This paper describes an avenue for artificial and computational intelligence techniques applied within games research to be deployed for purposes of physical therapy. We provide an overview of prototypical research focussed on the application of motion sensor input devices and virtual reality equipment for rehabilitation of motor impairment: an issue typical of patients of traumatic brain injuries. We highlight how advances in procedural content generation and player modelling can stimulate development in this area by improving quality of rehabilitation programmes and measuring patient performance.
In many respects the ideas of rehabilitation-driven games share similarities with that of dynamic difficulty adjustment. However, as noted in the likes of @cite_7 , the challenges faced are more nuanced given the physical challenges faced by patients. A notable example can be found in the Intelligence Game Engine for Rehabilitation (IGER) detailed in @cite_11 @cite_15 which is focussed on the recording and management of physiotherapy for stroke patients. This system adopts an adaptive fuzzy-driven approach to catering for the patients rehabilitation process. This is achieved while working with a variety of small mini-games that utilise peripherals such as the Microsoft Kinect and Nintendo Wii Fit board. This system places emphasis on ensuring that the parameters of the current game are such that it should not result in activities that player might find painful.
@cite_15 @cite_7 @cite_11
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Rehabilitation for chronic pain follows a multidisciplinary approach, which despite the effort, often lacks the long term success and patients often fail to translate the skills learned in therapy to every day life. Serious games are hypothesized to support patients to self manage their complaints and keep training their physical functions by themselves, especially, when the game is controlled by the patient's own body performance. In this paper we present the implementation of a system providing multimodal input, including our own full body motion capture system, a low cost motion capture system (Microsoft Kinect) and biosignal acquisition devices to a game engine. In addition, a workflow has been established, that enables the use of the acquired multimodal data for serious games in a medical environment. Finally, a serious game has been implemented, targeting rehabilitation of patients with chronic pain of the lower back and neck. The focus of this work is on the multimodal input and how it is used in a game to support rehabilitation of chronic pain patients. A brief comparison of a marker-based full body MoCap system and Microsoft's Kinect is included. Preliminary results of tests currently underway are provided. Computer games are a promising tool to support rehabilitation at home. It is widely recognized that rehabilitation games should (i) be nicely integrated in general-purpose rehabilitation stations, (ii) adhere to the constraints posed by the clinical protocols, (iii) involve movements that are functional to reach the rehabilitation goal, and (iv) adapt to the patients' current status and progress. However, the vast majority of existing rehabilitation games are stand-alone applications (not integrated in a patient station), that rarely adapt to the patients' condition. In this paper, we present the first prototype of the patient rehabilitation station we developed that integrates video games for rehabilitation with methods of computational intelligence both for on-line monitoring the movements' execution during the games and for adapting the gameplay to the patients' status. The station employs a fuzzy system to monitor the exercises execution, on-line, according to the clinical constraints defined by the therapist at configuration time, and to provide direct feedback to the patients. At the same time, it applies real-time adaptation (using the Quest Bayesian adaptive approach) to modify the gameplay according both (i) to the patient current performance and progress and (ii) to the exercise plan specified by the therapist. Finally, we present one of the games available in our patient stations (designed in tight cooperation with therapists) that integrates monitoring functionalities with in-game self-adaptation to provide the best support possible to patients during their routine. Abstract Objective: The aim of this article is to describe a game engine that has all the characteristics needed to support rehabilitation at home. The low-cost tracking devices recently introduced in the entertainment market allow measuring reliably at home, in real time, players' motion with a hands-free approach. Such systems have also become a source of inspiration for researchers working in rehabilitation. Computer games appear suited to guide rehabilitation because of their ability to engage the users. However, commercial videogames and game engines lack the peculiar functionalities required in rehabilitation: Games should be adapted to each patient's functional status, and monitoring the patient's motion is mandatory to avoid maladaptation. Feedback on performance and progression of the exercises should be provided. Lastly, several tracking devices should be considered, according to the patient's pathology and rehabilitation aims. Subjects and Methods: We have analyzed the needs of the clinicians