Objective: The adoption of telehealth rapidly accelerated due to the global COVID19 pandemic disrupting communities and in-person healthcare practices. While telehealth had initial benefits in enhancing accessibility for remote treatment, physical rehabilitation has been heavily limited due to the loss of hands-on evaluation tools. This paper presents an immersive virtual reality (iVR) pipeline for replicating physical therapy success metrics through applied machine learning of patient observation. Methods: We demonstrate a method of training gradient boosted decision-trees for kinematic estimation to replicate mobility and strength metrics with an off-the-shelf iVR system. During a two-month study, training data was collected while a group of users completed physical rehabilitation exercises in an iVR game. Utilizing this data, we trained on iVR based motion capture data and OpenSim biomechanical simulations. Results: Our final model indicates that upper-extremity kinematics from OpenSim can be accurately predicted using the HTC Vive head-mounted display system with a Mean Absolute Error less than 0.78 degrees for joint angles and less than 2.34 Nm for joint torques. Additionally, these predictions are viable for run-time estimation, with approximately a 0.74 ms rate of prediction during exercise sessions. Conclusion: These findings suggest that iVR paired with machine learning can serve as an effective medium for collecting evidence-based patient success metrics in telehealth. Significance: Our approach can help increase the accessibility of physical rehabilitation with off-the-shelf iVR head-mounted display systems by providing therapists with metrics needed for remote evaluation.
Inactivity and a lack of engagement with exercise is a pressing health problem in the United States and beyond. Immersive Virtual Reality (iVR) is a promising medium to motivate users through engaging virtual environments. Currently, modern iVR lacks a comparative analysis between research and consumer-grade systems for exercise and health. This article examines two such iVR mediums: the Cave Automated Virtual Environment (CAVE) and the head-mounted display (HMD). Specifically, we compare the room-scale Mechdyne CAVE and HTC Vive Pro HMD with a custom in-house exercise game that was designed such that user experiences were as consistent as possible between both systems. To ensure that our findings are generalizable for users of varying abilities, we recruited 40 participants with and without cognitive disabilities with regard to the fact that iVR environments and games can differ in their cognitive challenge between users. Our results show that across all abilities, the HMD excelled in in-game performance, biofeedback response, and player engagement. We conclude with considerations in utilizing iVR systems for exergaming with users across cognitive abilities.
Immersive Virtual Reality (iVR) Head-Mounted Display (HMD) systems paired with serious exercise games can positively augment physical rehabilitation process from both engagement and analytics perspectives. This paper presents a serious game for iVR HMD based long term upper-extremity exercise. We demonstrate the capabilities of our game through a case study with five users recovering from upper-extremity injuries. We examine how our program maintains engagement and motivation over eight weeks, where users completed bi-weekly prescribed movements framed as protecting a virtual butterfly. We assess user experiences through a mixture of biomarkers from brainwave, heart rate, and galvanic skin response recorded at runtime as well as motion capture and behavioral game data. Our results suggest that the iVR game was an effective medium in inducing high compliance, physical performance, and biometric changes even with increasing difficulty beyond the novelty effect period. We conclude with considerations of future work for iVR physical therapy games that adapt to biometric response.
Most physical therapists would agree that physical rehabilitation is difficult to perform remotely. Consequently, the global COVID-19 pandemic has forced many physical therapists and their clients to adapt to telehealth, especially with video conferencing. In this article, we ask: How has telehealth for physical rehabilitation evolved with the global pandemic and what are the largest technological needs, treatment methodologies, and patient barriers? With the increased widespread use of telehealth for physical therapy, we present a qualitative study towards examining the shortcomings of current physical therapy mediums and how to steer future virtual reality technologies to promote remote patient evaluation and rehabilitation. We interviewed 130 physical rehabilitation professionals across the United States through video conferencing during the COVID19 pandemic from July—August 2020. Interviews lasted 30–45 min using a semi-structured template developed from an initial pilot of 20 interviews to examine potential barriers, facilitators, and technological needs. Our findings suggest that physical therapists utilizing existing telehealth solutions have lost their ability to feel their patients’ injuries, easily assess range of motion and strength, and freely move about to examine their movements when using telehealth. This makes it difficult to fully evaluate a patient and many feel that they are more of a “life coach” giving advice to a patient rather than a traditional in-person rehabilitation session. The most common solutions that emerged during the interviews include: immersive technologies which allow physical therapists and clients 1) to remotely walk around each other in 3D, 2) enable evidence-based measures, 3) automate documentation, and 4) provider clinical practice operation through the cloud. We conclude with a discussion on opportunities for immersive virtual reality towards telehealth for physical rehabilitation.
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