A haptic floor for interaction and diagnostics with goal based tasks during virtual reality supported balance training

  • Andrej Krpič Univerzitetni rehabilitacijski inštitut Republike Slovenije – Soča, Linhartova 51, 1000 Ljubljana
  • Imre Cikajlo Univerzitetni rehabilitacijski inštitut Republike Slovenije – Soča, Linhartova 51, 1000 Ljubljana
  • Arso Savanović Smart Com d.o.o., Brnčičeva ulica 45, 1231 Ljubljana-Črnuče
  • Zlatko Matjačić Univerzitetni rehabilitacijski inštitut Republike Slovenije – Soča, Linhartova 51, 1000 Ljubljana
Keywords: virtual reality, balance training, postural responses, diagnostics, rehabilitation robotics

Abstract

Background: Balance training of patients after stroke is one of the primary tasks of physiotherapy after the hospitalization. It is based on the intensive training, which consists of simple, repetitive, goal-based tasks. The tasks are carried out by physiotherapists, who follow predefined protocols. Introduction of a standing frame and a virtual reality decrease the physical load and number of required physiotherapists. The patients benefit in terms of safety and increased motivation. Additional feedback – haptic floor can enhance the virtual reality experience, add additional level of difficulty and could be also used for generating postural perturbations. The purpose of this article is to examine whether haptic information can be used to identify specific anomalies in dynamic posturography.

Methods: The performance and stability of closed-loop system of the haptic floor were tested using frequency analysis. A postural response normative was set up from data assessed in four healthy individuals who were exposed to unexpected movements of the haptic floor in eight directions. Postural responses of a patient after stroke participating in virtual reality supported balance training, where collisions resulted in floor movements, were assessed and contrasted to the normative.

Results: Haptic floor system was stable and controllable up to the frequency of 1.1 Hz, sufficient for the generation of postural perturbations. Responses obtained after perturbations in two major directions for a patient after stroke demonstrated noticeable deviations from the normative.

Conclusions: Haptic floor design, together with a standing frame and a virtual reality used for balance training, enables an assessment of directionally specific postural responses. The system was designed to identify postural disorders during balance training and rehabilitation progress outside specialized clinics, e.g. at patient’s home.

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References

Truelsen T, Ekman M, Boysen G. Cost of stroke in Europe. Eur J Neurol 2005; 12 Suppl 1: 78–84.

Tyson S, Hanley M, Chillala J, Selley A, Tallis RC. Balance Disability After Stroke. Phys Ther 2006; 86: 30–8.

Kuo AD, Zajac FE. Human standing and posture: multi-joint movement strategies based on biomechanical constrains in Progress on Brain research (ed. Allum et al) 1993; 97: 349–358

Lim JY, Jung SH, Kim WS, Paik NJ. Incidence and risk factors of poststroke falls after discharge from inpatient rehabilitation. PM&R 2012; 4: 945–53

Nyström A, Hellström K. Fall risk six weeks from onset of stroke and the ability of the Prediction of Falls in Rehabilitation Settings Tool and motor function to predict falls. Clin Rehabil 2013; 27: 473–9

Mackintosh SF, Hill K, Dodd KJ, Goldie P, Culham E. Falls and injury prevention should be part of every stroke rehabilitation plan. Clin Rehabil 2005; 19: 441–51

Rushton D. Functional electrical stimulation. Physiol Meas 1997; 18: 241–75

Tong K, Chan S, Wong W, Lui K, Tang K, Gao X, et al. BCI-FES training system design and implementation for rehabilitation of stroke patients. IJCNN 2008; 2008 Jun 1–8; Hong Kong, China.

Kwakkel G, Wagenaar RC, Twisk JW, Lankhorst GJ, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet 1999; 354: 191–6.

Matjačić Z, Hesse S, Sinkjaer T. BalanceReTrainer: a new standing-balance training apparatus and methods applied to a chronic hemiparetic subject with a neglect syndrome. NeuroRehabilitation 2003; 18: 251–9.

Yang Y, Tsai M, Chuang T, Sung W, Wang R. Virtual reality-based training improves community ambulation in individuals with stroke: A randomized controlled trial. Gait Posture 2008; 28: 201–6.

Holden M. Virtual environments for motor rehabilitation: review. Cyberpsychol Behav 2005; 8: 187–219.

Kenyon RV, Leigh J, Keshner EA. Considerations for the future development of virtual technology as a rehabilitation tool. J Neuroeng Rehabil 2004; 1: 13.

Burdea G, Popescu V, Hentz V, Colbert K. Virtual Reality-Based Orthopedic Telerehabilitation. IEEE T Rehabil Eng 2000; 8: 430–2.

Adamovich SV, Fluet GG, Tunik E, Merians AS. Sensorimotor training in virtual reality: A review. NeuroRehabilitation 2009; 25: 29–44.

