U.S. patent application number 12/192818 was filed with the patent office on 2009-05-21 for rehabilitation systems and methods.
Invention is credited to Amine Arezki, Mourad Bouzit, Grigore C. Burdea, Daniel Cioi, Devin Fensterheim, Manjuladevi Kuttuva.
Application Number | 20090131225 12/192818 |
Document ID | / |
Family ID | 40642587 |
Filed Date | 2009-05-21 |
United States Patent
Application |
20090131225 |
Kind Code |
A1 |
Burdea; Grigore C. ; et
al. |
May 21, 2009 |
REHABILITATION SYSTEMS AND METHODS
Abstract
The present invention integrates an actuated tilting
rehabilitation table, video tracking of the patient arm and
opposite shoulder, a low-friction forearm support with grasping
force sensing, remote data transmission and additional weighing
means, one or more large displays, a computer and a plurality of
simulation exercises, such as video games. The patient can be
monitored by a local or remote clinician. The table tilts in order
to increase exercise difficulty due to gravity loading on the
patients arm and shoulder. In one embodiment, the present the
invention includes an actuated tilting table which tilts in four
degrees of freedom.
Inventors: |
Burdea; Grigore C.;
(Highland Park, NJ) ; Arezki; Amine; (Paris,
FR) ; Bouzit; Mourad; (Ormoy, FR) ; Cioi;
Daniel; (Piscataway, NJ) ; Kuttuva; Manjuladevi;
(San Diego, CA) ; Fensterheim; Devin; (Cambridge,
MA) |
Correspondence
Address: |
Diane Dunn McKay, Esq.;Mathews, Shepherd, McKay & Bruneau, P.A.
Suite 201, 29 Thanet Road
Princeton
NJ
08540
US
|
Family ID: |
40642587 |
Appl. No.: |
12/192818 |
Filed: |
August 15, 2008 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60964861 |
Aug 15, 2007 |
|
|
|
Current U.S.
Class: |
482/5 |
Current CPC
Class: |
A63B 2225/15 20130101;
A63B 24/0003 20130101; A63B 2220/13 20130101; H04L 65/403 20130101;
A63B 2060/464 20151001; A63B 23/12 20130101; A63B 21/4017 20151001;
A63B 2071/065 20130101; G06F 2203/011 20130101; A63B 21/06
20130101; A63B 24/0006 20130101; A63B 2024/0009 20130101; A63B
2220/51 20130101; G06F 16/335 20190101; H04L 65/4023 20130101; A63B
2220/56 20130101; A63B 23/03525 20130101; A63B 2225/20 20130101;
A63B 2071/0647 20130101; A63B 21/4035 20151001; A63B 24/0021
20130101; G10L 15/22 20130101; A63B 2220/806 20130101; A63B 2225/50
20130101; A63B 71/0622 20130101; A63B 21/4047 20151001; A63B
2022/0092 20130101; A63B 2209/10 20130101; H04M 3/56 20130101; H04M
7/0024 20130101; A63B 2024/0015 20130101 |
Class at
Publication: |
482/5 |
International
Class: |
A63B 21/00 20060101
A63B021/00 |
Claims
1. A system for rehabilitation comprising: a tilting table, said
tilting table adapted to be movable at a tilt angle in one or more
degrees of freedom; a forearm support adapted for receiving a
forearm of a user, said forearm support being movable on said
tilting table; an animated or virtual reality sequence forming an
exercise simulation being displayed on a display; and tracking
means for tracking movements of said forearm upon interaction of
said user with said exercise simulation.
2. The system of claim 1 wherein said tilting table has a top
surface having a U-shape.
3. The system of claim 1 wherein said tracking means comprises a
video camera and tracking software for tracking output from said
video camera.
4. The system of claim 1 wherein said tilting table is movable in
four degrees of freedom.
5. The system of claim 1 wherein said tilting table has a top
surface and said display is part of said top surface of said
tilting table.
6. The system of claim 5 further comprising a touch sensitive layer
in said display.
7. The system of claim 5 wherein said tracking means comprises a
video camera, said video camera is positioned beneath said
display.
8. The system of claim 1 further comprising: one or more actuators
connected to said tilting table, said one or more actuators moving
said tilting table at said tilt angle.
