Abstract:
The invention relates to rehabilitation systems and methods for providing therapy to individuals who have suffered a stroke or other neurological insult. A rehabilitation system may comprise a depth sensing camera positioned to view a workspace into which a patient&#39;s hands may be located, a display system viewable by the patient, and an electronic computer executing a stored program to display a representation of a virtual space holding at least one virtual object, display a representation of at least one hand of the patient, and monitor a virtual manipulation of the virtual object by the patient&#39;s hand. Other embodiments may include virtual reality goggles, head motion tracking, various exercises and of varying difficulty, tracking metrics and recording for subsequent playback.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims a benefit of priority under 35 USC §119 based on provisional patent application No. 61/513,323, filed on Jul. 29, 2011, the entire contents of which are hereby expressly incorporated by reference into the present application. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    The present invention relates to rehabilitation systems and methods for providing therapy to individuals who have suffered a stroke or other neurological insult and in particular to rehabilitation systems and methods for hand function. 
         [0003]    Current research has confirmed that the adult brain is capable of extensive plastic changes after injury accommodating changes in its motor and sensory experience. Retraining of the brain thus promises stroke victims the possibility of regaining the ability to perform many daily activities. 
         [0004]    Current devices for rehabilitation may provide for physical manipulation of a training device such as a freestanding blocks or puzzles or an instrumented exoskeleton type device. Some virtual reality devices provide for improving strength or function of muscles of larger joints of the body by tracking movement of those joints with a camera like device and displaying the results on a computer monitor. 
       SUMMARY OF THE INVENTION 
       [0005]    The present inventors have recognized that abstracting rehabilitation tasks from the physical environment can provide significant benefits in rehabilitation. These benefits include the ability to make imperceptible changes in the difficulty of the rehabilitation task to challenge the patient without discouraging the patient and to properly tailor the challenge level to the patient, the ability to break the rehabilitation task into elemental components that can be individually practiced and evaluated and to use elemental rehabilitation tasks that might not be physically realizable, and the ability to implement complex schedules of different tasks and challenge levels to optimize rehabilitation. In this regard, the present invention provides a virtual reality environment that provides simulations of physical structures and a representation of the patient&#39;s hands to allow virtual manipulation of the structures in rehabilitation tasks. The patient&#39;s performance level may be monitored during these tasks to provide detailed understanding of his or her progress, to adjust the task complexity, and to provide optimization of the rehabilitation program. 
         [0006]    The invention isolates the hand-eye control path, eliminating other possibly ambiguous or confusing sensory cues. The use of the virtual environment provides fine-grained control of the level of difficulty of the manipulation problem to sustain patient interest and maximize rehabilitative effort. 
         [0007]    Particular features and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention. The following description and Figs. illustrate a preferred embodiment of the invention. Such an embodiment does not necessarily represent the full scope of the invention, however. Furthermore, some embodiments may include only parts of a preferred embodiment. Therefore, reference must be made to the claims for interpreting the scope of the invention. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0008]      FIG. 1  is a side elevational view of an implementation of the present invention in a desk unit showing a workspace optionally shielded from the users direct vision monitored by a depth sensing camera and supporting a monitor in the patient&#39;s vision field; 
           [0009]      FIG. 2  is a fragmentary side elevational view similar to that of  FIG. 1  showing the use of virtual reality goggles and head tracking; 
           [0010]      FIG. 3  is a fragmentary side elevational view similar to that of  FIG. 1  showing the workspace monitored by the depth sensing camera positioned below the workspace; 
           [0011]      FIG. 4   a - c  are screen displays showing images on the monitor presenting manipulation tasks to the patient using virtual items positioned with respect to virtual representations of the patient&#39;s hands and fingers; 
           [0012]      FIG. 5  is a function block diagram of the present invention as may be implemented on a electronic computer; and 
           [0013]      FIG. 6  is a diagram showing an improving patient metric and adjustment of the task to maintain a given challenge range. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0014]    Referring now to  FIG. 1 , a rehabilitation system  10  of the present invention may provide for example a desktop unit  12  having an upper platform  14  supporting a computer monitor  16  (for example an LCD display) for viewing by a patient  18  seated on a chair  20  or the like in front of the desk unit  12 . A workspace  22  positioned beneath the upper platform  14  optionally shielded from vision of the patient  18  may be bounded by a lower platform  24  and the lower surface of the upper platform  14 . A depth sensing camera  26  may be attached to view the patient&#39;s hands  27  when placed in the workspace  22  and provide a fine-grained resolution indicating hand position and finger position of the patient&#39;s hands. A depth sensing camera believed to be suitable for the present invention is available commercially from PrimeSense of Tel Aviv, Israel. Other examples of depth sensing cameras may include Microsoft Kinect commercially available from Microsoft Corporation of Redmond, Wash. and Leap Motion cameras commercially available from Leap Motion of San Francisco, Calif. 
