Virtual environments increase participation of children with cerebral palsy in robot-aided treadmill training

Koenig, Alexander; Brütsch, Karin; Zimmerli, Lukas; Guidali, Marco; Duschau-Wicke, Alexander; Wellner, Mathias; Meyer-Heim, Andreas; Lünenburger, Lars; Koeneke, Susan; Jäncke, Lutz; Riener, Robert

doi:10.1109/icvr.2008.4625147

Cited by 17 publications

(8 citation statements)

References 12 publications

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“…When the opponent was more than 1.68 m behind the avatar, the opponent was not visible on the VR screen. In our previous study [ 20 ], we were able to show increased mean biofeedback values for the time when the opponent was visible and decreased values for the time the opponent was not visible. Therefore, we assume that a constant competitive situation could serve as an additional motivational factor.…”

Section: Methodsmentioning

confidence: 76%

Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children

Brütsch

Schuler

Koenig

et al. 2010

J NeuroEngineering Rehabil

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124

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BackgroundVirtual reality (VR) offers powerful therapy options within a functional, purposeful and motivating context. Several studies have shown that patients' motivation plays a crucial role in determining therapy outcome. However, few studies have demonstrated the potential of VR in pediatric rehabilitation. Therefore, we developed a VR-based soccer scenario, which provided interactive elements to engage patients during robotic assisted treadmill training (RAGT). The aim of this study was to compare the immediate effect of different supportive conditions (VR versus non-VR conditions) on motor output in patients and healthy control children during training with the driven gait orthosis Lokomat®.MethodsA total of 18 children (ten patients with different neurological gait disorders, eight healthy controls) took part in this study. They were instructed to walk on the Lokomat in four different, randomly-presented conditions: (1) walk normally without supporting assistance, (2) with therapists' instructions to promote active participation, (3) with VR as a motivating tool to walk actively and (4) with the VR tool combined with therapists' instructions. The Lokomat gait orthosis is equipped with sensors at hip and knee joint to measure man-machine interaction forces. Additionally, subjects' acceptance of the RAGT with VR was assessed using a questionnaire.ResultsThe mixed ANOVA revealed significant main effects for the factor CONDITIONS (p < 0.001) and a significant interaction CONDITIONS × GROUP (p = 0.01). Tests of between-subjects effects showed no significant main effect for the GROUP (p = 0.592). Active participation in patients and control children increased significantly when supported and motivated either by therapists' instructions or by a VR scenario compared with the baseline measurement "normal walking" (p < 0.001).ConclusionsThe VR scenario used here induces an immediate effect on motor output to a similar degree as the effect resulting from verbal instructions by the therapists. Further research needs to focus on the implementation of interactive design elements, which keep motivation high across and beyond RAGT sessions, especially in pediatric rehabilitation.

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Section: Methodsmentioning

confidence: 76%

Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children

Brütsch

Schuler

Koenig

et al. 2010

J NeuroEngineering Rehabil

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124

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“…Physical rehabilitation is an essential treatment for survivors, but many users never complete their rehabilitation process. For a successful rehabilitation, it is important to maintain the user’s motivation [ 4 , 5 , 6 , 7 ]. Some experts suggest that outcomes can be more favorable when users emulate desirable exercises.…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims

Pérez

Yepes

Vargas

et al. 2022

Sensors

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Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims.

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“…Biofeedback values recorded during the training sessions could not be compared directly, as we needed to re-adjust the Lokomat parameter settings between recordings, leading to biofeedback values of different magnitude for the same level of activity [12].…”

Section: A Speed Adaptation Algorithmmentioning

confidence: 99%

“…These control strategies recognize the movement intention of the patient and adapt the robotic assistance according to the patient's force contribution to the walking process [11]. Furthermore, virtual environments are used as they have proven to make repetitive rehabilitation exercises more motivating [12].…”

Section: Introductionmentioning

confidence: 99%

Voluntary gait speed adaptation for robot-assisted treadmill training

Koenig

Binder

Zitzewitz

et al. 2009

2009 IEEE International Conference on Rehabilitation Robotics

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Abstract-Robot-assisted gait training currently lacks the possibility of the robot to automatically adapt to the patient's needs and demands (so called "bio-cooperative control strategies"). It is desired to give the patient voluntary control over training parameters such as gait speed or joint trajectories. We implemented a control algorithm for the driven gait orthosis Lokomat that allows severely disabled stroke patients a limited and safe allowance of influence on their gait speed. To exercise gait symmetry, our algorithm can be configured such that only activity in the paretic leg will cause changes in treadmill speed. The algorithm was successfully tested with eight healthy subjects and six stroke patients.

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Virtual environments increase participation of children with cerebral palsy in robot-aided treadmill training

Cited by 17 publications

References 12 publications

Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children

Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims

Voluntary gait speed adaptation for robot-assisted treadmill training

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