9. The system of claim 1 wherein said actuators are connected to an
underside of a top surface of said tilting table with a top joint
assembly, said top joint assembly including a horizontal rotating
joint and a vertical rotation joint to produce two degrees of
freedom.
10. The system of claim 1 wherein said actuators are connected to
an underside of a bottom surface of said tilting table with a
bottom joint assembly, said bottom joint assembly including a
horizontal rotating joint and a vertical rotation joint to produce
two degrees of freedom.
11. The system of claim 1 further comprising: a hollow compliant
element and pressure sensor means for measuring grasping forces of
the user when grasping said hollow compliant means.
12. The system of claim 1 wherein said video camera is mounted with
a vertical support to provide the same relative orientation
regardless of the tilt angle and further comprising: one or more
LEDs coupled to a respective corner of a top surface of said
tilting table for providing calibration of said video camera.
13. The system of claim 12 further comprising: a pair of second
LEDs positioned on said forearm support for providing data on arm
movements and rotation.
14. The system of claim 1 further comprising: a harness assembly
adapted for attachment to a shoulder of a user, a LED being coupled
to said harness assembly, said LED providing data on compensatory
movements of the arm of the user.
15. The system of claim 1 wherein a pair of said forearm supports
are used in said system, each said forearm support receiving a
respective forearm of the user.
16. The system of claim 15 wherein one or more first LEDs are
positioned in a first forearm support of said pair and one or more
second LEDs are positioned on a second forearm support of said
pair, wherein the number of said first LEDs is different than the
number of said second LEDs.
17. The system of claim 1 wherein said exercise simulation includes
an avatar and further comprising: means for measuring a baseline of
said user; and means for mapping said measured baseline with said
exercise for tuning said exercise simulation and providing mapping
between real movement of said user and movement of said avatar
during said exercise simulation.
18. The system of claim 17 wherein said exercise simulation
includes a virtual representation of a rehabilitation surface, the
arm of the user is adapted to move in circles over said virtual
rehabilitation surface wherein a corresponding colored area is
displayed on said virtual rehabilitation surface.
19. The system of claim 17 wherein said exercise simulation
includes a virtual sphere and a virtual target area, the arm of the
user picks up the virtual sphere and places it in the virtual
target area, the arm of the user is moved to the extent of the
baseline.
20. The system of claim 19 wherein a trace of the arm movements of
the user is displayed in the exercise simulation.
21. The system of claim 17 wherein the exercise simulation includes
virtual objects in the shape of the baseline, virtual targets are
uncovered by moving the arm of the user.
22. The system of claim 17 wherein the exercise simulation includes
a virtual reality array of cubes, virtual reality ball and virtual
reality paddle, the user hits the virtual reality ball towards the
virtual reality cubes with the virtual reality paddle, each said
virtual reality cube is destroyed for each bounce of said virtual
reality ball on said virtual reality cube.
23. A method for rehabilitation comprising the steps of: providing
a forearm support adapted for receiving a forearm of a user on a
tilting table, said tilting table adapted to be movable in one or
more degrees of freedom; displaying an animated or virtual reality
sequence on a display; and tracking movements of the forearm
interaction with said exercise simulation.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application claims the benefit of U.S. Provisional
Patent Application No. 60/964,861 filed Aug. 15, 2007, the entirety
of which is hereby incorporated by reference into this
application.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention is a device, system and method for
providing rehabilitation to several types of patients in a
rehabilitation hospital or outpatient clinic. The approach
integrates an actuated tilting rehabilitation table, video tracking
of the patient's arm and opposite shoulder, a low-friction forearm
support with grasping force sensing, remote data transmission and
additional weighing means, one or more large displays, a computer
and a plurality of video games.
[0004] 2. Description of Related Art
[0005] A training system for arm rehabilitation is described in
Yu-Luen Chen et al, "Aid Training System for Upper Extremity
Rehabilitation," 2001 Proceedings of the EMBS International
Conference, Istanbul, Turkey. Patients exercise on a special table
that incorporates reed relays and a hand support ("arm skate") with
small underside wheels. The movement of the arm in the arm skate on
the supporting table is detected by the interaction of the magnet
incorporated in the arm skate with the relays integrated in the
table. A computer presents a variety of patterns on its monitor,
which the patient needs to replicate to improve arm coordination,
with performance data stored by the computer in a clinical
database. The table is horizontal and does not use virtual reality
simulations.