         [0015]    The camera  26  and display  16  may communicate with a computer  28  executing a stored program as will be described. 
         [0016]    In an alternative embodiment depicted in  FIG. 2 , the display  10  may be replaced by virtual reality goggles  17  which may be worn directly on the head of the patient  18  to receive data from the computer  28 . The system also provides a head motion tracking unit  19  working with the stationary beacon  21  to relay a signal to the computer  28  indicating the position of the patient&#39;s head  15  to provide for correction of the image displayed on the goggles  17  commensurate with that which would be in the field of view of the patient with the head movement were the patient immersed in the virtual reality space  30 . Head tracking virtual-reality goggles are commercially available for example, from Vuzix Corporation of Rochester, N.Y. 
         [0017]    In an alternative embodiment depicted in  FIG. 3 , the camera  26  may be attached below the workspace  22 , instead of above as shown in  FIG. 1 , to view the patient&#39;s hands  27  when placed in the workspace  22 . In this arrangement, the surface of the workspace may be a transparent material, such as glass, allowing the camera to view the workspace through the surface or the surface of the workspace may be removed. 
         [0018]    Referring now to  FIG. 4 , the computer  28  may provide a display of a virtual space  30  depicted in two dimensions on the display  16  including one or more virtual objects such as a ball  32  and hoop  34 . Each of these virtual objects  32  and  34  will have a defined location in the virtual space stored as a mathematical representation and a defined shape (outer periphery) and orientation. The program executing on the computer  28  may read information from the depth sensing camera  26  to reconstruct a virtual hand  36  in the display and to translate the actual hand location, orientation, and finger positions of the patient&#39;s hand, using a predetermined mapping, to the virtual space  30  so that the hand  36  may be displayed relative to the objects  32  and  34 . Typically such mapping will center the virtual space  30  with respect to the workspace  22  and will give each corresponding dimensions and orientation. By establishing the location of the patient&#39;s hand as a virtual hand  36  in virtual space  30  and knowing finger positions, the patient may manipulate the virtual objects  32  and  34  by causing the virtual hand  36  to grasp the objects and allowing them to be moved with respect to each other. Although the present invention does not contemplate any haptic feedback to the patient with respect to the grasping action, the virtual objects  32 ,  34  and  36  will observe correct collisional physics preventing them from moving through each other. The orientation of the objects  32  and  34  may be changed or fixed according to the particular puzzle problem. It should be emphasized, however, that the correct collisional physics may also be disabled to simplify the tasks and to isolate or amplify problems the patient may be experiencing. 
         [0019]    Referring now to  FIG. 5 , the computer  28  may include a processor  40  communicating with the memory  42  containing an operating system  44  and one or more application programs  46  as will be described that may be executed by the electronic computer. The memory may also hold a data table  50  for storing patient metrics for review by physical therapist or the like. The computer  28  may provide for an interface  52  communicating with the display  16  and the camera  26  according to techniques well known in the art. A keyboard or other user input device  54  may also be provided for initialization and starting of the program. 
         [0020]    In the depiction of  FIG. 4   a , the patient may grasp the ball  32  and pass it through the hoop  34  with the hoop  34  being maintained stationary and the hand blocked by physical structure of the hoop  34  or allowed to pass through the hoop  34  with the ball  32  not being allowed to pass through the physical structure of the hoop  34  but only through the opening in the hoop  34  or outside of the loop entirely. 
