A virtual-reality rehabilitation tool for stroke victims
© Fondation Hopale
The MINT research team at the Inria Lille Nord – Europe research centre has contributed to the development of a rehabilitation tool for stroke patients. Accepted by the ANR (French National Research Agency) as part of the TecSan call for projects in 2007, the REACTIVE project is being led by the Fondation HOPALE and is the fruit of a partnership between the LIFL (Lille Computer Science Laboratory), the CEA (French Atomic Energy Commission), the ANR, Idées-3com and Inria.
Strokes are the number one cause of loss of self-sufficiency in France, with 100,000 to 145,000 French men and women affected each year. Older people remain the worst affected, and survivors suffer from motor disorders, often compounded by cognitive difficulties.
The REACTIVE project has led to the development of a tool which applies virtual reality technologies to rehabilitation. The main idea is to combine motor work and cognitive work in a role-play situation that is as environmentally friendly as possible. The project draws on the experience of the company Idées-3Com, a partner in the project, which usually conceives and develops 3D applications designed to increase sales and boost interest in e-commerce sites.
The Idées-3com platform
The hardware architecture is based on a patient PC and a therapist PC, networked together, a video projector and a big screen. The patient is positioned in front of the big screen and interacts with the virtual environments using standard video game controllers or specially-designed peripherals.
An interface that can be adapted to each patient
Strokes can have different effects on different patients. The therapist can therefore adapt the situations to suit the patient’s motor and cognitive capabilities before beginning the exercise. Increasing the difficulty or length of the exercise, projecting distractions to test the subject’s attention, and customising part of a scenario are all an integral part of the rehabilitation process. During a session, the therapist may notice that the exercise is not suited to the patient and adjust it accordingly.
The system consists of two computers. The first will be dedicated to the patient. It executes the exercise and manages the various peripherals. The second, networked to the first, allows the therapist to modify the exercise during a session.
Once the graphic environment was created, a development engineer specialising in virtual world management added all the logic required for the scenarios:
- Identifying the sequences of actions that should result from the patient’s interactions.
- Adding the necessary information messages (text, voice, graphics, sounds or tactile messages) for the patient.
- Implementing the different behaviours of the objects in the virtual world, so that they react realistically to the patient’s actions.
- Integrating the different options and scenario customisation so as to enable the therapist to administer and customise the scenario.
Four possible scenarios
In virtual reality terminology, a scenario is the virtual environment in which the subject operates and can take action. As this project is geared towards creating a rehabilitation tool, the scenarios have primarily been designed with clinical objectives in mind. While patients adapt relatively well to their home when they leave hospital, internal surveys by the Fondation Hopale show that very few people dare to go out alone. This is high-risk behaviour, which isolates the individual concerned and increases their dependence on others. It appears that therapists in hospitals work with patients on home situations (kitchen, bathroom, bedroom, etc.), but that ventures into the outside world are harder to practice (due to availability of care staff, logistics, weather conditions, patient safety, etc.). Virtual reality offers the possibility of working in a safe and environmentally friendly environment outside of the home, and of practising interactions that are crucial to a patient’s rehabilitation.
Interview with Stéphane Bouilland, head of research and development projects at the Fondation Hopale
What advantages does this method have over conventional rehabilitation?
S. Bouilland : Virtual reality offers a number of advantages over current practices: the exercises are engaging and likely to motivate the patient, behaviour is measured objectively, different difficulty levels are available, stimuli can be controlled and measured, treatment can be tailored to each individual but the protocols are standardised, virtual reality facilitates the patient’s mental visualisation of movements and enables active learning in a safe environment... Nevertheless, virtual-reality rehabilitation does not replace traditional rehabilitation methods, but rather complements them.
Have you been able to measure the added value provided by the tool?
S. Bouilland : Two studies are underway. The first will allow us to assess the way in which hemiplegic patients understand right and left. This is a clinical study which aims to measure the importance of the disability. The second aims to review the progress made by patients who have used the system.