Virtual Intelligent Techniques for Rehabilitation of Persons with Motor Disability (VIHBRA)
What is VIHBRA?
VIHBRA is a virtual intelligent platform for motor rehabilitation of persons with disabilities. It combines experience from virtual reality and knowledge from machine intelligence to enhance neural reorganization that optimize the physical rehabilitation outcomes in individuals with disability.
It provides stimulating sensory feedback to promote motor learning and encompasses tools that help to understand the biology of disability. The system integrates a Walnut Medical Intelligent smart camera sensor with depth measurement capabilities and Walnut Medical Balance Board to improve balance and neuromuscular functions, in collaboration with advanced algorithms running on a high end computing device.
Quantification of motor disability is done through presenting the individuals with situations/tasks that require use of groups of muscles and body parts like an augmented rehabilitation measure such as Virtual Function Reach Test (Patented).
Joint Range of Motions, Muscle Strength:
Range-of-motion training's are regularly repeated movements that straighten out or bend one or more joints of the body and move them in all the directions that a body joint typically moves. The key purpose of these trainings is to keep the body joints flexible. They can aid avert joint stiffness, contractures, and joint deformities.
Range-of-motion exercises are particularly significant for prevention of joint contractures. It is at the highest when body paralysis or muscle spasticity causes ‘muscle imbalance’- which means the muscles that pull a joint one way are far sturdier than those that must pull it the other way, so that the joint is constantly kept bent or kept straight.
To avert contractures or deformities, range-of-motion trainings often need to be sustained all through life. Thus it is central that a child learn to move the affected portions of his/her body through their full range of motion as portion of work, play, and all daily activities. If the range of motion stays good, and the child appears to be getting adequate motion through daily activities, then the trainings can be done less often.
For a child who is fully paralyzed, this may mean exercising all the joints of the body. For a child with one paralyzed limb, range-of motion trainings usually only required to be done with that limb (including the hip or shoulder). VIHBRA contains exercise environments for shoulder flexion, shoulder abduction, elbow flexion, hip flexion, hip abduction, knee flexion, ankle plantar flexion range of motion exercises (Figure 1.5).
Visual and audio clues are provided to the child on the target ranges (Figure 1.6).
Also daily quantification is possible through the same environment with the provision of tracking their progress at any time (Figure 1.7).
VIHBRA has a special environment for children walking on toes only. Heel toe shifting is a great exercise for the ankle and calf muscles. During this activity the centre of gravity will shift within the limits of stability and can work as an assessment tool. It will strengthen all muscles of the lower leg, as well as help improve proprioception or balance
Child is trying to maintain the balance by putting pressure under left/right toe and heel.
Postural Control and Balance:
Cerebral palsy mainly affects a child's ability to move and the foremost reason contributing to this deficit is poor balance and postural control. Impaired postural control limits a child’s ability to recuperate from unforeseen threats to body stability, referred to as sensitive balance control. Impaired postural control in children with CP has been revealed to result from several factors: musculoskeletal complications, including muscle contractures, diminished range of motion, and changes in initial position, all disturb the sensitive balance mechanism in children with CP. Additional movement components comprise the disturbance of the spatio-temporal characteristics of postural muscle reactions during the recovery of stability subsequent an unforeseen external agitation. The start of postural muscle movement in children with CP is late when matched with typically developing children. In addition, the sequencing of several muscle activity is reduced and there is a high level of coactivation of agonist and antagonist muscles at joints in the body. Difficulty in establishing redundant sensory signals for balance control is another source of instability in children with CP.
Virtual Romberg Test
Lastly, researchers have exposed a diminished ability in children with CP to adjust the sensory and motor constituents of balance control to varying task and environmental loads. These balance control impairments disturb the skill of children with CP to respond to extortions to balance efficiently and effectively. Thus it is important to have a simple and efficient to assess static and dynamic balance as like a VIHBRA-Virtual Romberg Test
Standing balance is the conservation of upright position during whole body movement over an altering base of support. This contains mostly of keeping the body’s center of mass within the base of support. Children with cerebral palsy do not have the bonus of usual growth and must contend with learning balance via the control of joints which have developed muscle contractures, deformities and others; all of which lead to the use of inimitable movement function adaptations in order to uphold dynamic stability. Within this domain, all activities developed were controlled with a Walnut Medical Balance Board (WMBB) linked to a computer via Bluetooth and Walnut Medical smart camera. The therapeutic benefits of those activities were already established and we elevated the benefits using our system.
Improving postural control, and in specific sitting ability, is an significant feature of a child’s rehabilitation which can result in better well-being, functional ability and physical independence and a fall in the risk of contractures, deformity and foot ulcers. One method of trying to increase sitting ability is through the use of training exercises. It has been accepted that nonconcrete training tasks alone cannot give a whole image of the child’s ability and that treatments need to be based on a meaningful tasks to have the finest outcomes.
Very little has been researched on the efficiency of such therapies for improving balance control in children with cerebral palsy during sitting. Children were provided with the Wii Balance Board that detects movement of the center of pressure. Once connected to a computer the balance board could be used to control movement on the computer. The platform was used with various games such as Accelerate (Figure 1.12) and Numbers (Figure 1.13) to perform a number of activities. The children needed to change their center of pressure through trunk travels while sitting on the balance board.
Reach the Number: Person has been told to reach the particular number from 0 to 24 while standing in postural board.
VIHBRA Accelerate is the postural balance exercise game. User need to reach any particular level by putting pressure under left/right toes and heels.
Virtual Functional Reach Test and Modified Functional Reach Test:
Postural control, or balance can be defined as the ability to control the body’s position in space for the purposes of stability and orientation. Balance is important to meet the daily requirements of life and an assessment of balance is necessary for defining treatment objectives. Functional Reach Test (Figure 1.14) and Modified Functional Reach Test is a dynamic measure of balance of a person commonly performed in a clinical setting
Functional Reach Test
A method and apparatus was developed for measuring the functional reach in a functional reach test and modified functional reach test was created. Significantly, the invention can control the compensatory postural adjustment or movement strategies used by the test subjects that potentially can bias the functional reach score. The invention can provide quantified measures of functional reach appropriate for comparison with the nominal scores of the medical population in which the subject belongs to and to track the balance improvement of any individual in a clinical setting. Favorably, the invention is simple and affordable and can help different medical population for an objective measure of balance in their treatment protocol
Functional Reach Test has been developed for calculating the posture limits of user/person by completing all three stages as A, B, C.
Additional software modules for exercising and rehabilitaiton
VIHBRA Paint is the exercise where person is trying to paint the three boards as shown below for both left and right hand by keeping the distance of 2.5m from camera.
VIHBRA Stretch is the exercise for SCI patients for their spine therapy. It includes stretch exercise for neck, body and for left/right shoulder.
VIHBRA Criss Cross and Hurdles
Developed in collaboration with