Environmental Engineering Reference
In-Depth Information
these complex set of processes involved in walking. Liepert and his colleagues in 2000 along
with Jack and his fellow researchers in 2001 showed indications that virtual environments
can be used to simulate artificial images that trigger biofeedback mechanisms that can aid in
motor recovery.
In the work of Jack and his colleagues (Jack et al., 2001), a PC-based desktop system was
developed that employed virtual environments for rehabilitating the hand function in stroke
patients. The system uses two input devices, a CyberGlove and a Rutgers Master II-ND
(RMII) force feedback glove, that allow users to interact with the virtual environment. The
virtual environment presents four rehabilitation routines, each designed to exercise one
specific parameter of hand movement e.g., range of motion. The authors used performance-
based target levels to encourage patients to use the system and to individualize exercise
difficulty based on the patient's specific need. Three chronic stroke patients were employed
to carry out pilot clinical trials of the system daily for two weeks. Objective evaluations
revealed that each patient showed improvement on most of the hand parameters over the
course of the training.
In 2002, Boian and his colleagues used a similar virtual environment in a different context to
rehabilitate four post-stroke patients in the chronic phase. The system developed was
distributed over three sites (rehabilitation site, data storage site, and data access site) and
connected to each other through the Internet. At the rehabilitation site, the patients
underwent upper-extremity therapy using a CyberGlove and a Rutgers Master II (RMII)
haptic glove integrated with PC-based system that provides the virtual environment. The
patients interacted with the system using the sensing gloves, and feedback was given on the
computer screen. The data storage site hosted the main server for the system. It had an
Oracle database, a monitoring server, and a web site for access to the data. The data access
site was a 'place-independent' site, being any computer with Internet access. The therapist
or physician could access the patients' data remotely from any location with Internet
connections. The patients exercised for about two hours per day, five days a week for three
weeks, within the virtual environment to reduce impairments in their finger range of
motion, speed, fractionation and strength. Results showed that three of the four patients had
improvements in their thumbs' range of motion and finger speed over the three-week trial
while all the patients had significant improvements in finger fractionation, and modest
gains in finger strength.
Similarly, in the same year, Alma S. Merians, with some members of Boian's research group
continued related work using the CyberGlove and the RMII glove, coupled with virtual
reality technology, to create an interactive, motivating virtual environment in which practice
intensity and feedback were manipulated to present individualized treatments to retrain
movements in three patients who were in the chronic phase following stroke. The patients
participated in a two-week training program, spending about three-and-half hours per day
on dexterity tasks using real objects and virtual reality exercises. The virtual reality
simulations were targeted for upper-extremity improvements in range of motion, movement
speed, fractionation, and force productions. Results showed that one of the three patients,
the most impaired at the beginning of the intervention, gained improvement in the thumb
and fingers in terms of range of motion and speed of movement. Another patient improved
in fractionation and range of motion of his thumb and fingers. The third patient made the
greatest gains as that patient was reported to have gained improvements in the range of
motion and strength of the thumb, velocity of the thumb and fingers, and fractionation.