a... Effective stroke rehabilitation must be early, intensive and repetitive, which can lead to problems with patient motivation and engagement. The design of video games, often associated with good user engagement, may offer insights into how more effective systems for stroke rehabilitation can be developed. In this paper we identify game design principles for upper limb stroke rehabilitation and present several games developed using these principles. The games use low-cost video-capture technology which may make them suitable for deployment at home. Results from evaluating the games with both healthy subjects and people with stroke in their home are encouraging. Most formal rehabilitation facilities are situated in a hospital or care center setting, which may not always be conveniently accessible for patients, especially those in geographically isolated areas. Home-based rehabilitation has potential to offer greater accessibility and thus increase consistent uptake. In addition, the exercise performed in conventional rehabilitation contexts may be insufficient to ensure the patient's speedy recovery, with complimentary rehabilitation exercises at home required to make a difference. The goal is to provide effective home-based rehabilitation offering outcomes similar to those obtained through hospital-based rehabilitation under the supervision of an occupational therapist. This paper presents the development of a Kinect-based system for ensuring home-based rehabilitation using a Dynamic Time Warping (DTW) algorithm and fuzzy logic. The ultimate goal is to assist patients in conducting safe and effective home-based rehabilitation without the immediate supervision of a physician. This paper introduces a human computer interaction system by using hand gesture recognition to apply into game-based rehabilitation application. The basic concept of this project is to assist patient to carry out rehabilitation with hand gesture recognition, meanwhile therapist is able to follow recovery progress of patient through results. In this manner, a rehabilitation system created aimed to increase efficacy in patient treatment with interactive game. The system is applied in real time application to contribute as a function of a virtual mouse. Approach proposed including hand region segmentation, hand palm partition and finger counting. Computer mouse is configured to move according to the location of hand palm region, and perform function of ordinary mouse according to number of fingers detected. In the analysis, experiments is carried out to show how this system collaborate with the simple rehabilitation game in computer. Experiment evaluation as shown has successfully demonstrate the effectiveness and robustness in performing the mouse function and feasible to be implemented into rehabilitation games. In recent years, the field of Human-Computer Interaction (HCI) has been advanced with many technologies, however, most are limited to healthy users. In this paper, we leveraged the technology of free-hand interaction to rehabilitate patients with stroke. We modified the game of Fruit Ninja to use Leap Motion controller's hand tracking data for stroke patients with arm and hand weakness to practice their finger individuation. In a pilot study, we recruited 14 patients with chronic stroke to play the game using natural interaction. Their Fruit Ninja (FN) scores show high correlation with the standard clinical assessment scores such as Fugl-Meyer (FMA) and Box-and-Blocks Test (BBT) scores. This finding suggests that our free-hand Fruit Ninja's score is a good indicator of the patient's hand function and therefore will be informative if used in their rehabilitation. Abstract This paper proposes the use of a non-immersive virtual reality rehabilitation system "ReHabgame" developed using Microsoft Kinect™ and the Thalmic™ Labs Myo gesture control armband. The ReHabgame was developed based on two third-person video games that provide a feasible possibility of assessing postural control and functional reach tests. It accurately quantifies specific postural control mechanisms including timed standing balance, functional reach tests using real-time anatomical landmark orientation, joint velocity, and acceleration while end trajectories were calculated using an inverse kinematics algorithm. The game was designed to help patients with neurological impairment to be subjected to physiotherapy activity and practice postures of daily activities. The subjective experience of the ReHabgame was studied through the development of an Engagement Questionnaire (EQ) for qualitative, quantitative and Rasch model. The Monte-Carlo Tree Search (MCTS) and Random object (ROG) generator algorithms were used to adapt the physical and gameplay intensity in the ReHabgame based on the Motor Assessment Scale (MAS) and Hierarchical Scoring System (HSS). Rasch analysis was conducted to assess the psychometric characteristics of the ReHabgame and to identify if these are any misfitting items in the game. Rasch rating scale model (RSM) was used to assess the engagement of players in the ReHabgame and evaluate the effectiveness and attractiveness of the game. The results showed that the scales assessing the rehabilitation process met Rasch expectations of reliability, and unidimensionality. Infit and outfit mean squares values are in the range of (0.68–1.52) for all considered 