Computer Assisted Rehabilitation Environment System Research Articles

The use of the computer assisted rehabilitation environment in assessment and rehabilitation

Purpose. The purpose of this review article was to review and analyze the available literature regarding one of the most advanced virtual reality technologies. We reviewed and analyzed the use of the computer-assisted rehabilitation environment system in assessment and rehabilitation.
 Materials and methods. PubMed, Web of Science, Cochrane Library, Scopus, and Physiotherapy Evidence Database databases were searched from inception to October 2021. We used the search term “Computer Assisted Rehabilitation Environment” and included articles which directly or indirectly addressed the use of the computer assisted rehabilitation environment system in assessment, rehabilitation and on healthy people. We excluded articles not published in the English language, conference proceedings, reports of abstracts only, and duplicated articles. Also, articles addressing the use of other virtual reality technologies whether they used fully immersive, semi-immersive, or non-immersive interfaces or virtual reality devices such as the Wii or Xbox gaming technologies were also excluded. The relevant studies were collected and critically analyzed.
 Results. Our search retrieved 205 articles, with 119 duplicates identified and removed. Following screening 86 articles, we included 50 relevant articles which directly or indirectly addressed the computer-assisted rehabilitation environment system and were published in scientific journals. Twenty-two articles used the computer assisted rehabilitation environment for biomechanical analysis, 15 articles used the computer assisted rehabilitation environment for rehabilitation, 4 articles were reviews, and 9 articles addressed the computer assisted rehabilitation environment in other ways.
 Conclusion. The computer assisted rehabilitation environment system is a promising tool for assessment and rehabilitation. It can be used with different concepts to assist in diagnosis and treatment, can be used for healthy individuals and with patients, and basically follows biomechanical principles in operating. The high cost and complex infrastructure, however, may be the restriction to its use for research purposes and in clinical practice.

Multiview Video-Based 3-D Pose Estimation of Patients in Computer-Assisted Rehabilitation Environment (CAREN)

The computer-assisted rehabilitation environment (CAREN) system plays an important role in the training of rehabilitation patients, where the capture of the patient's 3-D pose and gait is critical for assessing the patient's requirements for effective training. Vision-based methods are highly effective for this task due to their low cost, high speed, and noninterference. Although various general vision-based pose estimation methods were developed recently, their performance is limited in the CAREN system due to the specific environment. To address these problems, we propose an improved framework for accurate 2-D and 3-D pose estimation for the CAREN system through using multiview videos. First, for 2-D pose estimation, we propose a coarse-to-fine heatmap shrinking (CFHS) strategy that gradually reduces the kernel size of the heatmap of joints during training to improve the performance. Second, to further obtain 3-D pose estimations, we propose a novel spatial-temporal perception network that fuses the 2-D results from multiple views and multiple moments; multiview early fusion uses complementary spatial information from different views, and multimoment late fusion leverages temporal information from the sequential input for higher accuracy. The experimental results, based on CAREN videos of 225 orthopedic patients, showed that the accuracy of 2-D human pose estimations with the CFHS training strategy reached 99.85% PCKh@0.5. For 3-D results, the mean per joint position error was 25.22 mm, and the 3DPCK reached 98.71%, which outperformed existing general video-based methods. The results showed that the proposed system is capable of estimating human poses with high accuracy for clinical applications.

The Effects of Ship’s Roll Motion on the Center of Mass and Margin of Stability During Walking: A Simulation Study

Walking strategies in an unstable environment like a ship differ from walking on stable ground. Extreme ship motions may endanger the safety of the crews. Notably, a loss of balance on board can lead to an injury or an accident of falling off a ship. Keeping one’s balance on board a ship is strongly influenced by the ship’s motion. Therefore, the objective of this study is to determine how walking on a ship differs from walking in a stable environment and explore the effects of the ship’s roll motion on balance control and stability while walking in sea environments. We hypothesized that step time variability, center of mass (COM), and margin of stability (MOS) would significantly differ between stable and unstable walking conditions. We also hypothesized that there would be an effect of rolling cycles and angles on increasing step time variability, COM excursion, and MOS variability. We recruited 30 healthy individuals between 21 and 39 years old for this study. Participants walked for two minutes at their self-selected speeds during the study with and without rolling on a computer-assisted rehabilitation environment (CAREN) system. The CAREN system was used to simulate the parametric roll motion of ships up to 20 degrees. This study quantified step time variability, peak COM excursion, and MOS variability in different rolling conditions. We found a significant difference in step time variability (p < 0.001), lateral peak COM excursion (p < 0.001), and MOS variability (p < 0.001) between waking on land and walking at sea.