[0006] Another training system that uses a forearm support on a
table for rehabilitation purposes is described by some of the
inventors of the present specification in Kutuva et al., "The
Rutgers Arm: An Upper-Extremity Rehabilitation System in Virtual
Reality," Proceedings of the Fourth International Workshop on
Virtual Rehabilitation (IWVR'05), pp. 94-103, Catalina Island,
Calif., September 2005. The table has a low-friction surface and a
forearm support has a low-friction underside (made of
TEFLON.RTM.studs). The tracking of the forearm movement is done by
a magnetic tracker (Fastrack, Polhemus Inc.), with a sensor mounted
on the forearm support, and an emitter mounted on the table away
from the patient. Patients exercise sitting at the table and
looking at a computer monitor, while playing a plurality of virtual
reality games. The games are designed to improve motor
coordination, as well as dynamic arm response. The table does not
tilt.
[0007] Several tilting tables exist commercially and are used in
rehabilitation. They are meant for people who have low blood
pressure and who get dizzy when they stand up. Tilting tables are
also used for the rehabilitation of patients who have to lie down
for a long period of time. The person lies face up on a padded
table with a footboard and is held in place with a safety belt. The
table is tilted so that the angle is very slowly increased until
the person is nearly upright. By slowly increasing the angle, the
patients blood vessels regain the ability to constrict.
[0008] A study describes development of a sensorized tilt table
which measures and displays the knee bent angle and pressure for
each foot during exercise in real time, as described in Kimet et
al. "An Intelligent Tilt Table for Paralytic Patients," 3.sup.rd
Kuala Lumpur International Conference on Biomedical Engineering,
Kuala Lumpur, Malaysia, 2006. It is expected that the patient's
exercising effect can increase by monitoring these two values
during exercise. Tilt tables are known for providing tilting
manually or using an electrical motor, such as in a Rehab Electric
Tilt Table manufactured by Cardon Rehab.
[0009] An automated stepping training developed with the tilting
table is described in Colombo et al. "Novel Stepping Mechanism:
Design Principles and Clinical Application," Rehabilitation
Robotics, ICORR 2005. Unlike the previous tilting tables it
exercises the feet in stepping. No virtual reality simulation is
incorporated and tilting is done manually, rather than determined
by a simulation.
[0010] All of the above tilting-table based systems are for
rehabilitation of the legs. The tilting tables described above do
not incorporate virtual reality simulations and do not store/upload
clinical data automatically. They have a single degree of freedom
(the tilting angle).
[0011] Systems for rehabilitating the arms are known, and are based
on force feedback joysticks (such as those manufactured by Logitech
or Microsoft), or various types of planar or 3D robots. Examples of
planar robots are the MIT Manus or those described in Colombo et
al., "Upper Limb Rehabilitation and Evaluation of Stroke Patients
Using Robot-Aided Techniques", Rehabilitation Robotics, 515-518
(2005). Other examples of 3D robots are the Reo robot manufactured
by Motorika, N.J., or the Haptic Master manufactured by FCS,
Holland.
[0012] Other upper limb rehabilitation systems have been described.
U.S. Pat. No. 7,204,814 describes an orthotic system that performs
predefined or user-controlled limb movements, collects data
regarding the limb movement, performs data analysis and displays
the data results, modifies operational parameters based on the data
to optimize the rehabilitative process performed by the system. A
force sensor data, torque data and angular velocity data can be
collected using an external actuating device.
[0013] U.S. Patent Application Publication No. 2007/0060445
describes a method and apparatus for upper limb rehabilitation
training of coordinated arm/forearm, forearm/forearm, and grasping
movements comprising a non-robotic, passive support, an arm/forearm
sensor, gripping device and sensor. A computer processes
measurements of movements to control a graphical representation of
the arm/forearm and grasping movements in interaction with a
virtual environment.
[0014] It is desirable to provide a device, system and method for
rehabilitation of an upper limb in which an activated tilting table
provides a plurality of degrees of freedom and grasping force is
sensing integrated into a video tracking system.
SUMMARY OF THE INVENTION
[0015] The present invention integrates an actuated tilting
rehabilitation table, video tracking of the patient arm and
shoulder, a low-friction forearm support with grasping force
sensing, remote data transmission and additional weighing means,
one or more large displays, a computer and a plurality of
simulation exercises, such as video games. The patient can be
monitored by a local or remote clinician. Online storage of data
obtained by the rehabilitation tilting table can be provided.