16 items. The Root Mean Square Residual (RMSR) and the person separation reliability were acceptable. The item person map showed that the persons and items were clustered symmetrically. Mobility improvement for patients is one of the primary concerns of physiotherapy rehabilitation. Providing the physiotherapist and the patient with a quantified and objective measure of progress can be beneficial for monitoring the patient's performance. In this paper, two approaches are introduced for quantifying patient performance. Both approaches formulate a distance between patient data and the healthy population as the measure of performance. Distance measures are defined to capture the performance of one repetition of an exercise or multiple repetitions of the same exercise. To capture patient progress across multiple exercises, a quality measure and overall score are defined based on the distance measures and are used to quantify the overall performance for each session. The effectiveness of these measures in detecting patient progress is evaluated on rehabilitation data recorded from patients recovering from knee or hip replacement surgery. The results show that the proposed measures are able to capture the trend of patient improvement over the course of rehabilitation. The trend of improvement is not monotonic and differs between patients. Objective: The objective of the proposed research is to develop a methodology for modeling and evaluation of human motions, which will potentially benefit patients undertaking a physical rehabilitation therapy (e.g., following a stroke or due to other medical conditions). The ultimate aim is to allow patients to perform home-based rehabilitation exercises using a sensory system for capturing the motions, where an algorithm will retrieve the trajectories of a patient’s exercises, will perform data analysis by comparing the performed motions to a reference model of prescribed motions, and will send the analysis results to the patient’s physician with recommendations for improvement. Methods: The modeling approach employs an artificial neural network, consisting of layers of recurrent neuron units and layers of neuron units for estimating a mixture density function over the spatio-temporal dependencies within the human motion sequences. Input data are sequences of motions related to a prescribed exercise by a physiotherapist to a patient, and recorded with a motion capture system. An autoencoder subnet is employed for reducing the dimensionality of captured sequences of human motions, complemented with a mixture density subnet for probabilistic modeling of the motion data using a mixture of Gaussian distributions. Results: The proposed neural network architecture produced a model for sets of human motions represented with a mixture of Gaussian density functions. The mean log-likelihood of observed sequences was employed as a performance metric in evaluating the consistency of a subject’s performance relative to the reference dataset of motions. A publically available dataset of human motions captured with Microsoft Kinect was used for validation of the proposed method. Conclusion: The article presents a novel approach for modeling and evaluation of human motions with a potential application in home-based physical therapy and rehabilitation. The described approach employs the recent progress in the field of machine learning and neural networks in developing a parametric model of human motions, by exploiting the representational power of these algorithms to encode nonlinear input-output dependencies over long temporal horizons. 3D interfaces use motion sensing, physical input, and spatial interaction techniques to effectively control highly dynamic virtual content. Now, with the advent of the Nintendo Wii, Sony Move, and Microsoft Kinect, game developers and researchers must create compelling interface techniques and game-play mechanics that make use of these technologies. At the same time, it is becoming increasingly clear that emerging game technologies are not just going to change the way we play games, they are also going to change the way we make and view art, design new products, analyze scientific datasets, and more. This introduction to 3D spatial interfaces demystifies the workings of modern videogame motion controllers and provides an overview of how it is used to create 3D interfaces for tasks such as 2D and 3D navigation, object selection and manipulation, and gesture-based application control. Topics include the strengths and limitations of various motion-controller sensing technologies in today's peripherals, useful techniques for working with these devices, and current and future applications of these technologies to areas beyond games. The course presents valuable information on how to utilize existing 3D user-interface techniques with emerging technologies, how to develop interface techniques, and how to learn from the successes and failures of spatial interfaces created for a variety of application domains. This paper presents a development program of a new rehabilitation workstation for hand dysfunction. The rehabilitation workstation has functions as follows: hand dysfunction diagnosis, assessment of disability, hand rehabilitation by physical training. With the assistance of data gloves as well as hand strength measuring training devices designed by the present