Effects of arm swing amplitude and lower limb asymmetry on motor variability patterns during treadmill gait

Motor variability is a fundamental feature of gait. Altered arm swing and lower limb asymmetry (LLA) may be contributing factors having been shown to affect the magnitude and dynamics of variability in spatiotemporal and trunk motion. However, the effects on lower limb joints remain unclear.Full-body kinematics of 15 healthy young adults were recorded during treadmill walking using the Computer-Assisted Rehabilitation Environment system. Participants completed six trials, combining three arm swing (AS) amplitude (normal, active, held) and two LLA (symmetrical, asymmetrical) conditions. The mean standard deviation (meanSD), maximum Lyapunov exponent (λmax), detrended fluctuation analysis scaling exponent of range of motion (DFAα), and sample entropy (SaEn) were computed for tridimensional trunk, pelvis, and lower limb joint angles, and compared using repeated-measures ANOVAs.Relative to normal AS, active AS increased meanSD of all joint angles, λmax of frontal plane hip and ankle angles, and SaEn of sagittal plane ankle angles. Active AS, however, did not affect λmax or SaEn of trunk or pelvis angles. LLA increased meanSD of sagittal plane joint angles, λmax of Euclidean norm trunk angle and of lower limb joint angles, and SaEn of ankle dorsiflexion/ plantarflexion, but decreased SaEn of tridimensional trunk angles and hip rotation in the slower moving leg.Alterations in lower limb variability with active AS and LLA suggest that young adults actively exploit their lower limb redundancies to maintain gait. This appears to preserve trunk stability and regularity during active AS but not during LLA.

Assessment of Computer Assisted Rehabilitation Environment (CAREN) System Use and Mood in Patients With Multiple Sclerosis.

Depression is a common comorbidity in patients with multiple sclerosis (MS) and is associated with decreased quality of life. Identifying treatments that aid psychological and physical rehabilitation in patients with MS provides valuable information for interdisciplinary teams. Seventy-five adults with MS who completed the Patient Health Questionnaire-9 (PHQ-9) and Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scale during routine physical therapy appointments where the (CAREN) system was used were studied. Data were retrospective and collected via patient-reported outcomes. Group comparisons used 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. To examine self-reported depression, mean ± SD baseline scores were computed and stratified by number of CAREN sessions. Patients with 5 or more sessions seemed to have lower baseline PHQ-9 and PROMIS Mental Health scores; however, no significant differences were found at the univariate level. There were no statistically significant differences in follow-up scores for the outcome measures. Current research evaluating the rehabilitation of patients with MS using the CAREN system is scarce. This pilot study is important to inform prospective studies exploring use of the CAREN system for psychological rehabilitation. Patients with 5 or more CAREN sessions had lower baseline PHQ-9 scores, which may suggest that mood plays a role in the selection of patients for CAREN system use. This study shows that mood is not affected by the CAREN system. More specific research needs to be completed with a more robust sample.

The effect of various arm and walking conditions on postural dynamic stability when recovering from a trip perturbation

BackgroundAppropriately responding to unexpected perturbations, such as a trip, is critical to sustain balance and avoid falling during walking. Research questionHow do arm motion and walking asymmetry affect postural stability when recovering from a trip perturbation? MethodsFifteen healthy young individuals, who had no experience with treadmill induced perturbations, participated in this study. The Computer-Assisted Rehabilitation Environment system (CAREN-Extended) was used to simulate unexpected perturbations while walking symmetrically and asymmetrically with various arm swings (normal, bound, released). Whole-body angular momentum (WBAM), peak trunk angular velocities, Center of Mass (COM), step width and stance time were analyzed before and when recovering from trip perturbations. ResultsParticipants were able to recover their postural stability within three strides following the sudden anterior-posterior trip perturbation. The perturbation increased peak trunk angular velocity, the COM excursion and WBAM but did not affect stance time and step width. The arm conditions had significant effects on peak trunk angular velocity, WBAM and step width during pre-perturbation. Walking conditions had a significant effect on all variables during pre-perturbation; however, post-perturbation showed significant effects only for peak trunk angular velocity, WBAM, and COM. SignificanceUnexpected perturbation had effects on most of gait variables; nevertheless, participants fully recovered and adapted their gait pattern to sudden perturbations even without using their arms while walking symmetrically and asymmetrically. Arm movements could help young individuals recover after a perturbation but are not essential for perturbations of moderate magnitude. The effect of medial-lateral perturbations on gait still need to be investigated.