         [0021]    In the depiction of  FIG. 4   b , the ball  32   a  has been decreased in size so that the patient must switch from a power grip to a precision grip in order to move the smaller object through the opening of the fixed hoop  34 . 
         [0022]    In the depiction of  FIG. 4   c , the opening of the fixed hoop  34   a  has been decreased in size so that greater precision of motion is required for the patient to maneuver the ball  32  through the hoop  34   a.    
         [0023]    In the depiction of  FIG. 4   d,  the hoop  34   b  is no longer fixed but must also be grasped by the patient using a second virtual hand  36 ′. Thus the patient must control both ball  32  and hoop  34   b  in virtual space  30  in order to maneuver the ball  32  through the opening of hoop  34   b.    
         [0024]    In the depiction of  FIG. 4   e , the virtual objects consist of a rectangular prism  33  and rectangular hoop  35 . The rectangular hoop  35  may be stationary or moveable. The patient must move the prism  33  through the hoop  35 , but as prism  33  cannot pass through the physical structure of hoop  35  the orientations  37  of the virtual objects  33  and  35  must be considered to complete the task. 
         [0025]    Significantly, the changes in the difficulty of the task, for example, changing the size of the opening in the fixed hoop  34   a  or the size of the ball  32   a  may be very gradually changed to be imperceptible to the patient allowing the task difficulty to be smoothly adjusted, for example, in response to changes in patient skill level. As will be described below, this change may be driven by a performance metric measuring how well the patient performs the task. Alternatively, the changes in difficulty and in fact the tasks themselves may be adjusted according to a predetermined schedule executed by the computer to optimize the rehabilitation according to empirical information derived from the system or elsewhere. Such a schedule may for example continuously change the difficulty to increase or decrease it, but more typically may alter tasks and difficulty levels both up and down in a pattern as may be determined to be therapeutically most effective. 
         [0026]    Various exercises, including such as these described in  FIGS. 4   a - 4   e,  may essentially be performed in a virtual environment to simulate activities of daily living. The present invention importantly allows the activities of daily living to be broken into elemental tasks without regard to physical constraints. So, for example, an activity of daily living may be picking up a glass while retaining the orientation of the glass vertically and moving it to set it on a different surface. This task can be broken into the tasks of: (a) grasping, (b) maintaining an orientation, (c) moving an object between two locations, and (d) releasing an object placed on a surface. With actual physical structures, these different tasks are inextricably linked, however, in the virtual environment each can be dealt with separately. For example, a virtual glass may automatically maintain correct orientation independent of the patient&#39;s hand so that the patient may work on task (c) without the distraction of task (b). Further the patient&#39;s ability with task (c), thus isolated, can be accurately measured. Whereas with physical structure, practicing releasing an object (d) necessarily requires completion of each of tasks (a)-(c), this is not necessarily true with the virtual environment where, for example, a glass may be initialized to be “attached” to and thus grasped by the patient&#39;s hand. Each of these separate tasks may be practiced independently or together in a sequence that emulates the everyday activity. Each of the tasks may nevertheless be independently monitored to permit reinforcement or practice of those tasks that represent the greatest challenge to the individual, in designing a therapeutic program. 
         [0027]    In the process of designing the tasks, the physics of the environment may also be adjusted, for example, the linear or rotational inertia of one or more of the manipulated items may be independently adjusted, friction may be increased or decreased, or items may be given local attraction to periodic coordinates as with a “snap, grid”. 
         [0028]    The computer  28 , program  42  and camera  26  will be constructed and organized to limit time delays to no more than approximately 16 to 33 ms in updating the position of the virtual hand  36  with respect to the objects  32  and  34 . 
         [0029]    Referring now to  FIG. 6 , the patient&#39;s success with the exercise of the type described with respect to  FIG. 4  above may be quantified according to one or more rehabilitation metrics  60  which may be tracked over time with the data provided to a physical therapist for review if desired. This data may include the metrics or may provide for an ability to review actual screen videos of the patient&#39;s performance or may provide for other types of data with respect to the patient&#39;s performance including for example data identifying particular muscle sets that remain poorly controlled, for example, by reverse kinematics techniques. The monitoring of the rehabilitation metrics  60  may be performed with respect to a predefined interest threshold  62  to change the task assigned to the patient to increase its challenge level a time t 0  to keep the challenge to the patient with in a zone  66  roughly established to maintain the patient&#39;s interest without being overly challenging for the patient such as might be discouraging. Change in the task or exercise given to the patient may be performed on extremely fine scale for example by incrementally shrinking the size of the hoop  34  to provide extremely tight control of the challenge reward of the system. 