authors, this workstation measures the hand joints movement accurately, and assesses and trains muscle strength. The system assists physiatrists to perform clinical activities and conduct scientific researches such as disability evaluation, treatment decision, recovery evaluation, clinical information analysis and data filing. As a result, an integral system can be established for rehabilitation of hand dysfunction. This system makes the simultaneous treatments available to patients by simply increasing the number of hand-training devices; the efficiency of rehabilitation is improved consequently. The application of a robot to rehabilitation has become a matter of great concern. This paper deals with functional recovery therapy, one important aspect of physical rehabilitation. Single-joint therapy machines have already been achieved. However, for more efficient therapy, multjoint robots are necessary to achieve more realistic motion patterns. This kind of robot must have a high level of safety for humans. A pneumatic actuator may be available for such a robot, because of the compliance of compressed air. A pneumatic rubber artificial muscle manipulator has been applied to construct a therapy robot with two degrees of freedom (DOF). Also, an impedance control strategy is employed to realize various motion modes for the physical therapy modes. Further, for efficient rehabilitation, it is desirable to comprehend the physical condition of the patient. Thus, the mechanical impedance of the human arm is used as an objective evaluation of recovery, and an estimation method is proposed. Experiments show the suitability of the proposed rehabilitation robot system. Monitoring and interpreting (sub)cortical reorganization after stroke may be useful for selecting therapies and improving rehabilitation outcome. To develop computational models that predict behavioral motor improvement from changing brain activation pattern, we are currently working on the implementation of a clinically feasible experimental set-up, which enables recording high quality electroencephalography (EEG) signals during inpatient rehabilitation of upper and lower limbs. The major drawback of current experimental paradigms is the cue-guided repetitive design and the lack of functional movements. In this paper, we assess the usability of the Kinect device (Microsoft Inc., Redmond, WA, USA) for tracking self-paced hand opening and closing movements. Three able-bodied volunteers performed self-paced right hand open-close movement sequences while EEG was recorded from sensorimotor areas and electromyography (EMG) from the right arm from extensor carpi radialis and flexor carpi radialis muscles. The results of the study suggest that the Kinect device allows generation of trigger information that is comparable to the information that can be obtained from EMG. This paper presents a novel generalized computational framework for quantitative kinematic evaluation of movement in a rehabilitation clinic setting. The framework integrates clinical knowledge and computational data‐driven analysis together in a systematic manner. The framework provides three key benefits to rehabilitation: (a) the resulting continuous normalized measure allows the clinician to monitor movement quality on a fine scale and easily compare impairments across participants, (b) the framework reveals the effect of individual movement components on the composite movement performance helping the clinician decide the training foci, and (c) the evaluation runs in real‐time, which allows the clinician to constantly track a patient’s progress and make appropriate adaptations to the therapy protocol. The creation of such an evaluation is difficult because of the sparse amount of recorded clinical observations, the high dimensionality of movement and high variations in subject’s performance. We addres... A comprehensive examination of the interfaces of logic, computer science, and game theory, drawing on twenty years of research on logic and games.This book draws on ideas from philosophical logic, computational logic, multi-agent systems, and game theory to offer a comprehensive account of logic and games viewed in two complementary ways. It examines the logic of games: the development of sophisticated modern dynamic logics that model information flow, communication, and interactive structures in games. It also examines logic as games: the idea that logical activities of reasoning and many related tasks can be viewed in the form of games.In doing so, the book takes up the ?intelligent interaction? of agents engaging in competitive or cooperative activities and examines the patterns of strategic behavior that arise. It develops modern logical systems that can analyze information-driven changes in players' knowledge and beliefs, and introduces the ?Theory of Play? that emerges from the combination of logic and game theory. This results in a new view of logic itself as an interactive rational activity based on reasoning, perception, and communication that has particular relevance for games.Logic in Games, based on a course taught by the author at Stanford University, the University of Amsterdam, and elsewhere, can be used in advanced seminars and as a resource for researchers. Scholars are increasingly citing electronic “web references” which are not preserved in libraries or full text archives. WebCite is a new