Additionally, the table surface can be constructed as a graphics
display making a separate display unnecessary.
[0016] In one embodiment, a patients arm rests on a forearm support
that has infrared LEDs. The patient wears similar LEDs on the
opposite shoulder, and an infrared video camera is used to track
the patients arm movement on the table. The table tilts in order to
increase exercise difficulty due to gravity loading on the patients
arm. In one embodiment, the present the invention includes an
actuated tilting table which tilts in four degrees of freedom. A
large display, facing the patient presents a sequence of
rehabilitation games with which the patient interacts by moving the
arm resting on the low-friction support, on the table surface.
[0017] The invention will be more fully described by reference to
the following drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0018] FIG. 1 is a schematic diagram of a tilting rehabilitation
table system being used by a patient.
[0019] FIG. 2 is a schematic diagram of the tilting rehabilitation
table system.
[0020] FIG. 3 is a schematic diagram in which a top surface of the
tilting table is provided at an increased angle from the
patient.
[0021] FIG. 4 is a schematic diagram in which the top surface of
the tilting table is provided at an increased right angle from the
patient.
[0022] FIG. 5 is a schematic diagram of actuators of the tilting
rehabilitation table system used with the tilting table.
[0023] FIG. 6 is a detailed view of a top joint assembly connecting
an actuator shaft to the top surface of the tilting table.
[0024] FIG. 7 is a detailed view of a bottom joint assembly
connecting an actuator shaft to the bottom surface of the tilting
table.
[0025] FIG. 8 is a side elevation view of patient wearing the
forearm support assembly used in the tilting rehabilitation table
system.
[0026] FIG. 9 is a schematic diagram of an underside of a forearm
support assembly of the tilting rehabilitation table.
[0027] FIG. 10 is a view of the patient wearing a shoulder harness
assembly used in the tilting rehabilitation table system.
[0028] FIG. 11 is a schematic diagram of an alternate embodiment of
the tilting table.
[0029] FIG. 12 is a schematic diagram of an alternate embodiment of
the tilting table where top surface is a display.
[0030] FIG. 13 is a system block diagram for the tilting
rehabilitation table system.
[0031] FIG. 14 is a schematic diagram of a patient baseline screen
displayed by the tilting rehabilitation table system.
[0032] FIG. 15A is a schematic diagram of a virtual scene displayed
by the tilting rehabilitation table system.
[0033] FIG. 15B is a schematic diagram of a virtual scene displayed
by the tilting rehabilitation table system.
[0034] FIG. 15C is a schematic diagram of a virtual scene displayed
by the tilting rehabilitation table system.
[0035] FIG. 16A is a schematic diagram of a virtual scene displayed
by the tilting rehabilitation table system.
[0036] FIG. 16B is a schematic diagram of a virtual scene displayed
by the tilting rehabilitation table system.
[0037] FIG. 17 is a schematic diagram of a virtual scene displayed
by the tilting rehabilitation table system.
DETAILED DESCRIPTION
[0038] Reference will now be made in greater detail to a preferred
embodiment of the invention, an example of which is illustrated in
the accompanying drawings. Whenever possible, the same reference
numerals will be used throughout the drawings and the description
to refer to the same or like parts.
[0039] FIGS. 1 and 2 illustrate tilting rehabilitation table system
1. Tilting rehabilitation table system 1 incorporates tilting table
2 which has top surface 3 and underside surface 4. Top surface 3
can be a U-shaped, symmetrical, low-friction surface. Underside
surface 4 can have a U-shape. For example, low top surface 3 can be
made of carbon fiber, or other durable and light material, covered
by a low-friction coating. Suitable low-friction coatings include
TEFLON.RTM. sheets. Underside walls 14 extend upwardly from
underside surface 4.