         [0030]    The same or different exercises may be performed one after another, in repetitions, and each exercise may have the same or a varying degree of difficulty, and in various combinations. The degree of difficulty may be set arbitrarily, to a consistent value, or in a preferred embodiment, according to one or more metrics that may be measured from one or more previous exercise. Metrics may include, for example, the total time to complete an exercise (e.g. to move the ball through the hoop), the maximum spatial distance encountered from the target while attempting the exercise (e.g. maximum distance encountered from the ball to the hoop) and/or the number of collisions encountered while attempting the exercise (e.g. number of times the ball hit the hoop). As noted above, the degree of difficulty may be varied both up and down according to a schedule as may be determined to be therapeutically valuable. 
         [0031]    In this latter embodiment, the difficulty of the exercise (e.g. the relative size of the ball and hoop) may be adjusted according to the metric obtained from a previous attempt at completing exercise. In this way the difficulty of the exercise, for example, may remain constant at a level that is neither too easy nor frustrating to the user. As the user proficiency increases as indicated by the metric, the difficulty of the task may automatically increase as well. Limits to difficulty may be placed on the low and high sides of difficulty and the progress of the user as reflected in the measured metric may be plotted and output to a supervising healthcare worker. It will be understood that the process of changing the difficulty of the task may be substantially continuous (for example by small increments of change in hoop diameter) or may be accomplished through a changing of the tasks from simpler tasks to harder tasks or combination of both. The changing of the tasks, may for example, involve different virtual objects or different required manipulations of the virtual objects, for example balancing objects on top of each other versus inserting one object through another object where orientation does not matter (e.g. ball and hoop) or where orientation does matter cylinder and cylindrical opening. 
         [0032]    The patient may also perform each exercise at a location other than where the therapist may be monitoring the exercise, which monitoring may be communicated, for example, in real time via a local area network (LAN), wide area network (WAN) and/or the Internet. In this regard the computer  28  may be attached to the Internet using a standard interface circuit of the type well known in the art. 
         [0033]    Certain terminology is used herein for purposes of reference only, and thus is not intended to be limiting. For example, terms such as “upper”, “lower”, “above”, and “below” refer to directions in the drawings to which reference is made. Terms such as “front”, “back”, “rear”, “bottom” and “side”, describe the orientation of portions of the component within a consistent but arbitrary frame of reference which is made clear by reference to the text and the associated drawings describing the component under discussion. Such terminology may include the words specifically mentioned above, derivatives thereof, and words of similar import. Similarly, the terms “first”, “second” and other such numerical terms referring to structures do not imply a sequence or order unless clearly indicated by the context. 
         [0034]    When introducing elements or features of the present disclosure and the exemplary embodiments, the articles “a”, “an”, “the” and “said” are intended to mean that there are one or more of such elements or features. The terms “comprising”, “including” and “having” are intended to be inclusive and mean that there may be additional elements or features other than those specifically noted. It is further to be understood that the method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed. 
         [0035]    References to “a controller” and “a processor” can be understood to include one or more controllers or processors that can communicate in a stand-alone and/or a distributed environment(s), and can thus be configured to communicate via wired or wireless communications with other processors, where such one or more processor can be configured to operate on one or more processor-controlled devices that can be similar or different devices. Furthermore, references to memory, unless otherwise specified, can include one or more processor-readable and accessible memory elements and/or components that can be internal to the processor-controlled device, external to the processor-controlled device, and can be accessed via a wired or wireless network. 
         [0036]    It is specifically intended that the present invention not be limited to the embodiments and illustrations contained herein and the claims should be understood to include modified forms of those embodiments including portions of the embodiments and combinations of elements of different embodiments as come within the scope of the following claims. All of the publications described herein, including patents and non-patent publications, are hereby incorporated herein by reference in their entireties.