Computer-Assisted Immersive Visual Rehabilitation in Argus II Retinal Prosthesis Recipients

The field of retinal prostheses is expanding. However, the best approach to training and assessing the functional benefit of postoperative vision has not been established. The purpose of this single-center prospective interventional case series was to evaluate the feasibility and effectiveness of using the Computer Assisted Rehabilitation Environment (CAREN) system as a visual rehabilitation tool in Argus II patients. Single-center prospective interventional case series (clinicaltrials.gov identifier, NCT03444961). Four Argus II recipients (3 men and 1 woman). Eight visual rehabilitation sessions using the CAREN system (twice weekly for 4 weeks). Baseline and postintervention assessments consisted of visual function, mobility, and balance tests. All patients successfully completed training on the CAREN system. While the Argus II device was active, walking speed increased from baseline to immediately after the intervention on flat and undulating surfaces and while localizing objects by 20%, 10%, and 18%, respectively. An improved ability to complete the timed up and go test successfully was observed. Novel methods of visual rehabilitation for retinal prostheses recipients, such the CAREN system, are feasible and may result in improved ability to use the Argus II while performing functional tasks. Immersive technology may provide a solution for the standardization of effective rehabilitation approaches to augment retinal prosthesis performance. Heterogeneity of results indicates that a larger sample size would be beneficial.

Gait Characteristics of Children with Spastic Cerebral Palsy during Inclined Treadmill Walking under a Virtual Reality Environment.

Objective To investigate gait characteristics in children with spastic cerebral palsy during inclined treadmill walking under a virtual reality environment. Methods Ten spastic cerebral palsy (CP) children and ten typically developing (TD) children were asked to walk at their comfortable speed on a treadmill at a ground level and 10° inclined. Three-dimensional kinematic data and ground reaction force data were captured in a computer-assisted rehabilitation environment system. Kinetic parameters and dynamic balance parameters were calculated using a standard biomechanical approach. Results During uphill walking, both groups decreased walking speed and stride length and increased peak pelvis tilt, ankle dorsiflexion, and hip flexion. Compared with TD children, CP children had decreased walking speed and stride length, decreased peak hip abduction moment, increased stance phase percentage, increased peak ankle dorsiflexion and knee flexion, and increased peak hip extension moment. The peak trunk rotation angle, ankle angle at initial contact, and stride length showed a significant group∗walking condition interaction effect. Conclusions CP children showed similar adjustments for most gait parameters during uphill walking as TD children. With a lower walking speed, CP children could maintain similar dynamic balance as TD children. Uphill walking magnifies the existing abnormal gait patterns of the cerebral palsy children. We suggest that during a treadmill training with an inclination, the walking speed should be carefully controlled in the case of improving peak joint loading too much.

Effects and feasibility of virtual reality system vs traditional physical therapy training in multiple sclerosis patients

Background/Aims: Traditionally, physical therapy for gait and balance training takes place in a gym setting, which may not fully reproduce situations in everyday activities. The Computer Assisted Rehabilitation ENvironment system provides an immersive virtual environment, allowing a simulation of complex conditions conducive to gait and balance training. The purpose of this study was to determine: (1) the feasibility and safety of using the Computer Assisted Rehabilitation ENvironment system for physical therapy sessions with multiple sclerosis patients, and (2) pre-post treatment changes observed with the Computer Assisted Rehabilitation ENvironment system compared to traditional physical therapy. Findings: Data from functional outcome measures Berg Balance Scale, Timed Up and Go test, Timed 25-Foot Walk, and 6-Minute Walk Test were extracted from the medical records of 62 patients with multiple sclerosis who had at least three physical therapy sessions in either environment. Statistically significant within-group improvements were observed for all outcome measures in the physical therapy Computer Assisted Rehabilitation ENvironment system group (P&lt;0.05), and only for Berg Balance Scale in the traditional physical therapy group. There was a significant between-group difference in favour of physical therapy with the Computer Assisted Rehabilitation ENvironment system for the Timed 25-Foot Walk (P=0.022). Conclusions: The results suggest the Computer Assisted Rehabilitation ENvironment system is a safe and effective tool for physical therapy-led gait and balance training for individuals with multiple sclerosis.

