than training with the virtual reality simulator or plastic temporal bone. For medical students, the average comprehension score was significantly increased from before to after training for all anatomic structures. Medical students had significantly more collisions with the dura than residents. The residents had similar mean performance scores after the first and third training sessions for all dissection procedures. DISCUSSION The virtual reality temporal bone simulator provided satisfactory training for otolaryngology residents and medical students.

Inhibitory repetitive transcranial magnetic stimulation of the contralesional premotor and primary motor cortices facilitate poststroke motor recovery.

PURPOSE The premotor cortex plays a major role in motor planning and control, exhibiting hierarchical importance comparable to that of the primary motor cortex (M1). In this study, we compared the effects of cPMd modulation, which was achieved using inhibitory repetitive transcranial magnetic stimulation (rTMS), with those of contralesional M1 (cM1) modulation, to elucidate the roles of both regions on longitudinal motor recovery following a stroke. METHODS Forty-four patients who had sustained hemiplegia for 3 to 12 months were randomly allocated to a cPMd group, cM1 group, or sham group and received 10 sessions of 1-Hz rTMS. The Medical Research Council (MRC) Scale, Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and a cortical excitability test were administered pre- and post- rTMS intervention. RESULTS cPMd modulation yielded significant improvements in MRC, FMA, and WMFT scores compared with sham stimulation and a significant effect on cortical excitability suppression equivalent to that of cM1 modulation, but engendered effects on motor improvement inferior to those of cM1 modulation. CONCLUSIONS In patients with chronic stroke, the cPMd can fulfill a role similar to that of the cM1 in interhemispheric imbalance, which can be ameliorated by applying inhibitory rTMS to achieve substantial motor restoration.

Intelligent Frozen Shoulder Rehabilitation

Frozen shoulder, or adhesive capsulitis, which reportedly affects 2â5 percent of the general population, is a shoulder condition characterized by painful and limited active and passive range of motion. The main treatment involves applying proper shoulder exercises and joint mobilization to break up adhesions at the joint capsules and improve joint mobility and functions. However, due to a lack of persistence, not all patients complete rehabilitation. To address this concern, this study focused on providing interactive treatments to encourage patients to participate in regular rehabilitation. Patients can inquire freely about their rehabilitation progress with real-time sensing and game-based feedback. In addition, six progressive and hierarchical training tasks make each training step adjustable based on the patients physical condition. The authors used standard randomized clinical trial criterion to recruit 40 patients for a sequence of trials over a four-week period. The evaluation of the study group revealed that shoulder joint mobility and muscle strength of the patients significantly improved compared to that achieved by the traditional rehabilitation method.

A Virtual Iraq System for the Treatment of Combat-Related Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is reported to be caused by traumatic events that are outside the range of usual human experience including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that at least 1 out of 5 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. The current paper is a follow-up to a paper presented at IEEE VR2006 and will present the rationale and description of a VR PTSD therapy application (Virtual Iraq) and present the findings from its use with active duty service members since the VR2006 presentation. Virtual Iraq consists of a series of customizable virtual scenarios designed to represent relevant Middle Eastern VR contexts for exposure therapy, including a city and desert road convoy environment. User-centered design feedback needed to iteratively evolve the system was gathered from returning Iraq War veterans in the USA and from a system deployed in Iraq and tested by an Army Combat Stress Control Team. Results from an open clinical trial using Virtual Iraq at the Naval Medical Center-San Diego with 20 treatment completers indicate that 16 no longer met PTSD diagnostic criteria at post-treatment, with only one not maintaining treatment gains at 3 month follow-up.

A virtual reality system integrated with robot-assisted haptics to simulate pinch-grip task: motor ingredients for the assessment in chronic stroke

BACKGROUND Among numerous studies on virtual reality (VR) technology for motor rehabilitation, the majorities have only used it as a motor training system and did not use the kinematic or kinetic information obtained as the basis for therapeutic effect assessment. OBJECTIVE Incorporating the kinematic and kinetic information acquired through a robot-assisted VR system on pinch-grip training, this study intends to propose novel motor ingredients represented as indices for the interpretation of motor behaviors and verify the efficacy of them for the assessment in chronic stroke. METHODS Clinical trials were conducted on eight stroke patients and clinical assessments were made as the objective standard. Non-parametric test and correlation analysis were performed on results of motor indices and clinical assessments. RESULTS Non-parametric test indicated that 50% of the motor indices significantly improved while the others showed a trend of improvement, consisting with the findings in clinical assessments. Correlation analysis showed that the three clinical assessment items were correlated to items in the motor ingredients. CONCLUSIONS The proposed motor ingredients gathered from the robot-assisted VR training system were able to contribute to the assessment of therapeutic effect in chronic stroke and were capable for the interpretation of behavior phases.

The Development of Interactive Shoulder Joint Rehabilitation System Using Virtual Reality in Association with Motion-Sensing Technology

Virtual Reality combined with medical rehabilitation has become the modern trend. In the clinical therapy, frozen shoulder is a common shoulder disease. They usually use proper rehabilitation exercise to pole adhesive joint capsule. In these long time process, patients usually can’t continue. Our research is using virtual reality to combine with motion tracking in order to develop interactive shoulder joint rehabilitation system. We decide to use interactive game-based oriented way and to give real-time visual and auditory feedback to improve user’s motivation and willingness of doing rehabilitation. In this way, patients can achieve better result of rehabilitation compared with traditional therapy.

Motion controllers for learners to manipulate and interact with 3D objects for mental rotation training

Mental rotation is an important spatial processing ability and an important element in intelligence tests. However, the majority of past attempts at training mental rotation have used paper-and-pencil tests or digital images. This study proposes an innovative mental rotation training approach using magnetic motion controllers to allow learners to manipulate and interact with three-dimensional ( 3D) objects. Stereovision allows learners to perceive the spatial geometric form of a 3D object. This approach allows learners to perceive 3D objects in space through stereovision and make mental rotation visible from each intrinsic and invisible mental rotation step using motion-interaction methods. This study examines the effects of user training performance and perceptions. The results indicate that the proposed approach can improve user mental rotation ability effectively. Learners expressed high degrees of concentration toward the mechanism that included direct control and immediate feedback. The results also suggest that female testers perceive greater degrees of playfulness toward the mechanism and improve more through training than male testers. [ABSTRACT FROM AUTHOR]

Evaluation approach for post-stroke rehabilitation via virtual reality aided motor training

This paper introduces an evaluation approach that was applied to clinical data collected from a virtual reality aided motor training program for post-stroke rehabilitation. The goal of the proposed evaluation approach is to diagnose the patients current status (performance) and detect change in status over time (progression). Three measures, performance time, movement efficiency, and movement speed, were defined to represent kinematic features of reaching. 3-D performance maps and progression maps were generated based on each kinematic measure to visualize a single patients behavior. The case study revealed the patients current status as to direction and range of upper extremity reach ability, composed of pitch, yaw and arm length. Further, progression was found and visualized quantitatively over a series of practice sessions. Keywords: Virtual reality, rehabilitation, evaluation approach, human computer interaction.