Method to Improve Recovery Through Rehabilitation Techniques

Using Virtual Reality with Motor Imaging Techniques

Christian Ovalle

, Sandra Meza

, Wilver Auccahuasi

, Oscar Linares

, Kitty Urbano

Gabriel Aiquipa

, Yoni Nicolas-Rojas

, Aly Auccahuasi

, Tamara Pando-Ezcurra

and Karin Rojas

10 j

Universidad Tecnológica del Perú, Lima, Peru

Universidad ESAN, Lima, Peru

Universidad Privada del Norte, Lima, Peru

Universidad Continental, Huancayo, Peru

Universidad Científica del Sur, Lima, Peru

Universidad Tecnológica de los Andes, Apurimac, Peru

Escuela superior la Pontificia, Ayacucho, Peru

Universidad de Ingeniería y Tecnología, Lima, Peru

Universidad Privada Peruano Alemana, Lima, Peru

Universidad César Vallejo, Lima, Peru

kurbano@cientifica.edu.pe, gaiquipa@utea.edu.pe, yoninicolas@elp.edu.pe, aly.auccahuasi@utec.edu.pe,

tamara.pando@upal.edu.pe, krojas@ucv.edu.pe

Keywords: Virtual Reality, Rehabilitation, Imagery, Motor Activity, Image, Video.

Abstract: The new technological tools provided by information and communication technologies are changing the

concepts and ways to perform certain actions, in the field of health, it is being applied to a great extent, we

can note that one of them is the Virtual Reality technology, in its different equipment and applications, one

of the related areas where you can take advantage of the immersion and abstraction, is related to

rehabilitation procedures, In this case we can indicate if you have any immobilization or absence of these

members, the rehabilitation processes of these situations, is highly aggressive in order to walk again in a

coordinated manner or a more serious case is when resorting to the use of a prosthesis, we must indicate that

when we walk, there is a harmony in the movement of the arms and legs, any absence or immobilization of

these, will affect the movement. In the present work we present a method applying Virtual Reality, which

uses the techniques of motor imagery, to help in the recovery through virtual therapies, the proposed method

uses three main elements, such as Virtual Reality glasses, which will be used by the patient and where he

will visualize the movements and images of the feet, arms, legs, among other images or videos to strengthen

self-confidence in the recovery process, Then we need a computer, which will be responsible for issuing and

controlling the sequence of images, a third element that is responsible for making possible the connectivity

and the ability to share images and videos, is the Virtual Desktop application, through this tool you can

share the computer screen to visualize the virtual reality glasses, we must consider that the equipment must

be connected to the same network.

https://orcid.org/0000-0002-5559-5684

https://orcid.org/0000-0002-4650-1340

https://orcid.org/0000-0001-8820-4013

https://orcid.org/0000-0002-7952-9518

https://orcid.org/0000-0003-2009-000X

https://orcid.org/0000-0002-3755-7393

https://orcid.org/0000-0001-6493-6084

https://orcid.org/0000-0001-5069-0415

https://orcid.org/0000-0003-0301-3440

https://orcid.org/0000-0002-6867-0778

Ovalle, C., Meza, S., Auccahuasi, W., Linares, O., Urbano, K., Aiquipa, G., Nicolas-Rojas, Y., Auccahuasi, A., Pando-Ezcurra, T. and Rojas, K.

Method to Improve Recovery Through Rehabilitation Techniques Using Virtual Reality with Motor Imaging Techniques.

DOI: 10.5220/0011962700003612

In Proceedings of the 3rd International Symposium on Automation, Information and Computing (ISAIC 2022), pages 603-610

ISBN: 978-989-758-622-4; ISSN: 2975-9463

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

603

1 INTRODUCTION

Performing a literature review, we found works

related to the application of technological tools in

favor of patients, where it is evidenced that

presenting related images as the way of walking,

patients begin the retraining process (Auccahuasi, et

al. 2019). In rehabilitation procedures we can

evidence the level of behavior of patients, managing

to measure the level of concentration when they are

performing rehabilitation exercises, these

measurements are made thanks to techniques related

to the use of brain-computer interface (Auccahuasi,

et al. 2019). The use of technology is used for the

benefit of evaluating the gait aspect, seen in this way,

we find that gait is one of the main mechanisms of

the human being, so there is much concern that

people who have been affected, manage to recover

the ability to walk, for this opportunity through

inertial navigation systems can evaluate the behavior

of the center of gravity (Auccahuasi, et al. 2021).

