A PC-based orthopedic rehabilitation system was developed for use at home, while allowing remote monitoring from the clinic. The home rehabilitation station has a Pentium II PC with graphics accelerator, a Polhemus tracker, and a multipurpose haptic control interface. This novel interface is used to sample a patient's hand positions and to provide resistive forces using the Rutgers Master II (RMII) glove. A library of virtual rehabilitation routines was developed using WorldToolKit software. At the present time, it consists of three physical therapy exercises (DigiKey, ball, and power putty) and two functional rehabilitation exercises (peg board and ball game). These virtual reality exercises allow automatic and transparent patient data collection into an Oracle database. A remote Pentium II PC is connected with the home-based PC over the Internet and an additional video conferencing connection. The remote computer is running an Oracle server to maintain the patient database, monitor progress, and change the exercise level of difficulty. This allows for patient progress monitoring and repeat evaluations over time. The telerehabilitation system is in clinical trails at Stanford Medical School (CA), with progress being monitored from Rutgers University (NJ). Other haptic interfaces currently under development include devices for elbow and knee rehabilitation connected to the same system.

Abstract-Rehabilitation interventions in remote areas are problematic because of distance and available resources. Orthopedic impairments acquired by individuals in remote areas can then lead to permanent disabilities/loss of function because of lack of appropriate rehabilitation. A system being developed by Rutgers and Stanford Universities provides therapy at the patient's home, with remote monitoring and periodic re-assessment. This telerehabilitation system uses virtual reality and haptic interfaces, and a pair of networked PCs. It is intended for rehabilitation of patients with hand, elbow, knee and ankle impairements. Data from the first patient treated with the telerehabilitation system is encouraging.

Prostate malignancies are the second leading cause of cancer deaths among men. The most common method of detecting this disease is digital rectal examination (DRE). Current DRE training is inadequate, since the number of patients that students can practice on is limited. Furthermore, allied care personnel do not train in screening for prostate cancer. Finally, there is no objective way to follow the improvement in DRE skills for medical personnel. This paper presents a virtual reality-based simulator that addresses the above problems. The prototype consists of a PHANToM haptic interface which provides feedback to the trainee's index finger, a motion restricting board, and an SGI workstation, which renders the patient's anatomy. Four types of prostates were modeled--normal, enlarged with no tumor, incipient malignancy (single tumor), and advanced malignancy (tumor cluster). Human factors studies were conducted on both nonmedical students and urology residents in order to quantify the system usefulness. After only five minutes of training, nonmedical students had a 67% correct diagnosis rate of malignant versus nonmalignant cases. This compared with 56% for urology residents in the same trials. Subjective evaluation by the residents pointed out the need to improve the virtual prostate model realism. A control group formed of urology residents performed the same trials on a modified Merck Procar simulator. The control group scored significantly better (96% correct diagnosis of malignancies). We conclude that the virtual prostate palpation simulator, while promising, needs significant improvement in both model realism and haptic interface hardware.