VR4NEUROPAIN: Interactive Rehabilitation System
Micaela Fonseca
1,2,3,4
, Heitor Cardoso
3
, Nuno Ferreira
3
, Tiago Loureiro
5
, Inês Gomes
6
and Claudia Quaresma
1,2,*
1
Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa,
2892-516 Monte da Caparica, Portugal
2
Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física,
Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2892-516 Monte da Caparica, Portugal
3
VR4NeuroPain, Rua Comandante António Feio nº26 1C1, 2800-255 Almada, Portugal
4
Universidade Europeia, Laureate International Universities, Estrada da Correia, nº53, 1500-210 Lisboa, Portugal
5
Collide, Avenida D. João II, nº 43, 9º. 1990-084 Lisboa, Portugal
6
IMG - Strategy Branding Visual Communication, Avª Oscar Monteiro Torres 16, 2.ºD, 1000-219 Lisboa, Portugal
tiagoloureiro@collide.rocks, gomes.iim@gmail.com, q.claudia@fct.unl.pt
Keywords: Rehabilitation, Spinal Cord Injury, Software, Neuropathic Pain, Virtual Reality, Gaming.
Abstract: Virtual Reality (VR) has finally found its way to be used in the healthcare industry, covering many different
areas such as medical training, marketing, patient education, psychotherapy and physiotherapy, and many
others. The need to develop increasingly personalized technology to be used during the rehabilitation
process is extremely important. Therefore, the VR4NeuroPain solution aims to cover the unique influence
that it obtains from the VR applied to the rehabilitation area, creating unique and virtual spaces where
patients with neuropathic pain can be submitted to their therapy sessions, not only in hospitals and clinics,
but also at home. The VR4NeuroPain system monitors electrophysiological data in real time, and consists of
the following components: Virtual Reality Interface, Plataform and a Glove-“GNeuroPathy”. The main
objective of this paper is to describe all the components of VR4NeuroPain solution. The system can be used
by physicians, occupational therapists and physiotherapists. VR4Neuropain allows the use of innovative and
interactive intervention methodologies.
1 INTRODUCTION
VR4NeuroPain is a customized solution of
interactive technology that aims to promote the
rehabilitation of patients with neuropathic pain in a
hospital or home environment. This innovative
system combines virtual reality headsets, haptic
feedback gloves with motion and biomedical sensors
allowing the collection and analysis of physiological
parameters. This approach while is used as a
rehabilitation facilitator, the patient is also immersed
into a virtual world where he can perform several
gamified tasks. These required tasks are specified
physical exercises prescribed and recommended by
therapists under conventional therapy but with the
plus of the virtual reality world engagement that
increase the patient motivation.
VR4NeuroPain aims to promote rehabilitation of
Stroke patients, Spinal cord Injury patients,
Neuropathic Pain, physiotherapy, as also promote
active ageing.
The stroke is one of the main disability factors of
the upper member causing functional losses
associated with cognitive and perceptual disorders
(Thrift, 2017). With the currently used intervention
methods in the conventional rehabilitation process,
30% to 60% of the individuals that suffered a stroke
will not regain their competencies effectively.
Worldwide, the incidence of Spinal cord Injury
ranges from 3.6 to 195 per million leading to a major
medical problem (Massetti, 2018).
Neuropathic pain is a type of chronic pain caused
by damage or disease affecting the central nervous
system and can affect anyone. It manifests itself in
various ways such as burning sensation, weight,
needle sting and shocks. Up to 7% to 8% of the
European population is affected by neuropathic pain
(Liedgens, 2016). Among people in the US reporting
at least some pain in the last year, 15.7% likely had a
Fonseca, M., Cardoso, H., Ferreira, N., Loureiro, T., Gomes, I. and Quaresma, C.
VR4NEUROPAIN: Interactive Rehabilitation System.
DOI: 10.5220/0007581402850290
In Proceedings of the 12th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2019), pages 285-290
ISBN: 978-989-758-353-7
Copyright
c
2019 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
285
syndrome with a neuropathic component
(DiBonaventura, 2017).