We found works referred to robot-assisted

manual training applied to people who have suffered

stroke, with which you can perform practical

activities, with the use of a VR environment, so it

has been used to analyze about the robotic device on

the final effects of hand Amadeo used by improving

cognitive performance which is compared with the

amount of treatment that focuses on the hand which

is applied to 48 people with an average age 54.3 ±

10.5 years and the amount of women was 62, 5%

who have suffered an ischemic or hemorrhagic

stroke, which have been separated into 2 groups

called experimental group (GE) which were applied

the Amadeo Robotic Training and the control group

(CG) were subjected to occupational therapy

involving the upper limb, maintaining an evaluation

at the beginning and end of rehabilitation with a

neuropsychological battery, and motor function

tests, obtaining the results that in GE has been

obtained improvements in cognitive domains

including attention skills and executive functions,

hand motor, however robotic rehabilitation based on

VR showed improvements in both motor function in

the paretic arm and global cognitive skills in

cerebrovascular patients (Torrisi, et al. 2021).

We found works referred to VR technology used

in rehabilitation applied to people who have suffered

strokes, in order to analyze the effectiveness of VR

training without the use of glasses to improve motor

functions of the upper extremities applied to patients

who have suffered strokes for which 12 patients with

stroke have been considered for the process for 3

weeks, For this purpose, examinations were taken at

the beginning and end of the process in which the

evaluation was performed twice, including the Fugl-

Meyer upper extremity scale (FMS-UE), the

measurement of transcranial magnetic stimulation

(TMS) and the evaluation of movement from which

the results were obtained, which showed no

differences between the groups in the initial

evaluation, where after the intervention the FMS-UE

score showed superior improvement for the VR

group than for the control group, the TMS had a

significant difference on the latency of the cortex, on

motor conduction after the intervention, no

differences were shown on the amplitude of the

motor event potential (Xie, et al. 2021).

We found works referred to IT applied in patient

care and rehabilitation. We found works referring to

IT applied to patient care and rehabilitation, so a

review of the literature on games based on VR used

for motor rehabilitation was carried out. The

objective is to propose a methodology used to

improve the design and reporting process of clinical

trials using the search for publications on this type of

experiments, which were carried out in databases

such as Science and Medline (PubMed), which have

been evaluated. The publications about this type of

experiments were searched in databases such as

Science and Medline (PubMed), which have been

evaluated with the Downs and Black checklist, and

the following results were obtained: 86 studies were

identified in which the main tool used was the

Kinect, the EyeToy system and GestureTek IREX

based on VR games for rehabilitation which have

been tested in patients with cerebral palsy and stroke

focusing on posture control, limb exercises (Ayed, et

al. 2019).

We found works referred to multiple sclerosis

(MS) and diseases of the central nervous system

which affect motor, sensory, visual and cognitive

activities for which a review is made about the

virtual reality tools that can be used to perform

cognitive and motor rehabilitation for which an

analysis of studies between 2010 and 2017 searched

in PubMed databases is used, Scopus, Cochrane and

Web of Sciences with keywords such as "VR

rehabilitation" and "MS", where the results obtained

after the use of VR for rehabilitation can be seen an

improvement in motor and cognitive function, which

confirms the positive results about the improvement

of the outcomes of patients with MS (Maggio, et al.

2019).