[0040] Patient 5 sits in chair 6 and rests arm 7 to be
rehabilitated in low-friction forearm support 25. Patient 5
exercises while watching display 8 placed at the opposite side of
tilting table 2. Preferably, display 8 is a large display having
dimensions of at least about 9 ft by 6 ft. Video camera 9 is
attached to vertical support 10. Vertical support 10 can be
U-shaped and rigid. Vertical support 10 extends from and is
attached to top surface 3. This arrangement allows video camera 9
to view tilting table 2 and patient 5 simultaneously. Video camera
9 can be a conventional digital camera. Infrared filter 11 can be
attached to lens 12 of video camera 9. LEDs 13 are mounted at the
corners of top surface 3 and can be wired to direct current source
(not shown). For example, three LEDs can be used for providing
calibration of video camera 9. Vertical support 10 is mounted to
top surface 3 such that it keeps the same relative orientation
regardless of tilt angle 15 of top surface 3, thereby making
re-calibration of video camera 9 unnecessary once tilt angle 15
changes during a rehabilitation session.
[0041] Computer 16 renders exercise simulation 17 and displays them
on display 8. For example, exercise simulation 17 can be an
animated or virtual reality sequence. Computer 16 is preferably a
multi-core PC workstation. Computer 16 also receives input from
video camera 9. Computer 16 runs tracking software 18 and
communicates with controller 19. Controller 19 activates actuators
20 to provide tilt of top surface 3. Computer 16 is connected to
Internet 66 and transparently uploads clinical data 67 to remote
clinical database server 68. Remote computer 181 connected to
clinical database server 68 over Internet 66 is used to execute
remote graphing software 180.
[0042] FIG. 3 shows the orientation of top surface 3 and camera
support 10 when tilt angle 15 is increased to move the angle away
from patient 5. Increased tilt angle 15 makes in/out movements of
arm 7 more difficult.
[0043] FIG. 4 shows a different tilt of top surface 3, in which
tilt angle 15 is to the right of patient 5. This tilt angle makes
arm movements from left-to-right more difficult than those when top
surface 3 is horizontal. Other tilt angles 15 can be used when the
left side of top surface 3 is tilted up or when the side closer to
patient 5 is tilted up. These make more difficult corresponding arm
7 movements, such as right-left or out-in, respectively. In one
embodiment, top surface 3 can be tilted in four degrees of
freedom.
[0044] Tilt angle 15 is produced by two or more actuators 20 placed
under top surface 3, as shown in FIG. 5. Actuators 20 are
preferably linear electrical actuators. Actuators 20 are positioned
under top surface 3. Each actuator 20 includes base 21 and
translating shaft 22. Translating shaft 22 is connected to top
surface 3 by top joint assembly 23. Base 21 is connected to
underside walls 14 with bottom joint assembly 30. Actuators 20 are
controlled by controller 19. Controller 19 can be a multi-channel
micro-controller such as those which are available commercially.
Controller 19 in turn receives commands from computer 16 running
exercise simulation 17. In one embodiment, five actuators 20 can be
used and the amount of translation of actuator shaft 22 provides
tilt angle 15 which can be varied from about 0 degrees (horizontal)
to about 30 degrees. The more top surface 3 is tilted, the larger
the effect gravity has due to the weight of arm 7 of patient 5 and
of forearm support 25 and the harder exercise simulation 17 is to
perform.
[0045] FIG. 6 shows a detailed view of top joint assembly 23 which
connects actuator shaft 22 to the underside of top surface 3. Top
joint assembly 23 has horizontal rotating joint 26 and vertical
rotating joint 27 which together produce two degrees of freedom for
top joint assembly 23. The axis of rotation of horizontal rotating
joint 26 is perpendicular to the axis of rotation of vertical
rotating joint 27. Horizontal rotating joint 26 is attached to the
underside of top surface 3 using plate 28 and bolts 29.
[0046] FIG. 7 shows a detailed view of bottom joint assembly 30,
which connects base 21 to the inner side of underside walls 14.
Bottom joint assembly 30 has horizontal rotating joint 31 and
vertical rotating joint 32 which together produce two degrees of
freedom for bottom joint assembly 30. The axis of rotation of
horizontal rotating joint 31 is perpendicular to the axis of
rotation of vertical rotating joint 32. Vertical rotating joint 32
is attached to the inner side of underside walls 14 through plate
33 and bolts 34.
[0047] A side view of the patient 5 sitting in chair 6 and using of
forearm support assembly 25 used by patient 5 is shown in FIG. 8.