Bisson E, Contant B, Sveistrup H, Lajoie Y. Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training. Cyberpsychol Behav 2007; 10: 16–23.

Deutsch JE, Mirelman A. Virtual reality-based approaches to enable walking for people poststroke. Top Stroke Rehabil 2007; 14: 45–53.

Koenig A, Wellner M, Köneke S, Meyer-Heim A, Lünenburger L, Riener R. Virtual gait training for children with cerebral palsy using the Lokomat gait orthosis. St Heal T 2008; 132: 204–9.

Padala KP, Padala PR, Malloy TR, Geske JA, Dubbert PM, Dennis RA, Garner KK, Bopp MM, Burkeand WJ, Sullivan DH. Wii-Fit for Improving Gait and Balance in an Assisted Living Facility: A Pilot Study. J Aging Res 2012; Article ID 597573, 1–6

Brown R, Sugarman H, Burstin A. Use of the nintendo wii fit for the treatment of balance problems in an elderly patient with stroke: A case report. Int J Rehabil Res 2009; 32: 109–110.

Crosbie JH, Lennon S, Basford JR, McDonough SM. Virtual reality in stroke rehabilitation: still more virtual than real. Disabil Rehabil 2007; 29: 1139–52.

Nyberg L, Lundin-Olsson L, Sondell B, Backman A, Holmlund K, Eriksson S, et al. Using a virtual reality system to study balance and walking in a virtual outdoor environment: a pilot study. Cyberpsychol Behav 2006; 9: 388–95.

Bardorfer A, Munih M, Zupan A, Čeru B. Upper limb functional assessment using haptic interface. Zdrav Vestn 2004; 73: 19–24

Merians AS, Fluet GG, Qiu Q, Lafond I, Adamovich SV. Learning in a virtual environment using haptic systems for movement re-education: can this medium be used for remodeling other behaviors and actions? J Diabetes Sci Technol 2011; 5: 301–8.

Horak F, Henry S, Shumway-Cook A. Postural Perturbations: New Insights for Treatment of Balance Disorders. Phys Ther 1997; 77: 517–33.

Cikajlo I, Matjačić Z. Directionally specific objective postural response assessment tool for treatment evaluation in stroke patients. IEEE T Neur Sys Reh 2009; 17: 91–100.

Cikajlo I, Rudolf M, Goljar N, Matjačić Z. Virtual reality task for telerehabilitation dynamic balance training in stroke subjects. Virtual Rehabilitation International Conference 2009; 2009 Jun 29-Jul 2; Haifa, Israel.

Cikajlo I, Rudolf M, Goljar N, Burger H, Matjačić Z. Telerehabilitation using virtual reality task can improve balance in patients with stroke. Disabil Rehabil 2012; 34: 13–8.

Loram ID, Gawthrop PJ, Lakie M. The frequency of human, manual adjustments in balancing an inverted pendulum is constrained by intrinsic physiological factors. J Psychol 2006; 557: 417–32.

Varmah H. Control Systems. New Delhi: Tata Mc-Graw Hill Education Private Limited; 2010.

Nashner LM. Adapting reflexes controlling the human posture. Exp Brain Res 1976; 26: 59–72.

Moore SP, Rushmer DS, Windus SL, Nashner LM. Human automatic postural responses: responses to horizontal perturbations of stance in multiple directions. Exp Brain Res 1988; 73: 648–58.

Krebs DE, McGibbon CA, Goldvasser D. Analysis of postural perturbation responses. IEEE T Neur Sys Reh 2001; 9: 76–80.

Sayenko DG, Masani K, Vette AH, Alekhina MI, Popovic MR, Nakazawa K. Effects of balance training with visual feedback during mechanically unperturbed standing on postural corrective responses. Gait Posture 2012; 35: 339–44.

Cikajlo I, Krpič A, Gorišek-Humar M. Changes in EMG Latencies during Balance Therapy Using Enhanced Virtual Reality with Haptic Floor. 35th Annual International Conference of the IEEE EMBS Osaka, Japan, 3–7 July, 2013: 4129–132

Yu E, Abe M, Masani K, Kawashima N, Eto F, Haga N, et al. Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke. Arch Phys Med Rehabil 2008; 89: 1133–9.

Baetens T, De Kegel A, Calders P, Vanderstraeten G, Cambier D. Prediction of falling among stroke patients in rehabilitation. J Rehabil Med 2011; 43: 876–83

Popović BD, Popović MB. New trends in neurorehabilitation of subjects with central nervous system lesions. Zdrav Vestn 2010; 79: 296–301.

How to Cite
1.
Krpič A, Cikajlo I, Savanović A, Matjačić Z. A haptic floor for interaction and diagnostics with goal based tasks during virtual reality supported balance training. TEST ZdravVestn [Internet]. 1 [cited 5May2024];83(2). Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1098
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