Virtual Reality Makes Physical Therapy Fun
The School of Physical Therapy at Old Dominion University is teaming with the university's Virginia Modeling, Analysis and Simulation Center (VMASC) and Center for Learning Technologies to give walking-impaired patients a helpful dose of virtual reality.
Researchers are using virtual-reality Parisian scenery or a dragon-and-princess fantasy game to encourage therapy patients to extend their workouts on a treadmill.
One team, led by Martha Walker, chair of physical therapy in ODU's College of Health Sciences, has recorded an impressive success rate through the first 18-months of a project for adults who are recovering from strokes.
Another project started in mid-2007 and led by Karen Kott, associate professor of physical therapy, and Gianluca De Leo, assistant professor of medical laboratory and radiation sciences, shows promise for improving ambulation in children with cerebral palsy.
The rehabilitation strategy being employed by Walker's team was illustrated by a visit to a lab in the Health Sciences Building early in February by a 62-year-old Portsmouth man who has hardly walked at all since he was disabled by a stroke in 2007. He does not have confidence in his balance, but he has told the researchers that he knows he must rise from his wheelchair and practice getting around on his own two feet if he is to get his balance back.
He is the seventh patient-hence the moniker of Patient 007 that he claimed for himself-to participate in the research project.
Toward the end of the 90-minute visit, Patient 007 will take a treadmill walk in a make-believe environment displayed on a large-screen television and driven by computer software. "It's more like you're out for a stroll than on a treadmill," Walker says. And it's not a routine stroll. The virtual environment follows a sidewalk along a busy boulevard, and as patients walk they see on the horizon the Arc de Triomphe. Could this be the Champs Elysees? Are we in Paris? A virtual walking mate named Chris urges patients to keep going so they can get a close-up look at the celebrated Arc.
The visual stimulation works for Patient 007. He surprises everyone in the lab, including himself, by walking five full minutes during his first therapy session.
In the virtual reality program developed by Kott and De Leo for children with cerebral palsy, three youngsters have been tested in a video-game environment to encourage their workouts on the treadmill. The better they perform, the quicker they can help conquer a dragon and rescue a princess. Each of the three young patients has shown improvements in various phases of ambulation measurements after three weeks of the workouts.
Virtual reality has long been used for military and pilot training. More recently, researchers have been looking at ways to adapt the technology for rehabilitation uses. Some groups have developed programs to enhance hand function or ankle function. Walker and her team decided to work on the whole-body task of walking. The combination of rehabilitation professionals and techno-wizards, such as engineers at VMASC, made ODU the perfect place to carry out research in virtual-reality-assisted therapies.
For startup funds, both projects turned to seed grant programs sponsored by the ODU Office of Research. The grants are designed to support collaborative research projects until they can compete for external funding.
Walker's team of investigators won a $75,000 multidisciplinary grant in 2006 for their project, "Virtual Reality in Gait Rehabilitation." Members of her team include De Leo and another faculty member from the College of Health Sciences, George Maihafer, associate professor of physical therapy. Stacie Ringleb, a biomechanical engineer and VMASC researcher, and Jessica Crouch, assistant professor of computer science, signed on as well, and so did Bonnie Van Lunen, assistant professor of exercise science, sport, physical education and recreation at ODU's Darden College of Education. From outside of ODU, Walker recruited Jean Shelton, chair of the physical medicine and rehabilitation department at EVMS, as well as Robert Walker, attending physician for the stroke rehabilitation unit at Sentara Norfolk General Hospital.
With the seed funding, the researchers began assembling their hardware-a personal computer, a 50-inch flat-screen television, a professional-grade treadmill and a harness-and-hoist device that can steady patients and, if necessary, support a little of their weight while they are gaining strength. Next came the software phase. Some of the simulation software could be purchased, but it had to be integrated into an overall program.
Early in 2007, Walker and Maihafer began to see patients. When Walker made the progress report that the Office of Research required in the summer of 2007, she told her audience that four patients had been seen, and that all four had made significant progress. These patients were recovering stroke victims who for one reason or another had stopped making progress in their physical therapy and were not walking as well as they wanted to. But put them on the Champs Elysees and, Voila! They walked and walked and walked, gaining strength with every visit to the lab.
Similar success was recorded for patients five and six in the second half of 2007. Patient 007 is off to a good start, and with each visit to the lab over the late winter and early spring, he will be encouraged to exercise for longer stretches of time on the treadmill.
Walker said this is just the start of the research project. She believes the research will be sustained by additional funding, which will allow the team to conduct more tests of the concept. She wants to tweak the concept, too. What if there were a selection of virtual environments from which the patients could choose? "We could say, 'Where would you like to go today?' My favorite is a zoo," she confesses. "The patient could make a virtual visit to a zoo." Also, she would like to present graphics on the screen that are more lifelike.
But she steadfastly maintains that she wants neither the hardware nor the software to get too sophisticated or expensive. "The idea is for this to be inexpensive enough so every clinic can afford to have one of these systems," she explains. Right now, the system in use, which is producing excellent results, can be had for under $10,000 if used with an existing treadmill and harness. A fancier set-up with three-dimensional imagery or holographs could cost many times that, putting it out of reach for the average clinic to buy. "Our goal," says Walker, "is to create a gait rehabilitation system that is effective and affordable so that all patients who need it can get the benefits."
Kott and De Leo, who received a $17,000 summer project grant from the Office of Research, are using the same television-and-treadmill system. Most of that team's effort has gone into the development of nine hours of virtual reality software. The title of the project is "Virtual Reality for Treadmill Training: Improving Functional Ambulation in Children with Cerebral Palsy."
Assisting with the project are Dr. Katrina Lester from the physical medicine and rehabilitation department at Eastern Virginia Medical School; physical therapy students Valerie Southerland, Nicole Ellis, Sherita Wilson and Shawn Rosengrant; and multimedia production staffers Brian Williamson, Stuart Gordon and Jacky Edwards from the ODU Center for Learning Technologies.
Rosengrant presented a winning paper at the VMASC national Capstone Conference in April 2007 outlining the project objectives. "Incorporating game-based, virtual-reality treadmill training into the treatment of children with cerebral palsy is proposed to improve their ability to develop to their highest ability and may prove to have benefits that last throughout their lifetime," the paper stated.
Kott and De Leo said they are working with the Office of Research to find sources of funding to keep the project going.