With the help of VR glasses and playful exercises, tele-rehabilitation of patients is to be made more attractive. To this end, researchers at HSLU have developed a digital platform together with practitioners.
A mole jumps out of various holes and is immediately pushed down again with a wave of the hand. Immediately afterwards, another animal jumps out. Whew - and yet another one of these little guys has slipped out of your hand... Not in real life, of course, but as an online game: "Whack a mole" is the name of the training game that runs in front of the virtual eye on the VR glasses and is designed to strengthen the shoulder muscles and mobility of the arms and hands. Sensors on the index and ring fingers record the movements. A camera is attached to the VR goggles, which films arm and hand movements and superimposes them directly onto the game.
Exergames are games that combine physical activity and mental tasks. "In the context of tele-rehab, they are a valuable addition to modern therapy," explains Sebastian Frese, Head of Technology and Innovation at Zurzach Care. Together with researchers from the iHome Lab at Lucerne University of Applied Sciences and Arts, the clinic group has been developing an innovative teletherapy system for two and a half years. The EU-funded "RecoveryFun" project is packed with technological expertise, big data and AI knowledge. But that’s not all: The human factor - patients, relatives and therapy specialists - plays just as central a role as in traditional on-site therapy.
Gamification does the trick
Back to virtual reality: in the next exergame (a portmanteau word made up of exercise and game), the aim is to escape from "Alpatraz". This is an alpine-style labyrinth through which the player must guide their hand as quickly as possible without getting stuck on obstacles. Easier said than done... A prickly cactus here, a dead end there, a stone in the way here. This maneuvering through the alpine maze makes you pretty tired.
Sebastian Frese explains: "We deliberately take patients into virtual worlds so that they can train their upper extremities, i.e. arms, shoulders and hand movements. Cognitive abilities and coordination of movements are also to be promoted with the developed tele-rehab solution - for example after strokes."
Based on sensor signals, the therapists can use AI algorithms to deduce the subjective stress and fatigue of the exercisers. The pseudonymized data - which cannot be decrypted by third parties - is stored in a secure cloud.
Nothing to do with cheating
In addition to these exotic game worlds, classics such as "memory", "basketball" and "hand clapping" are also included. The exercises differ in their requirements and can be adapted in terms of difficulty. The advantage of this is that patients can exercise regularly and in good portions - when they have the time and inclination.
Incidentally, the system cannot be tricked. "It uses a biometric fingerprint to recognize that a third party has exercised instead of the person concerned," explains Andrew Paice, Head of iHomeLab at HSLU. "We have created a low-threshold form of physical and cognitive exercise that anyone can do anywhere." Paice knows from practical experience that some patients neglect to exercise if it cannot be easily integrated into their everyday lives. "The simpler the set-up, the greater the chances that the training will also take place regularly at home," Paice continues.
Simple set-up - close exchange
The materials required for online training of this kind are limited: The clinic provides VR goggles with a data transmission device and a bio-sensor on the finger. This is the basic equipment. There is also an app for relatives. Sebastian Frese from Zurzach Care explains: "We rely heavily on this card. Family and partners play an important role in supporting and motivating affected relatives during rehabilitation. They can also provide support when it comes to technical questions relating to exercise." The therapists can connect to the patients exercising remotely via a multi-protected line. They can follow the exercises live and online with pinpoint accuracy. This allows the training sessions to be analyzed in real time.
The specialists can also see on an ongoing basis how exactly the exercises are being carried out; the therapy plans can therefore be individually adapted to the abilities and needs of those affected. In addition, the exercises can be compared with each other afterwards and recommendations for additional exercises can be made. According to Sebastian Frese, this innovative form of therapy also changes the therapists’ tasks: In this situation, they see themselves more as coaches. The interaction via the video function also strengthens the personal connection between the trainee and the therapist.
Motivation thanks to interaction
The interpersonal level is therefore a very important element in tele-rehabilitation. This is another reason why the video function was integrated into the system with the HSLU specialists. "With this function, we can see the patients live as they train and also recognize where any difficulties arise in the execution of movements," explains Frese. "The exercisers themselves can also get much more involved and give immediate feedback or ask questions." The aim of the therapy is to gain as holistic a picture as possible. The opportunities for interaction and contact also have the potential to increase motivation for training.
The human factor remains important
The feedback from the test subjects was very positive overall - in particular, the ease of use of the instruments was highly praised, as the researchers emphasize. The participants were correspondingly committed to their work. "The entry into the virtual world, where the sensory experience is initially different, initially led to questions such as:" However, thanks to the simple and direct video function, such concerns could be clarified quickly and personally, reports Ramon Straumann, who, as a project member and therapist in Sebastian Frese’s team, accompanied several tele-therapies during the project.
"It is crucial that patients are taught how to use the devices correctly right from the start," explains Straumann. It has proven to be a good idea to first explain how to use the devices during a physical appointment before the remote therapies. This is also about listening to patients’ needs and questions and reducing any fear of contact. "Because not all patients have had to deal with VR glasses before," adds Straumann.
Very welcome: complementary form of therapy
Sebastian Frese is convinced: "This form of tele-rehab represents an innovative care model." The model has the potential to conserve the resources of the healthcare system and close an existing gap in treatment thanks to its flexibility in terms of time and location: As a complementary form of therapy, it can significantly reduce the workload for patients and their relatives. They have to spend less time on on-site visits to the clinic and can save on costly travel. The added value for clinics and rehabilitation centers is also obvious - "especially in view of the shortage of specialists in the medical field," explains Frese.
Next goal: transfer to everyday medical practice
In total, around 70 patients, 15 relatives and over 40 specialists have been involved in the test series over the past two and a half years. The result is a large amount of anonymized data and diagrams. From this, experts can derive overarching patterns using big data analysis. The aim is to use AI to develop new personalized treatment and training approaches that are even more effective. "With our Tele-Rehab platform, we have provided both the technological prerequisites and the proof of concept in clinical practice," explains Andrew Paice from HSLU. The next step is to transfer the technology to everyday medical practice - together with interested business partners.
The "RecoveryFun" project (original title: An integrated VR-based tele-rehabilitation platform to support RECOVERY and maintenance of ctional abilities among seniors) ran from January 2022 to June 2024. The research program is part of the European Union’s "AAL - Active Assisted Living" thematic cluster. In addition to the iHomeLab, practical teams from Italy (Tech4Care, INRCA), Switzerland (ZURZACH Care), Romania (Canary Technology) and Belgium (Unmatched, Trainm) were involved in the interdisciplinary project.
The iHomeLab of the Lucerne University of Applied Sciences and Arts - "Living in the future. Today."
Under the leadership of Andrew Paice, the iHomeLab team at Lucerne University of Applied Sciences and Arts is researching how intelligent systems can reduce energy consumption in buildings or enable older people to live longer. The results of the research projects are presented in the iHomeLab Visitor Center on the Horw campus and explained in an understandable way. Visits can be booked at www.ihomelab.ch/besuchen.
Text: Reto Wilhelm
Pictures: Zurzach Care
Published: October 24, 2024