Showing papers by "Albert Rizzo published in 2011"

Development and evaluation of low cost game-based balance rehabilitation tool using the microsoft kinect sensor

Abstract: The use of the commercial video games as rehabilitation tools, such as the Nintendo WiiFit, has recently gained much interest in the physical therapy arena. Motion tracking controllers such as the Nintendo Wiimote are not sensitive enough to accurately measure performance in all components of balance. Additionally, users can figure out how to "cheat" inaccurate trackers by performing minimal movement (e.g. wrist twisting a Wiimote instead of a full arm swing). Physical rehabilitation requires accurate and appropriate tracking and feedback of performance. To this end, we are developing applications that leverage recent advances in commercial video game technology to provide full-body control of animated virtual characters. A key component of our approach is the use of newly available low cost depth sensing camera technology that provides markerless full-body tracking on a conventional PC. The aim of this research was to develop and assess an interactive game-based rehabilitation tool for balance training of adults with neurological injury.

FAAST: The Flexible Action and Articulated Skeleton Toolkit

Abstract: The Flexible Action and Articulated Skeleton Toolkit (FAAST) is middleware to facilitate integration of full-body control with virtual reality applications and video games using OpenNI-compliant depth sensors (currently the PrimeSensor and the Microsoft Kinect). FAAST incorporates a VRPN server for streaming the user's skeleton joints over a network, which provides a convenient interface for custom virtual reality applications and games. This body pose information can be used for goals such as realistically puppeting a virtual avatar or controlling an on-screen mouse cursor. Additionally, the toolkit also provides a configurable input emulator that detects human actions and binds them to virtual mouse and keyboard commands, which are sent to the actively selected window. Thus, FAAST can enable natural interaction for existing off-the-shelf video games that were not explicitly developed to support input from motion sensors. The actions and input bindings are configurable at run-time, allowing the user to customize the controls and sensitivity to adjust for individual body types and preferences. In the future, we plan to substantially expand FAAST's action lexicon, provide support for recording and training custom gestures, and incorporate real-time head tracking using computer vision techniques.

Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic

Abstract: Exposure therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD), but research evaluating its effectiveness with active duty service members is limited This report examines the effectiveness of virtual reality exposure therapy (VRE) for active duty soldiers (N = 24) seeking treatment following a deployment to Iraq or Afghanistan Relative to their pretreatment self-reported symptoms on the PTSD Checklist, Military Version (M = 6092; SD = 1103), patients reported a significant reduction at posttreatment (M = 4708; SD = 1270; p < 001) Sixty-two percent of patients (n = 15) reported a reliable change of 11 points or more This study supports the effectiveness of exposure therapy for active duty soldiers and extends previous research on VRE to this population

Virtual Reality Goes to War: A Brief Review of the Future of Military Behavioral Healthcare

Abstract: Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. Virtual Reality delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. This article details how virtual reality applications are being designed and implemented across various points in the military deployment cycle to prevent, identify and treat combat-related PTSD in OIF/OEF Service Members and Veterans. The summarized projects in these areas have been developed at the University of Southern California Institute for Creative Technologies, a U.S. Army University Affiliated Research Center, and this paper will detail efforts to use virtual reality to deliver exposure therapy, assess PTSD and cognitive function and provide stress resilience training prior to deployment.

Virtual Reality and Interactive Digital Game Technology: New Tools to Address Obesity and Diabetes:

Abstract: The convergence of the exponential advances in virtual reality (VR)-enabling technologies with a growing body of clinical research and experience has fueled the evolution of the discipline of clinical VR. This article begins with a brief overview of methods for producing and delivering VR environments that can be accessed by users for a range of clinical health conditions. Interactive digital games and new forms of natural movement-based interface devices are also discussed in the context of the emerging area of exergaming, along with some of the early results from studies of energy expenditure during the use of these systems. While these results suggest that playing currently available active exergames uses significantly more energy than sedentary activities and is equivalent to a brisk walk, these activities do not reach the level of intensity that would match playing the actual sport, nor do they deliver the recommended daily amount of exercise for children. However, these results provide some support for the use of digital exergames using the current state of technology as a complement to, rather than a replacement, for regular exercise. This may change in the future as new advances in novel full-body interaction systems for providing vigorous interaction with digital games are expected to drive the creation of engaging, low-cost interactive game-based applications designed to increase exercise participation in persons at risk for obesity.

