Project Lead(s): Philippe Archambault
More than 100 million people worldwide currently live with physical disabilities resulting from conditions such as stroke and spinal cord injuries, with arm and hand dysfunction as a major consequence.
Many patients in developing countries have limited access to rehabilitation services, due to a lack of medical infrastructure and trained personnel.
Stroke contributes significantly to the incidence of disabilities of the upper limb and there is mounting evidence that functional recovery of arm paresis can occur well into the chronic stage of stroke.
An affordable Virtual Rehabilitation (VR) system for arm rehabilitation – a type of computer game to enhance training motivation – was developed by Jintronix Inc.
The system provides three unilateral and two bilateral activities, each with ten difficulty levels.
The system consists of a computer interfaced with a Kinect camera to track upper body movements (head and trunk, as well as shoulder, elbow and wrist, on both sides).
In different VR activities, participants reach for, transport and release objects, move their arm through a prescribed trajectory, or use both hands at the same time.
Such systems have been shown to increase patient motivation and can also improve access to necessary rehabilitation services by enabling patients to perform clinical exercises at home.
In this proof-of concept, the project team aimed to:
1. Develop a bilateral virtual reality activity for stroke upper extremity rehabilitation
2. Assess the usability of the system by stroke patients and clinicians
3. Create an initial flowchart, linking level of motor impairment in stroke patients with activities of the rehabilitation gaming system.
An activity for bilateral reaching movements named ‘Catch, Carry & Drop’ was developed. This activity promotes controlled and coordinated bilateral movements of the upper extremities, while limiting compensatory trunk movements.
The Catch, Carry & Drop activity was then integrated with the other upper-extremity activities of the Jintronix Rehabilitation System.
The system was evaluated with 15 clinicians and 36 stroke patients, with a mean age of 58 years, who completed the three sessions with the VR arm rehabilitation system.
This included 8 clinicians and 18 stroke patients in Manipal, India, as well as 7 clinicians and 18 stroke patients recruited in Montreal, Canada.
All participants in India and Montreal completed the sessions and, on average, spent 15.7 minutes per 20-minute session actively engaged in arm movement activities.
More than 80% of study subjects expressed positive feelings about the use of the arm rehabilitation VR system.
The evaluation also showed a statistically significant improved performance of unilateral and bilateral arm movement activities.
Through this grant and in collaboration with researchers at the University of Montreal, the team was able to secure additional funding of $100,000 from the Heart & Stroke Foundation of Canada.
The aim of this additional funding is to evaluate the effects of using the Jintronix system as a home-based treatment for arm motor recovery in stroke patients, as compared to a home exercise program.
Results of the project were presented at the International Conference on Virtual Rehabilitation in Philadelphia in 2013 and at the International Conference on Neurorehabilitatio in Aalborg, Denmark, in 2014, as well as being published in Biosystems & Biorobotics.