Forearm 7 and wrist 35 of patient 5 are secured to forearm support
base 36 using a plurality of straps 37. For example, straps 37 can
be formed of a hook and loop material of VELCRO.RTM.. Forearm
support base 36 can be made of a lightweight material such as
plastic, and is hollow. Pressure sensor 41 measures the air
pressure inside hollow compliant element 44. A suitable hollow
compliant element 44 can be a rubber ball. Grasping forces 45
exercised by fingers 46 of patient 5 are measured. Video camera 9
shown in FIG. 1 views LED assembly 42 which is formed of two
infrared LEDs 50 mounted on plastic support 51 for providing data
on arm movements and rotation. LED assembly 42 in turn is mounted
on movable assembly 52. Movable assembly 52 rotates on hinges 53
attached to forearm support base 36. Movable assembly 52 rotates
open to allow forearm 7 to be placed on forearm support top surface
54. Forearm support top surface 54 is preferably made of a
compliant material (such as plastic foam), for increased comfort.
Forearm support base 36 has chambers 39, 76 and 77. Chamber 39 can
be used to incorporate electronics assembly 40 to which is
connected pressure sensor 41. Output of pressure sensor 41 is
processed by electronics assembly 40. Electronics assembly 40
includes an analog-to-digital converter 47 and wireless transmitter
48. Transmitter 48 can be a conventional wireless Bluetooth.RTM.
type transmitter. Transmitter 48 communicates with receiver 49
incorporated in computer 16, as shown in FIG. 2. Computer 16 can
change exercise simulation 17 according to grasping forces 45 of
patient 5. Computer 16 can also change exercise simulation 17 based
on forearm 7 position/orientation given by video camera 9. For
example, exercise simulation 17 can be rehabilitation games. LED
assembly 42 and electronics assembly 40 are connected to battery 43
in chamber 77. Chamber 76 of base 36 can be used to allow the
addition of modular weights 56. The addition of modular weights 56
to forearm support base 36 allows an increased difficulty of
exercise simulation 17. The difficulty of performing exercise
simulation 17 is increased with the increase in modular weights 56,
with the increase in tilting angle 15, and with the number and
level of exercise simulation 17.
[0048] FIG. 9 is a view of the underside of the forearm support
assembly 25. Underside surface 38 of forearm support 25 has a
plurality of low friction studs 55. Low friction studs 55 are
preferably made of TEFLON.RTM..
[0049] FIG. 10 shows shoulder harness assembly 57 worn by patient 5
on shoulder 58 opposite to arm 7 being rehabilitated. Shoulder
harness assembly 57 incorporates shoulder LED 59 wired to battery
60. Shoulder LED 59 is an infrared LED for providing data on
compensatory movements of patient 5. Harness assembly 57 is formed
of adjustable segments 61. Segments 61 are preferably formed of a
hook and loop material, such as VELCRO.RTM.. Video camera 9 takes
images of shoulder LED 59. Tracking software 18 running on computer
16 determines when patient 5 is doing undesirable compensatory
leaning movements. Tracking software 18 can be adjusted by a
therapist to be more sensitive, or less sensitive to leaning of
patient 5.
[0050] FIG. 11 illustrates an alternate embodiment of tilting table
62 for use with two forearm supports 25. Top surface 3 has a
U-shape cutout 63 allowing patient 5 to be seated centrally to
table axis 64. Patient 5 moves two arms 7 while supported by two
low-friction forearm support assemblies 25. This allows training of
both arms simultaneously, with benefits to recovery of patient 5.
In one embodiment, patient 5 also wears one shoulder harness 57, as
it is sufficient to detect the leaning of the shoulder opposite to
the disabled arm 7. Video camera 9 views LEDs 42 on both forearm
support assemblies 25, as well as LEDs 59 on one shoulder harness
assembly 57. Forearm support assembly 25 is modified such that the
number of infrared LEDs 42 differs between the two forearm support
assemblies 25. For example three LEDs 42 will be on the left-arm
forearm support 73, while the right-arm support 71 still has two
LEDs 42 as previously described in FIG. 8. This allows tracking
software 18 to differentiate between left arm and right arm
movements. Tracking software 18 tracks two arms 7 in real time.
Data from tracking software 18 is used by computer 16 to run
two-arm exercise simulation 17. In this embodiment, the same type
of actuators 20 as shown in FIG. 5, can be used in this embodiment.
Preferably, four actuators 20 are used in this embodiment.