Assessment of cognition in early dementia

Abstract: Better tools for assessing cognitive impairment in the early stages of Alzheimer's disease (AD) are required to enable diagnosis of the disease before substantial neurodegeneration has taken place and to allow detection of subtle changes in the early stages of progression of the disease. The National Institute on Aging and the Alzheimer's Association convened a meeting to discuss state of the art methods for cognitive assessment, including computerized batteries, as well as new approaches in the pipeline. Speakers described research using novel tests of object recognition, spatial navigation, attentional control, semantic memory, semantic interference, prospective memory, false memory and executive function as among the tools that could provide earlier identification of individuals with AD. In addition to early detection, there is a need for assessments that reflect real-world situations in order to better assess functional disability. It is especially important to develop assessment tools that are useful in ethnically, culturally and linguistically diverse populations as well as in individuals with neurodegenerative disease other than AD.

An intelligent virtual human system for providing healthcare information and support.

Abstract: Over the last 15 years, a virtual revolution has taken place in the use of Virtual Reality simulation technology for clinical purposes. Shifts in the social and scientific landscape have now set the stage for the next major movement in Clinical Virtual Reality with the "birth" of intelligent virtual humans. Seminal research and development has appeared in the creation of highly interactive, artificially intelligent and natural language capable virtual human agents that can engage real human users in a credible fashion. No longer at the level of a prop to add context or minimal faux interaction in a virtual world, virtual humans can be designed to perceive and act in a 3D virtual world, engage in spoken dialogues with real users and can be capable of exhibiting human-like emotional reactions. This paper will present an overview of the SimCoach project that aims to develop virtual human support agents to serve as online guides for promoting access to psychological healthcare information and for assisting military personnel and family members in breaking down barriers to initiating care. The SimCoach experience is being designed to attract and engage military Service Members, Veterans and their significant others who might not otherwise seek help with a live healthcare provider. It is expected that this experience will motivate users to take the first step - to empower themselves to seek advice and information regarding their healthcare and general personal welfare and encourage them to take the next step towards seeking more formal resources if needed.

Virtual Reality Technologies for Research and Education in Obesity and Diabetes: Research Needs and Opportunities

Abstract: The rising rates, high prevalence, and adverse consequences of obesity and diabetes call for new approaches to the complex behaviors needed to prevent and manage these conditions. Virtual reality (VR) technologies, which provide controllable, multisensory, interactive three-dimensional (3D) stimulus environments, are a potentially valuable means of engaging patients in interventions that foster more healthful eating and physical activity patterns. Furthermore, the capacity of VR technologies to motivate, record, and measure human performance represents a novel and useful modality for conducting research. This article summarizes background information and discussions for a joint July 2010 National Institutes of Health - Department of Defense workshop entitled Virtual Reality Technologies for Research and Education in Obesity and Diabetes. The workshop explored the research potential of VR technologies as tools for behavioral and neuroscience studies in diabetes and obesity, and the practical potential of VR in fostering more effective utilization of diabetes- and obesity-related nutrition and lifestyle information. Virtual reality technologies were considered especially relevant for fostering desirable health-related behaviors through motivational reinforcement, personalized teaching approaches, and social networking. Virtual reality might also be a means of extending the availability and capacity of health care providers. Progress in the field will be enhanced by further developing available platforms and taking advantage of VR's capabilities as a research tool for well-designed hypothesis-testing behavioral science. Multidisciplinary collaborations are needed between the technology industry and academia, and among researchers in biomedical, behavioral, pedagogical, and computer science disciplines. Research priorities and funding opportunities for use of VR to improve prevention and management of obesity and diabetes can be found at agency websites (National Institutes of Health: http://grants.nih.gov/grants/guide/index.html; Department of Defense: www.tatrc.org).

Virtual reality applications for addressing the needs of those aging with disability.

Abstract: As persons with disabilities age, progressive declines in health and medical status can challenge the adaptive resources required to maintain functional independence and quality of life [1]. These challenges are further compounded by economic factors, medication side effects, loss of a spouse or caregiver, and psychosocial disorders [1-2]. With the gradual loss of functional independence and increased reliance on others for transportation, access to general medical and rehabilitation care can be jeopardized [2]. The combination of these factors when seen in the context of the average increase in lifespan in industrialized societies has lead to a growing crisis that is truly global in proportion. While research indicates that functional motor capacity can be improved, maintained, or recovered via consistent participation in a motor exercise and rehabilitation regimen [3], independent adherence to such preventative and/or rehabilitative programming outside the clinic setting is notoriously low [1]. This state of affairs has produced a compelling and ethical motivation to address the needs of individuals who are aging with disabilities by promoting home-based access to low-cost, interactive virtual reality (VR) systems designed to engage and motivate individuals to participate with "game"-driven physical activities and rehabilitation programming. The creation of such systems could serve to enhance, maintain and rehabilitate the sensorimotor processes that are needed to maximize independence and quality of life. This is the theme of the research to be presented at this MMVR workshop.