We found works referred to advanced robotic

technologies (RT), virtual reality (VR) and

transcranial direct stimulation (TDC), in order to

make a combination of devices and apply them to

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the recovery of hand-arm function based on the

hypothesis of functional reorganization of the

undamaged motor system, while early and intensive

motor treatment according to the patient's potential,

thus demonstrating that the application of new

technologies for rehabilitation is giving more

effective results in patients with cognitive deficits,

Therefore, the aim is to declare the application

criteria, limits and application procedures for which

a search and registration of post-stroke patients will

be used to undergo conventional rehabilitation and

rehabilitation with RT and TDC to then compare

them, which will be supported with virtual reality

(VR) methodology in the treatment of the paretic

upper limb after a stroke, obtaining the results of

superiority of VR methods compared to the classical

methodology (Pistarini & Maggioni, 2019).

We found works referred about VR applied in

the restoration of motor function in stroke patients

where the analysis was used in 45 patients with

acute stroke diagnosis, which were randomly

divided into 2 groups where the first group received

standard rehabilitation and neuro-trainer classes

while the other group only received standard

rehabilitation classes. Both groups were evaluated

according to Berg's balance test where the results

about the neurotransmitter showed an efficacy on the

15th to 19th day after the stroke, where re-sults can

be found superior to the beginning of training with a

neurotransmitter within days 5 to 9 after stroke (p =

0.022), with a degree of recovery about the

neurotransmitter (p = 0.001), reached within 3 to 5

sessions (Kate, et al. 2019).

We found works referred about VR exercises

implemented in motor rehabilitation on the lower

extremities applied in a Spinal Cord Injury (SCI)

rehabilitation center where 12 patients with SCI and

10 control patients have been used, for which heart

rate and electromyographic activity of both legs

have been recorded, obtaining results about the

interactivity considered as the main interaction of

the participants, where it is considered that the

feedback is of vital importance for the improvement

of the patient assisted by robot (Steadman, et al.

2015).

We can indicate that within the rehabilitation

techniques, we find those related to the exercises

that are performed with a health personnel, this is a

traditional mechanism, one of the disadvantages is

the need to be able to travel to the health center, to

perform rehabilitation exercises, depending on the

resources available to patients, you can have access

to a health personnel to perform rehabilitation

exercises in a personalized way. We also have the

mechanisms where technology is applied, as is the

case of being able to use automated devices to

perform rehabilitation exercises, in this sense not all

patients can count on them, as well as health centers

do not have the necessary resources to be able to

acquire this equipment.

In retraining related to walking, involves

relearning how the movements of the arms and legs

are performed when the movement is being

performed, this technique uses videos and images of

the affected limbs to get to know them again, as well

as how they interact when walking, this technique is

known as motor imagery, which can be implemented

with the visualization of photographs or videos.

Having made a description of the state of the art

regarding the use of techniques related to the use of

technology in the health sector, as is the case of

virtual reality with emphasis on rehabilitation issues,

this paper develops a method that uses virtual reality

techniques to develop the technique of motor

imagery, organizing images and videos of the

components of the arms and legs and their

interaction in walking, through the projection of

these in the virtual reality glasses, with which you

can get patients to increase the level of concentration

and thus to recover their skills in the shortest time.

2 MATERIALS AND METHODS

The materials and methods that we are presenting

have an important particularity, which is their

dynamics, based on being able to create different

scenarios according to the particularity and

preference of the patients, we can indicate that it is a

modular method organized with the intention of

being able to be replicated, for which we describe

the necessary components as well as their respective

integration plan and we end with previous results:

Figure 1: Description of the methodology.

Method to Improve Recovery Through Rehabilitation Techniques Using Virtual Reality with Motor Imaging Techniques

605

In Figure 1, we present the description of the

methods to be developed, starting with the definition

of the inputs, followed by the integration of

techniques and ending with the previous results, then

we develop the details:

2.1 Description of the Inputs

The inputs that we describe in the development of

the methodology, is characterized by the description

of the needs, we can indicate that in a real situation

we have two possible situations, the first in an

environment of a rehabilitation center, where we

have many patients, of different types of ailments

and rehabilitation therapies, as well as different ages

and a second environment can indicate that we are in

performing rehabilitation therapies performed in the

homes of patients, where we try to reinforce the

exercises performed in rehabilitation centers, or also

managing to have a particular staff to be able to

perform rehabilitation exercises.