[0051] FIG. 12 illustrates an alternate embodiment of tilting table
2. In this embodiment, top surface 3 is also display 69. For
example, display 69 can be similar to commercially available thin
organic LED (OLED) displays. In this embodiment, the tracking of
forearm 7 may be performed by infrared camera 9, or through a
touch-sensitive layer 70 incorporated in display 69. In this case
the display 69 is a touch sensitive screen such as those available
commercially. In case overhead camera 9 is used, forearm support
assembly 25 is modified as shown in FIG. 11. Actuator assembly 20
can be connected to frame 72 bordering display 69 and to supporting
surface 4. A low-friction transparent film 75 can be retrofitted to
display 69, to prevent scratching by the forearm support assemblies
71 and 73 that sit on it.
[0052] A system block diagram for the tilting rehabilitation table
system 1 is illustrated in FIG. 13. Each rehabilitation session
starts with session start block 78. Session start block 78 loads
the patient's ID and other clinical data 67 for arm 7 to be
rehabilitated. Session start block 78 transfers control to the
session scheduler block 79 which sets the structure of a
rehabilitation session, for example, number, type and order of
exercises, as well as the difficulty level settings. Session
scheduler block 79 is structured such that it applies a customized
treatment depending on progress of patient 5 (the order of the
particular session being done out of the prescribed number of
sessions). Session scheduler block 79 begins by starting session
baseline 80 which measures the performance of patient 5 in that
day. Session baseline 80 is stored transparently by clinical
database server 68 and can be used to track progress of patient 5
over the sequence of rehabilitation sessions. Patient 5 progress
can be graphed using remote graphing application 180 running on
remote computer 181. It is envisioned that remote computer 181
communicates with clinical database server over Internet 66.
Session baseline 80 is also used to fine-tune the "gains" of
exercise simulation blocks 81, 82 and 83, such that in virtual
reality movements are amplified and success assured even for very
limited real arm 7 movements. Exercise simulation blocks 81, 82 and
83 can perform exercise simulation 17. Intelligent agent block 84
monitors the patient progress and can automatically vary tilt angle
15 to assist/resist movement. Intelligent agent block 84 can
control actuators 20 through their controller 19 connected to
computer 16 running exercise simulation blocks 81, 82 and 83.
Actuators 20 provide data to exercise simulation blocks 81, 82 and
83 such that virtual table (not shown) in the scene mimics tilt of
tilting table 2. Video camera 9 detects the position of LEDs 50 at
the top of forearm support assembly 25 and sends the information to
tracking software 18 run by computer 16. Tracking software 18
extracts arm position information and body leaning information and
transmits this data to exercise simulation blocks 81, 82 and 83.
This data is then used to animate in real time an avatar of the
patient's hand(s) (not shown). Manual emergency switch 85, when
pressed by attending therapist and/or patient 5 triggers an end to
the rehabilitation session through software block 86.
[0053] FIG. 14 illustrates an example of patient baseline screen 87
displayed in display 8 or on display 69. Patient 5 is asked to move
the arm 7 in large circles to color virtual representation 88 of
the rehabilitation table surface 3. The surface of colored area 89
increases with the movement of virtual sphere 90 which responds to
the movements of forearm support assembly 25. Size and shape of
colored area 89 are a measure of the ability of patient 5 that day.
Extent of movement 91 in the left/right (horizontal) direction and
extent of movement 92 in the in/out direction are used to adjust
the rehabilitation exercise simulation blocks 81, 82 and 83.
Baseline screen 87 also shows tilt angle 15 at which baseline 80
was taken.
[0054] FIG. 15A shows an embodiment of rehabilitation exercise
simulation block 81 with a virtual world representation having
tilted table avatar 88. Virtual sphere 94 is shown on table surface
93 together with a virtual target rectangle 95. An ideal path
between virtual sphere 94 and virtual target rectangle 95 is
visualized by path shown as dotted line 96. The placement of
virtual target rectangle 95 and virtual sphere 94 on table surface
88 is such that it requires patient 5 to move arm 7 close to extent
of movement 91 and extent of movement 92 of baseline 87. Patient 5
is asked to pick up virtual sphere 94 with a semi-transparent hand
avatar 98 and place it in virtual target rectangle area 95. In
order to grasp virtual sphere 94, transparent hand avatar 98 has to
overlap virtual sphere 94 and patient 5 squeezes compliant element
44 on forearm support assembly 25, as shown in FIG. 1. Real
movement of patient 5 is tracked by video camera 9 and computer 16
shows a corresponding trace 97 on table surface 88.