Laver et al. (2012) refer that virtual reality seems
to be a promising technology, however, currently,
the studies are few and do not ensure the
occupational interests of individuals, nor allow an
active participation of caregivers. Computer games
will be part of the future of healthcare and
personalised healthcare system (Yannakakis, 2012).
The games should be integrated into contingency
plans for its high potential (Mc Callum, 2012).
On the other hand, the acquisition of biosignals
has been increasingly used to monitor the
physiological and biomechanical parameters, thus
helping, in the definition of the intervention plan.
So, the human activity monitoring by wearable
electronic equipment is a new research area and it
has been growing constantly over the past years.
This approach is possible due to the easy self-
adapting sensors, which provide the collected data to
be processed to obtain the relevant analysis of the
biosignals. Furthermore, the optimal combination of
the sensors used (less as possible) and the data
collected (much as possible) could provide a simple,
but complete, health monitoring system.
Despite the portable systems are easy to use with
these procedures, when monitoring requires
extensive periods of time, the use of wearables
devices is the most suitable method. Its
implementation has a severe impact on some health
assessment and interventions on the patient's and on
the patient's clinical evolution.
Aligned with the wearable devices and the
ubiquitous computing resources, the opportunity to
use biofeedback therapy emerged. Biofeedback is a
technique of training in which a person learns how
to control involuntary bodily functions using the
devices and it is increasingly used in clinical.
Therefore, the real-time acquisition enables the
subject to control involuntary bodily functions and
the clinician can monitor in a real context.
So, biosignals and virtual reality, due to their
impact importance, are relevant methodologies to be
applied in rehabilitation
Therefore, an innovative solution was developed
named "VR4NeuroPain", which associates virtual
reality with sensory and motor stimulation
(Quaresma, 2018). The system consists of the
following components: Virtual Reality Interface,
Platform and a Glove - "GNeuroPathy", that
monitors electrophysiological data in real time.
The "VR4NeuroPain" system was developed to
play an active role in the rehabilitation process,
promoting patients' quality of life and well-being. It
is based on the following therapeutic objectives:
Performing fine and global movement;
Distinguish tactile sensory stimuli;
The "VR4NeuroPain" also aims to motivate the
rehabilitation process and stimulate technological
literacy.
For that reason, the use of interactive
technologies in rehabilitation process allows to
reduce the time spent in that process and greater
economic sustainability of the units of the health
sector. In order to guarantee the applicability of the
system it is necessary to carry out the validation of
all the components. Therefore, one of the
components of the "VR4NeuroPain" is the
"GNeuroPathy" and has already been applied in
people with no associated pathology and it has been
found to be easy to apply and meets the proposed
objectives (Quaresma et al., 2018).
It allows the integration in the conventional
rehabilitation of interactive and playful
methodologies that are in tandem with the
motivations and occupational interests of the
patients.
2 MATERIAL AND METHODS
The study was approved by the Portuguese Ethics
Committee of the Medicine and Rehabilitation
Center of Alcoitão, in Portugal.
The components of VR4NeuroPain solution are
(Figure 1): Haptic feedback Device, Glove
“GNeuroPathy” System, VR4NeuroPain Platform
and VR Game.
Figure 1: VR4NeuroPain Solution components.
2.1 Haptic Feedback Device
For the haptic feedback device will be used the
ESP32 BLE (development Board WiFi+Bluetooth
Ultra Low Power Consumption - Dual Cores) placed
inside a wrist band and wired connected to 5 small
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vibrator motors (4.0 cm x 1.0 cm x 0.3 cm / Rated
Voltage: DC 3.0V) embedded in the underside of
each “GNeuroPathy” glove's fingers.
This device will be powered by a 3.7v battery
while is bluetooth paired with the developed
software providing different vibration patterns for
each several virtual stimulus controlled by the
therapist.
Figure 2: On the left - esp32 development board with
Bluetooth low energy embedded (BLE).
On the right - the vibration motors that will be
placed inside the glove's fingers.