Markerless Full Body Tracking: Depth-Sensing Technology within Virtual Environments

Abstract: Over the last decade there has been growing recognition of the potential value of virtual reality and game technology for creating a new generation of tools for advancing rehabilitation, training and exercise activities. However, until recently the only way people could interact with digital games and virtual reality simulations, was by using relatively constrained gamepad, joystick and keyboard interface devices. Thus, rather than promoting physical activity, these modes of interaction encourage a more sedentary approach to playing games, typically while seated on the couch or in front of a desk. More complex and expensive motion tracking systems enable immersive interactions but are only available at restricted locations and are not readily available in the home setting. Recent advances in video game technology have fueled a proliferation of low-cost devices that can sense the user’s motion. This paper will present and discuss three potential applications of the new depth-sensing camera technology from PrimeSense and Microsoft Kinect. The paper will outline the technology underlying the sensor, the development of our open source middleware allowing developers to make applications, and provide examples of applications that enhance interaction within virtual environments and game-based training/rehabilitation tools. The PrimeSense or Kinect sensors, along with open source middleware, provide markerless full-body tracking on a conventional PC using a single plug and play USB sensor. This technology provides a fully articulated skeleton that digitizes the user’s body pose and directly quantizes their movements in real time without encumbering the user with tracking devices or markers. We have explored the integration of the depth sensing technology and middleware within three applications: 1) virtual environments, 2) gesture controlled PC games, 3) a game developed to target specific movements for rehabilitation. The benefits of implementing this technology in these three areas demonstrate the potential to provide needed applications for modern-day warfighters.

Leveraging unencumbered full body control of animated virtual characters for game-based rehabilitation

Abstract: The use of commercial video games as rehabilitation tools, such as the Nintendo® Wii Fit™, has recently gained much interest in the physical therapy arena. However, physical rehabilitation requires accurate and appropriate tracking and feedback of performance, often not provided by existing commercial console devices or games. This paper describes the development of an application that leverages recent advances in commercial video game technology to provide fullbody control of animated virtual characters with low cost markerless tracking. The aim of this research is to develop and evaluate an interactive game-based rehabilitation tool for balance training of adults with neurological injury. This paper outlines the development and evaluation of a game-based rehabilitation tool using the PrimeSense depth sensing technology, designed to elicit specific therapeutic motions when controlling a virtual avatar in pursuit of in-game goals. A sample of nine adults participated in the initial user testing, providing feedback on the hardware and software prototype.

Intelligent Virtual Patients for Training Clinical Skills

Abstract: JVRB, 8(2011), no. 3. - The article presents the design process of intelligent virtual human patients that are used for the enhancement of clinical skills. The description covers the development from conceptualization and character creation to technical components and the application in clinical research and training. The aim is to create believable social interactions with virtual agents that help the clinician to develop skills in symptom and ability assessment, diagnosis, interview techniques and interpersonal communication. The virtual patient fulfills the requirements of a standardized patient producing consistent, reliable and valid interactions in portraying symptoms and behaviour related to a specific clinical condition.

Virtual reality posttraumatic stress disorder (PTSD) exposure therapy results with active duty OIF/OEF service members

Abstract: Posttraumatic stress disorder (PTSD) is reported to be caused by exposure to traumatic events including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggest that at least 1 out of 6 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual reality (VR) delivered exposure therapy for PTSD has been used with reports of positive outcomes. The aim of the current paper, is to present the rationale and brief description of a Virtual Iraq/Afghanistan PTSD VR therapy application and present initial findings from its use with PTSD patients. Thus far, Virtual Iraq/Afghanistan consists of a series of customizable virtual scenarios designed to represent relevant Middle Eastern VR contexts for exposure therapy, including a city and desert road convoy environment. User-centered design feedback, needed to iteratively evolve the system, was gathered from returning Iraq War veterans in the USA and from a system deployed in Iraq and tested by an Army Combat Stress Control Team. Results from an open clinical trial at San Diego Naval Medical Center of the first 20 treatment completers indicate that 16 no longer met PTSD screening criteria at post-treatment, with only one not maintaining treatment gains at 3 month follow-up.