Figure 2: Description of the inputs and creation of the

environment.

Figure 2 shows the approach of the inputs, which

result in the creation of the environment where the

sequence of images is represented, as well as the

representation of the background, this is one of the

characteristics of using virtual reality glasses,

because it not only presents the sequence of images,

but also a view of the depth, allowing the patient to

isolate himself from the physical place where he is

and can only visualize the scenarios provided by the

glasses, then we present what each of the inputs

consists of:

• The years, as the environment where it will

be presented will be implemented, to have a

better reception by the patient, the

background of the environment should be

developed according to themes related to

the patient's age, we must indicate that the

Virtual Desktop tool, allows us to select

different topics to be configured as

background of the scenario.

• In the environment, it is recommended that

the images and the environment are related

to the patient's activities, for example

sports, educational, work environments,

these help because they motivate the patient

in the recovery process.

• Preference is a very important aspect in the

process of personalizing the environment, it

would be ideal to know the preferences of

patients so we get a greater commitment of

the patient which would lead us to have

better results.

• Patience, one of the factors to take into

account and is related to age, this aspect is

very important to time the sequence in

which the images appear giving the

sensation that the patient is watching a

video.

Figure 3: Virtual Desktop application configuration mode.

In Figure 3, we present the screen to configure the

environment where the images corresponding to the

motor imagery technique are presented, where the

recommendations of the 4 described inputs are

applied, managing to select the environment

according to the tastes and preferences of the

patients, to achieve a better response from the

patients.

2.2 Integration Techniques

The integration that must be considered is related to

the necessary equipment to implement the model, as

hardware a computer is needed that has the task of

being able to present the sequence of images and to

control the sequence of images, it is necessary and

virtual reality device, such as glasses, for the

demonstration we use a virtual reality glasses model

Oculus Gest II, The function of the glasses is to be

able to replicate what is observed on the computer

screen, the total control is in the computer, an

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additional mobile device can be considered, which

can be a cell phone, where you can replicate what is

displayed on the glasses, it also fulfills the function

of quality control to verify the operation of the

glasses.

As a software component, the Virtual Desktop

application is required, which provides connectivity

tools, with which we can share computer resources

and virtual reality glasses, we must indicate that it is

necessary that all devices are connected to the same

network, with which the application works as an

integrating agent, all devices must be registered with

the application that is installed on the computer. One

of the functionalities that this configuration allows

us, is to be able to work in a multiple configuration,

managing to configure several virtual reality glasses

connected to the same computer, with which the

therapy can be performed to several patients.

Figure 4: Description of the integration mode.

Figure 4 shows the integration mode between the

different components through the Virtual Desktop

application, the integration requirement is to be

connected to the same network and to be able to

Figure 5: Device connectivity.

Figure 5 shows the configuration in the Virtual

Desktop application, in the virtual reality glasses, the

virtual desktop client must be installed, when the

application is opened, it searches for the server that

can be connected in the same network, in our case,

we are connected in a laptop, so the application finds

and connects us to share resources.

2.3 Previus Results

For the case of the previous results, we present the

results that are observed in the virtual reality glasses,

as well as in the cellular equipment, we must

consider that what we observe in the cellular

equipment is the same image that is observed in the

glasses, so we can recommend as a quality control

mechanism, to only place the glasses on the patient

without any other action that may cause discomfort

to patients.

Figure 6: Verification of the connection with the simulated

cellular device.

In Figure 6, we present the connection of the cellular

device, where connectivity and access to the

computer is verified, what is displayed on the

cellular device is the same as what is displayed on

the virtual reality glasses.

Method to Improve Recovery Through Rehabilitation Techniques Using Virtual Reality with Motor Imaging Techniques

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Figure 7: Virtual reality lens configuration.

Figure 7 shows the configuration of the Oculus Gest

II lenses, where the connection with the Virtual

Desktop application is shown, by means of which it

is possible to connect to the equipment as well as to

select the environment. The mode of use is through

the controls of the lenses, in the case of patient use,

the configuration is done before placing the lenses

on the patients.