2.2 Glove “GNeuroPathy” System
The "GNeuroPathy" system is a glove that monitors
electrophysiological data in real time. During the
design process of "GNeuroPathy" it was necessary
to take into account a set of requirements. Therefore,
it was decided that the "GNeuroPathy" should:
Allow integration of muscle activity with
eletri-miography (EMG) and electro-dermal
activity (EDA) sensors and not interfere
with therapy performance.
Be portable.
Be light, comfortable and not interfere with
the tasks performed by the subject. must be
adaptable to various sizes of hand.
Allowing a more real interaction with the
subject and the object being manipulated.
Be cheap for use by doctors and patients.
Recreating a different sense of touch.
The "GNeuroPathy" glove (Figure 3) is easy to
put on, allows object manipulation and integrates
two types of sensors that collect EDA and EMG
data. To record the EMG and EDA signals, a
Bitalino * acquisition module, 2 EMG sensors and 2
EDA sensors were used. To connect the sensors to
the subject, 2 Ag / AgCL with adhesive electrodes
nailed with solid adhesive were used by sensor
(TIGA-MED Gold 01-7500, TIGA-MED GMBH,
Germany).
Usability validation that examines subject’s
degree of satisfaction when using the glove
(Quaresma et al., 2018).
Figure 3: The glove "GNeuroPathy.
Bitalino (Figure 4) records the biological signals
simultaneously with a 16-bit resolution and
sampling frequencies up to 1000 Hz. All data is
transmitted via Bluetooth. To record the data
transmitted from Bitalino, the software used was
Plux OpenSignals.
Figure 4: The components of the Bitalino and the EDA
sensors (Guerreiro et al., 2013; Guerreiro et al., 2014).
2.3 VR4NeuroPain Platform
The VR4NeuroPain platform is a responsive web-
based solution and has the objective to help promote
the rehabilitation of patients with neuropathic pain,
through integration with the VR4NeuroPain solution
(Figure 5). The platform can be used on desktops,
laptops, tablets or mobile phones.
The VR4NeuroPain platform is composed of a
database where is recorded all the information about
patients, physicians, rehabilitation sessions
schedules, configuration parameters for virtual
reality games and scenarios, and other important
information. The platform has also many user-
friendly web pages created for registered users to
manage all the necessary information.
The platform allows access to two types of users:
clinicians (such us physicians/occupational,
therapists) and platform administrators.
VR4NEUROPAIN: Interactive Rehabilitation System
287
The physicians/occupational therapists can record
all clinical information of patients such as age,
diagnosis, evaluation of rehabilitation parameters for
patient sessions. They can also manage the schedule
of their patient’s rehabilitation sessions and have
also access to reports and dashboards to assess the
evolution of the patients.
The administrators manage the VR4NeuroPain
platform, doing operations like configuring new
users to access the platform, manage all
rehabilitation sessions schedule, payments of
sessions and they are also responsible in the
configuration of all parameters of virtual reality
games and scenarios used in VR4NeuroPain
rehabilitation sessions and based on physicians
requests.
Figure 5: The VR4NeuroPain Platform.
The VR4NeuroPain platform was created using
WordPress which is a free and open-source content
management system (CMS) based on PHP and
MySQL. Wordpress is used by more than 60 million
websites and is the the most popular website
management system in use. Some areas of the
VR4NeuroPain platform were customized using a
template and applying several programming
languages such as PHP, HTML, JavaScript and CSS.
The database was based on MySQL which is an
open-source relational database management system
(RDBMS). To create the database the language
chosen was SQL.
2.4 VR4NeuroPain Game
Virtual Reality has great capabilities in person’s
embodiment and sense of presence inside virtual
environments (Pozeg, 2017), where the user can
really feel that they’re living that virtual experience.
Because of this, VR become commonly used among
medical treatments due the fact that the virtual
environment variables are more likely to be
controllable and repeated. From phobias (Banos,
2002), motor cortex rehabilitation due stroke
conditions (Alves, 2018) to spinal-cord injury
focused either in neuropathic pain improvements
(Villiger, 2013), studies have shown that this
technique is sustainably promising.