[0055] FIG. 15B shows an alternate embodiment of exercise
simulation block 81 of the pick-and-place exercise in which ideal
path 96 shown as a straight dotted line. This corresponds to in/out
movements of arm 7. This process is repeated a number of times,
with the trial (repetition) number 190 and the total arm movement
(endurance) 191 corresponding to these repetitions being displayed
in simulation 81. Other placements of virtual target rectangle 95
and virtual sphere 94 can be used with corresponding ideal path
specifications 96. The difficulty exercise simulation block 81 such
as a pick-and-place exercise, is varied by making virtual target
rectangle 95 smaller and by requiring patient 5 to make more
pick-and-place movements. For patient 5 capable of exerting finger
forces 45, difficulty is further increased by elevating the
threshold of finger grasping forces 45 detected by the forearm
assembly 25 in FIG. 8 at which level corresponding hand avatar 98
can capture virtual sphere 94.
[0056] FIG. 15C shows bundle of traces 99 displayed by exercise
simulation block 81 at the end of exercises after a number of
pick-and-place movements were completed. In this embodiment, bundle
of traces 99 corresponds to repeated pick-and-place movements of
arm 7 in the left-right-left direction. The tightness of bundle of
traces 99 is indicative of the motor control abilities that day for
patient 5.
[0057] FIG. 16A shows an embodiment of exercise simulation block 82
referred to "Breakout 3D". This exercise depicts ball 100, paddle
101, and array of cubes 102, all located on play board 103. Paddle
101 is used to bounce ball 100 towards cubes 102 with one cube
being destroyed for each bounce of ball 100 off of paddle 101. Ball
100 can bounce off of three sides 104 of play board 103, or off
multiple cubes 102, but is lost if it misses paddle 101. In an
alternate embodiment, paddle 101 can move mostly left-right, within
the lower portion of play board 103, delineated by dashed line 105.
The difficulty of exercise simulation block 82 is set by the number
of available balls 100, the speed of balls 100, and the size of
paddle 101. The higher the speed of ball 100, the smaller the size
of paddle 101, and the fewer the number of available balls 100, the
harder the Breakout 3D of exercise simulation block 82 game is. The
goal of the Breakout 3D exercise simulation block 82 is to destroy
all cubes 102 with the available number of balls 100. The Breakout
3D of exercise simulation block 82 is designed to improve hand-eye
coordination and cognitive anticipatory strategies of patient
5.
[0058] FIG. 16B is another embodiment of the Breakout 3D of
exercise simulation block 82, in which board 103 is rotated to show
array of cubes 102 to one side of the scene. In this example paddle
101 moves mostly vertically in the scene, within the area to the
right of dotted line 105, requiring corresponding in-out-in
movements of arm 7.
[0059] FIG. 17 is an embodiment of exercise simulation block 83
called "Treasure Hunt". The scene depicts deserted island 106 with
line of stones 107 on top of virtual sand 108. The shape of line of
stones 107 replicates the shape of baseline surface colored area
89. There are a number of virtual treasures chests 109 inside sand
108 surrounded by line of stones 107. Patient 5 controls virtual
shovel 110 with which to remove sand 108 covering treasure chests
109. Every time a new treasure chest 109 is found score 111
displayed in the scene is increased. In order to find a new
treasure chest 109 shovel 110 has to be moved in sand 108 that
overlaps treasure chest 109. If tracking software 18 detects
leaning of patient 5 treasure chest 109 is not revealed even if
shovel 110 is in the correct position and score 111 is not
increased. At higher level of difficulty, a sand storm occurs. Part
of the already uncovered treasure chests 109 are covered again by
sand 108 requiring more movement of arm 7 of patient 5 arm 7 to
uncover treasure chest 109 again. The Treasure Hunt exercise
simulation block 83 is timed and remaining time 112 is displayed at
the top of the scene. Patient 5 attempts to uncover all of treasure
chests 109 in the allowed amount of time 112. This exercise is
aimed at increasing arm endurance of patient 5. In other
embodiments, other simulation exercises can be played by patient
5.
[0060] It is to be understood that the above-described embodiments
are illustrative of only a few of the many possible specific
embodiments, which can represent applications of the principles of
the invention. Numerous and varied other arrangements can be
readily devised in accordance with these principles by those
skilled in the art without departing from the spirit and scope of
the invention.
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