Recording Auditory and Visual Evoked Responses With Mobile EEG Systems in a Computer Assisted Rehabilitation Environment (CAREN)

The Computer Assisted Rehabilitation Environment (CAREN) is a novel, real-time virtual reality environment for recording, evaluation, and training of functional human behavior. Advances in the field of neuroscience have demonstrated that recording electroencephalography (EEG) in such a dynamic setting is necessary for studying brain functions and critical in evaluating and rehabilitating human behaviors after brain injuries. Advances in technology over the last few years have made it feasible to record EEG on human subjects performing cognitive tasks in a dynamic setting with real-time actions, although this remains to be tested extensively. The purpose of this study was to test the performance of three mobile EEG systems integrated into the CAREN on subjects performing classic auditory and visual oddball tasks in resting and active states. The recorded EEG signals were processed off-line to remove movement artifact by using algorithms representing state-of-the-art techniques of digital signal processing. Results revealed similar patterns of evoked responses whether the subjects were sitting or walking while performing the oddball tasks, demonstrating the feasibility and viability of recording EEG in a virtual reality environment with real-time actions. Implementation of mobile EEG recording systems into the CAREN system will offer unique opportunities to study cognitive brain function in a dynamic virtual environment and to develop effective methods for behavior and functional rehabilitation after brain injuries.

Use of the CAREN system as a treatment adjunct for Canadian Armed Forces members with chronic non-specific low back pain: a pilot study

Introduction: Non-specific chronic low back pain (cLBP) is a significant concern for the Canadian Armed Forces (CAF). Some CAF members develop pain-related fear of movement that is difficult to treat. The goal of this pilot study was to test the feasibility of applying a virtual reality exercise program using the Computer Assisted Rehabilitation Environment (CAREN) with CAF members with cLBP and kinesiophobia. Methods: Participants were randomized into one of two treatment groups or a control group. The treatment groups received 10 CAREN sessions over 2.5 weeks (high intensity) or over 5 weeks (low intensity), and the control group received exercise instruction alone. A standard CAREN protocol using five applications was used to encourage trunk movement and stability. Results: Eleven participants were recruited. Both CAREN treatment protocols were feasible, with 100% attendance, and CAREN performance continued to improve over the 10 sessions with no plateau. CAREN participants showed stable or slightly improved scores on outcome measures from baseline to post-intervention. Participants showed no consistency on the physical performance measures, with ceiling effects or variability noted between participants. Discussion: Significant inferences regarding effectiveness cannot be made because of the low number of participants. The CAREN treatment protocol was shown to be feasible and well tolerated at these intensities. The outcome measures that show the most promise for future study include the Oswestry Disability Index, Fear of Daily Activities Questionnaire, Edgren Side Step Test, and 30-second chair stand. Future randomized controlled trials to study the effectiveness of the CAREN intervention should include military-relevant outcomes and cost efficiency.

The use of a computer-assisted rehabilitation environment (CAREN) for enhancing wounded warrior rehabilitation regimens

PurposeThis paper seeks to describe how novel technologies such as the computer-assisted rehabilitation environment (CAREN) may improve physical and cognitive rehabilitation for wounded warfighters.Design/methodology/approachThe CAREN system is a dynamic platform which may assist service members who have sustained improvised explosive device injuries during Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. The complex nature of warfighter injuries present unique rehabilitation challenges that demand new tools for quick return to active duty or the civilian community.FindingsVirtual reality-based gait training programs may directly influence physiological and biomechanical performance for those who have endured combat injuries. The CAREN system provides a safe, interactive environment for the user while capturing kinematic and kinetic data capture to improve rehabilitation regimens.ConclusionsThis paper provides an overview of the CAREN system and describes how this dynamic rehabilitation aid may be a translational tool for collecting biomechanical and physiological data during prosthetic training. The CAREN platform allows users to be fully immersed in a virtual environment while healthcare providers use these simulations to improve gait and stability, obstacle avoidance, or improved weight shifting. As such, rehabilitation regimens may be patient specific.