For example, (Villiger, 2013) found that Two
thirds of the patients improved, immediately after
the treatment and 12 to 16 weeks after treatment,
showing long term effects, probably due beneficial
effects of visual illusions on pain as they point on
this study.
Said that, we expect either positive results with
our approach, once literature present positive
evidences.
The VR4NeuroPain game is a VR real-time
rendering application made with the Unity engine,
that enables neuropathic pain patients to undergo
physical therapy at hospitals, clinics and also at
home. By tracking the patient’s movements and bio-
signals, the app is capable of monitoring posture,
tracking therapy performance, correlate exercises
with bio-signals and much more.
By using the Leap Motion interface as means to
interact with the virtual environment we are
removing the need for another physical interface to
be used by the patient, thus allowing for a more
natural and intuitive human machine interface
(HMI) that will not require the adaptation of hand-
based exercises. Interactivity with the environment
has been designed so that patients mimic everyday
actions like pressing buttons or moving levers each
time they are interacting with the virtual world.
Project Chatrooms is a multiplayer, multiplatform
framework that enables multiple users to connect to
the same virtual space and interact with one another.
As such, it makes VR multiplayer development
faster, easier, affordable and customized for
developers.This framework is Hardware Agnostic -
runs on all VR hardware and non-VR on PC and
Mac; Engine Agnostic - Unity and Unreal engines
supported; Multiplayer Services Agnostic - Photon,
GameSparks, SpatialOS or any other solution and
supports Haptic gear and other VR specific
equipment.
Thanks to the Project Chatrooms multiplayer VR
framework, VR4NeuroPain may have health
professionals following patients in real-time from
anywhere in the world. Not only are they capable of
joining the same virtual world (and therapy session)
to monitor the patient’s exercises, but they also have
real-time access to the patient’s bio-signals.
2.5 Branding
VR4NeuroPain is a state-of-art scientific product
with a commercial purpose that aims to upgrade
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neuropathic patients therapies with portable therapy.
As it's about to improve patients quality of life, the
brand identity strategy was based on how important
was to keep the visual message straight and effective
to those who will benefit on it.
Figure 6: The VR4NeuroPain Game.
2.5.1 Brand Visual Solution
The approach to the graphic identity solution comes
down to the visual translation of the users
experience - VR Glasses, which take the patient to a
virtual therapy room, and biosensors gloves that
connect that virtual reality with tactile stimulation
(Figure 7).
Round and smooth shapes illustrates the flow of
this experience with a real human purpose, and at
the same time an hidden matrix structuring different
levels of information.
The brand will predominantly live on screens, so
using gradients was an opportunity to reinforce the
flow concept and to make it feel bright and alive.
Dark blue and electric green were combined as a
positive standout palette that can grow over time.
In application, it’s mostly about the gradient
offset rounded shapes demanding the attention of
VR4NeuroPain main asset - sensory vibration -
which can be sized and cropped in different layouts
that create tension and make good use of free space.
Figure 7: Brand visual solution.
3 CONCLUSIONS
The principal objective of this article is to present an
ongoing project for system development named
"VR4NeuroPain". In order to guarantee the
applicability of the system it is necessary to carry
out the validation of all the components.
In the future will be developed software with
algorithms of processing of physiological signals,
such us EDA and EMG. These algorithms must
allow the correlation of the mentioned biosignals. In
addition, the glove - "GNeuroPathy" must also be
validated associated with the other parts of the
system. Tests in individuals with neuropathic pain
will be performed with the "VR4NeuroPain" and
compared with the conventional procedure in order
to prove that this is a reliable system.
The system can be used by multiple users and
will allow us to apply innovative and interactive
methodologies of intervention promoting the process
of rehabilitation.
ACKNOWLEDGEMENTS
The authors would like to thank all the healthcare
professionals of Medicine and Rehabilitation Center
of Alcoitão. The authors would like to thank Collide
for the help and support provided in this
investigation.
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