3 RESULTS

The results that we present are related to the

implementation of the method and the results that

we obtain in each of the processes, the fundamental

idea of the publication is to explain how the method

can be implemented, as well as the results in each of

the stages. The results will explain the resulting

images in each process, similarly when replicated

the images can be used as a reference.

Figure 8: Generation of lower limb imaging sequence.

In Figure 8, we present the image generation

process, in this case we generate the images

corresponding to the feet, first we register the image

of the foot and then we eliminate the outline of the

foot, leaving the foot with a black background.

One of the recommended ways is to be able to

create your own sequence of images, the

recommended method is to be able to take pictures

of the limbs as appropriate, for a better reception of

patients, you can take images of the patient himself,

this way you have a better reception of the patient to

the therapy.

Figure 9: Generation of upper limb imaging sequence.

In Figure 9, we present, analogously to Figure 8,

how we generate the images of the hand, having the

hand with a commonly used background, and the

image of the hand with a black background.

Just as we made the collection of images of the

lower limbs, we present the sequence of images of

the upper limbs, for which we also recommend that

the image is of the same patient, you can take

several images as well as to rotate them in both

cases, to be able to reproduce them in sequential

form, so we can have more images.

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Figure 10: Generation of image sequence.

The images shown in Figure 10 correspond to the

sequence of images generated, starting from the

same image we can add backgrounds, rotate them,

so that we can have a greater number of images.

Figure 11: Performance of motor imagery exercises.

In Figure 11, we present an example of the

application of the method, in which the patient is a

teenager who is performing the exercises, we can

observe the application of the method, by connecting

the computer, the virtual reality glasses and the

mobile device, the same image that is observed on

the computer is observed on the glasses and on the

cellular equipment.

Figure 12: Final visualization of the exercise.

In Figure 12, we present the final work mode, where

the recommendations of the method were applied,

the patient indicated is an adolescent who likes

movies, so the virtual environment was configured

to simulate a movie theater, the patient visualizes the

sequence of images as if he were in a movie theater,

improving the patient's perception, which would

help in their collaboration and thus improve

rehabilitation therapies.

4 CONCLUSIONS

The conclusions we reached at the end of the

research, is related to the implementation of the

method, as well as the benefits of the application, we

indicate from the perspective of the implementation

method, that the method is applicable because you

can perform exercises using the technique of remote

imaging, it is scalable, because it can be scaled

towards improvements in the images and replicable

because we present the procedures to implement the

method. The method can be applied in rehabilitation

centers using different equipment that provide a

virtual reality scenario, all of them connecting to the

same computer, and replicating it in all devices.

The benefits of using the motor imagery

techniques are related to the benefit of the patients

by reducing the recovery time, thus improving self-

confidence and eliminating all kinds of anxiety that

Method to Improve Recovery Through Rehabilitation Techniques Using Virtual Reality with Motor Imaging Techniques

609

is typical of patients, who try to recover as soon as

possible. Being able to control anxiety is very

important, increasing the motivation of the patients

themselves and generating confidence in their

recovery, using the method concentrating the patient

increases learning and performance at the time of

evaluating the patient's recovery.

The application of the method is related to

different types of patients, in which case they require

certain exercises to recover and perform daily

activities, can be applied to all types of patients,

adults, children, adolescents, workers, athletes,

although the technique of remote imagery helps in

recovery, to be complemented with the techniques

and advantages that provide us with virtual reality

helps to benefit the patient, using the proposed

method helps in the strategy for the recovery of the

patient.

Comparing traditional techniques with the

present proposal, they are related to the use and

exploitation of the different tools and techniques

provided by virtual reality, applied in the process of

learning how the arms and legs interact when

walking, known as motor imagery, being able to

provide patients with these images and videos in a

virtual environment, improve the perception and

attitude of patients, helping their recovery for the

benefit of recovering the mobility of patients, after

being immobilized by various factors.

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