standard for citing web references. To “webcite” a document involves archiving the cited Web page through www.webcitation.org and citing the WebCite permalink instead of (or in addition to) the unstable live Web page. This journal has amended its “instructions for authors” accordingly, asking authors to archive cited Web pages before submitting a manuscript. Almost 200 other journals are already using the system. We discuss the rationale for WebCite, its technology, and how scholars, editors, and publishers can benefit from the service. Citing scholars initiate an archiving process of all cited Web references, ideally before they submit a manuscript. Authors of online documents and websites which are expected to be cited by others can ensure that their work is permanently available by creating an archived copy using WebCite and providing the citation information including the WebCite link on their Web document(s). Editors should ask their authors to cache all cited Web addresses (Uniform Resource Locators, or URLs) “prospectively” before submitting their manuscripts to their journal. Editors and publishers should also instruct their copyeditors to cache cited Web material if the author has not done so already. Finally, WebCite can process publisher submitted “citing articles” (submitted for example as eXtensible Markup Language [XML] documents) to automatically archive all cited Web pages shortly before or on publication. Finally, WebCite can act as a focussed crawler, caching retrospectively references of already published articles. Copyright issues are addressed by honouring respective Internet standards (robot exclusion files, no-cache and no-archive tags). Long-term preservation is ensured by agreements with libraries and digital preservation organizations. The resulting WebCite Index may also have applications for research assessment exercises, being able to measure the impact of Web services and published Web documents through access and Web citation metrics. @PARASPLIT [J Med Internet Res 2005;7(5):e60] In a clinical setting, pain is reported either through patient self-report or via an observer. Such measures are problematic as they are: 1) subjective, and 2) give no specific timing information. Coding pain as a series of facial action units (AUs) can avoid these issues as it can be used to gain an objective measure of pain on a frame-by-frame basis. Using video data from patients with shoulder injuries, in this paper, we describe an active appearance model (AAM)-based system that can automatically detect the frames in video in which a patient is in pain. This pain data set highlights the many challenges associated with spontaneous emotion detection, particularly that of expression and head movement due to the patient's reaction to pain. In this paper, we show that the AAM can deal with these movements and can achieve significant improvements in both the AU and pain detection performance compared to the current-state-of-the-art approaches which utilize similarity-normalized appearance features only. This study examines the usability challenges faced by new players of massively multiplayer online role-playing games (MMORPGs), one of the fastest-growing segments of the video game industry. Played in completely online worlds, these games allow players to communicate with one another, form groups and communities, and compete in a variety of fantasy environments.Nineteen subjects participated in an exploratory usability study of four games, three MMORPGs and a similar single-player game used for comparison. Results reveal that many people not usually considered as potential players of these games may be interested in them, but a wide variety of usability issues present serious problems for players inexperienced with the genre. Based on an analysis of the usability data and player feedback, specific recommendations are made to improve the experience of these games for new players. These results further demonstrate the applicability and importance of usability testing to video games. Rehabilitation, for a large part may be seen as a learning process where old skills have to be re-acquired and new ones have to be learned on the basis of practice. Active exercising creates a flow of sensory (afferent) information. It is known that motor recovery and motor learning have many aspects in common. Both are largely based on response-produced sensory information. In the present article it is asked whether active physical exercise is always necessary for creating this sensory flow. Numerous studies have indicated that motor imagery may result in the same plastic changes in the motor system as actual physical practice. Motor imagery is the mental execution of a movement without any overt movement or without any peripheral (muscle) activation. It has been shown that motor imagery leads to the activation of the same brain areas as actual movement. The present article discusses the role that motor imagery may play in neurological rehabilitation. Furthermore, it will be discussed to what extent the observation of a movement performed by another subject may play a similar role in learning. It is concluded that, although the clinical evidence is still meager, the use of motor imagery in neurological rehabilitation may be defended on theoretical grounds and on the basis of the results of experimental studies with healthy subjects.