Development of an interactive stepping game to reduce falls in older adults

Abstract: Abstract More than one-third of people over the age of 65 years experience falls each year, and those who fall once are two to three times more likely to fall again. A fall can significantly limit a person’s ability to remain self-sufficient. Fall injuries are responsible for significant disability, reduced physical function, and loss of independence. However, falls are not an inevitable result of aging. Systematic reviews of fall intervention studies have established that prevention programs can reduce falls. Physical activities, including strengthening exercises, Tai Chi, dancing and walking have been demonstrated to improve balance and decrease risk of falls in older adults. Modified dance-based exercises that include step-based movements have been demonstrated to improve endurance and balance in older adults. Dance video games, using a dance mat with areas that the player must step on in time with cues on the screen, have been demonstrated to improve activity and mood and reduce weight in children and youth. However, these dance games often include fast paced music, frequent jumping and an overload of visual information, movement and colors on the screen. This paper outlines the development of a prototype rhythm game that leverages the benefits of step-based exercise and dance video games to improve balance and reduce falls in older adults.

Breathe: A Game to Motivate the Adherence of Breathing Exercises

Abstract: Background and Purpose.Breathing often becomes impaired or difficult after surgeries or in the presence of disease or injury. Breathing exercises are imperative to ensure the health of lungs. Despite this, patient adherence with breathing exercise regimes is not commonly assessed. There is a need fo

Virtual Reality Assessment of Cognitive Functions: A Promising Tool to Improve Ecological Validity

Abstract: 24 IntroductIon Military service in Iraq and Afghanistan comes with the risk of exposure to improvised explosive devices (IEDs), vehicle borne IEDs, rockets, mortars and other blasts. Vehicle roll-over accidents, small arms fire and other non-battle injuries also occur. Accordingly, service members deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom are at increased risk of traumatic brain injuries (TBIs). Since 2000, over 169,000 service members have been diagnosed with a TBI1 (Department of Defense, 2010) and the RAND Corporation reported that nearly one in five service members who deployed to Iraq or Afghanistan reported a probable TBI (Tanielian and Jaycox, 2008).2 Although mild TBIs, or concussions, typically result in full recovery following a brief period of time, more serious injuries can result in new symptoms or changes in functioning and behavior. Some of these changes occur in cognitive domains such as attention, memory, executive functions, language, spatial abilities and psychomotor skills. These changes are usually documented with paper and pencil tests that compare the service member’s cognitive performance to that of their peers. For the comparison to be valid, these tests must be administered in a similar manner to that used to determine the norms — typically quiet, well-controlled environments that minimize distractions and maximize best effort. Cognitive tests can serve a number of clinical purposes including accurate diagnosis, informing the level of care a patient requires, treatment planning and treatment evaluation (Lezak, et al., 2004).3 Repeated assessments can also characterize the nature of the injury and document any changes over time. Providers in both civilian and military contexts have increasingly been asked to use neuropsychological test performances to make recommendations about patients’ everyday functioning (Lynch, 2008).4 In the civilian sector, these questions may relate to driving or activities of daily living, whereas clinicians working in the deployed environment or at military treatment facilities may use cognitive assessments to inform questions related to fitness for duty. For example, deployed commanders may have referral questions related to the safety of personnel to perform basic tactical skills. On the home front, military neuropsychologists may be consulted as part of a “fitness for duty” evaluation that is conducted when impairments significantly interfere with work performance. In addition, there is increasing interest in the assessment of the severity of functional impairment following TBI. The complexity and lethality of modern warfare place great demands on a service member’s neurocognitive resources. At varying levels of threat, service members must be able to exercise control of cognitive functions. It may be challenging to interpret the results of traditional cognitive assessment tools to answer military specific questions. With tremendous individual variability in responses to stress, how well does performance during a well-controlled cognitive assessment predict performance during the stresses of war? It is not known, for example, how well a service member with low average mental efficiency or processing speed following a TBI will react to fire during a tactical convoy. Is this individual fit for combat duty? What kind of performance is required on cognitive tests for a service member to be judged fit to man an automatic weapon during a convoy? Following a mild TBI, how do we assess the functional impairment of service members whose occupational environment has significant, unpredictable low and high intensity stress? Hence, for a measure to be relevant to an assessment of service member neurocognitive functioning, it should provide some indication of a service member’s cognitive performance within high and low threat settings. Questions such as these relate to concerns about tests’ ecological validity — the degree to which performance on cognitive tests accurately predict future behavior in the real world. Although some tests have demonstrated evidence of ecological validity5 (Strauss, et al., 2006). developments in the area of virtual reality may offer new opportunities to improve ecological validity and inform key questions related to the postTBI assessment of service members.

Describing the attention deficit profile of children with neurofibromatosis type 1 using a virtual classroom environment

Abstract: The objective of this study was to describe the nature of the attention deficits in children with NF1 in comparison with typically developed children using the Virtual Classroom (VC). Twenty nine NF1 children and 25 age-and gender-matched controls, aged 8 –16 were assessed in a VC. Parent ratings on the Conners' Parent Rating Scales-Revised; Long (CPRS-R:L) questionnaire was used to monitor for ADHD. Significant differences were found between the NF1 and control groups on the number of targets correctly identified and the number of commission errors in the VC, with NF1 children performing poorer (p< 0.005). Significant correlations were found between total correct hit and the cognitive problems/inattention scale and two indexes of the CPRS-R:L (the DSM-IV Symptom Subscales and on the ADHD Index). The attention profile of NF1 children include deficits in sustained attention and impulsivity. These results suggest that the VC is a sensitive and ecologically valid assessment tool to aid in the diagnosis of attention deficits among children with NF1

A 3D Motion Controlled Method for the Training of Mental Rotation

Abstract: Mental Rotation is the ability to rotate mental representations of two dimensional and three dimensional objects, and usually regarded as a predictor of math or science achievement. This study utilized a 6DOF-controlled method with stereoscopics in the training of mental rotation and investigated how these training methods may affect useri¦s learning performance, perceived playfulness, and willingness to continue use. To evaluate the method, a video/animation-based training method was used in control group. A subject test with 30 participants was conducted. These participants were classified into two groups and trained with two different methods respectively. Results showed that the 6DOF-controlled method with stereoscopics gained higher improvement of the difference from pre-test to post-test in average, although the difference was not significant. While considering perceived playfulness and willingness to continue use, the 6DOF-controlled method with stereoscopics gained higher scores significantly then the control group.

Emotions and telerebabilitation: pilot clinical trials for virtual telerebabilitation application using haptic device and its impact on post stroke patients' mood and motivation

Abstract: We describe a pilot clinical trial with a flexible telerehabilitation platform that allows a therapist to remotely monitor the exercise regimen and progress of a patient who previously suffered from a stroke. We developed virtual game environments which were host to a progressive set of training tasks from precise fine motor movements to reaching movements that involve full arm and shoulder activity. Concurrently, the therapist monitored the progress of the patient through a video channel. Assessment of psychosocial variables show that negative feelings (confusion, t(13)=2.54, p<.05, depression t(13)=2.58, p<.05, and tension, t(13)=2, p<.1) were significantly lessened after the game play. Patients' overall satisfaction with the telerehabilitation system was positively correlated with the feeling of co-presence of the therapist, r(8)=.770, p<.005. Patients felt less efficacious in continuing therapy after participating in the telerehabilitation game compared to their reported perseverance self-efficacy before the game, t(5)=2.71, p<.05 and showed decreased willingness to persist in therapy regardless of fatigue after the game play, t(5)=2.67, p<.05. However, when patients' pretest mood scores were taken into account, this trend was reversed. Patients' active mood before the game was positively correlated with their willingness to persist in the therapy after the game, r(14)=.699, p<.005. Telerehabilitation significantly enhanced stroke patients' psychological states.

NIDRR Perspectives on VR Applications for Addressing the Needs of those Aging with and into Disability

Abstract: As persons with disabilities age, progressive declines in health and medical status can challenge the adaptive resources required to maintain functional independence and quality of life [1]. These challenges are further compounded by economic factors, medication side effects, loss of a spouse or caregiver, and psychosocial disorders [1-2]. The gradual loss of functional independence and increased reliance on others for transportation, access to general medical and rehabilitation care can be jeopardized [2]. The combination of these factors when seen in the context of the average increase in lifespan in industrialized societies has lead to a growing crisis that is truly global in proportion. While research indicates that functional motor capacity can be improved, maintained, or recovered via consistent participation in a motor exercise and rehabilitation regimen [3], independent adherence to such preventative and/or rehabilitative programming outside the clinic setting is notoriously low [1]. This state of affairs has produced a compelling and ethical motivation to address the needs of individuals who are aging with disabilities by promoting home-based access to low-cost, interactive virtual reality (VR) systems designed to engage and motivate individuals to participate with “game”-driven physical activities and rehabilitation programming. The creation of such systems could serve to enhance, maintain and rehabilitate the sensorimotor processes that are needed to maximize independence and quality of life. This is the theme of the workshop to be presented at the MMVR conference.