Virtual reality—play, recover, live. VR technologies for rehabilitation medicine

Source: Rehabilitation Industry of Russia company’s blog, Game Development, Accessibility, AR and VR.

Spending hours playing computer games is not an activity only for professional e-sports players or amateur gamers. There are people to whom immersion in virtual reality is prescribed by the attending physician. How successful they are in the game has much greater consequences than leveling up or getting a new game object. Virtual reality for these people is a simulator that improves the quality of life, how comfortable that life is, and how long it is, some cases. Welcome to the world of VR rehabilitation. 

Graphics that’s been used in video games for decades have been implemented in medicine for a long time, as well. Russian media doesn’t talk about this often because it’s not the most popular topic. But it doesn’t diminish the importance of such technologies. 

But it doesn’t diminish the importance of such technologies. Thousands of people in Russia need rehabilitation using virtual reality technology. Hundreds of them receive such assistance and confirm its effectiveness by their own example. Some Russian startups and scientific medical centers are trying to respond to market demands for simulators and VR rehabilitation programs. But for now, there are too few companies to fill the niche in the market that will only grow in the coming years. Although the results are already showing market prospects and, of course, importance for those in need of rehabilitation. 

“Motorica” company develops and manufactures technologies that are at the intersection of medicine and robotic engineering. Their main product is arm and hand prostheses for children and adults. In addition to mechanical traction prosthesis, “Motorica” successfully produces complex and science-based bionic devices, the functionality of which practically turns its owner into a cyborg. A person can control this device almost as well as a natural hand, using the same muscles and nerve endings. 

But to fully master the control of the bionic prosthesis and confidently use it, months of training and rehabilitation are required. In order to qualitatively improve the process, the programmers of “Motorica” have developed a digital rehabilitation platform ATTILAN. It’s basically a VR headset video game with a straightforward plot. Players visit the orbit of Mars, stay inside the international space station ATTILAN and prepare for the upcoming colonization of the planet. 

But the challenges and difficulties awaiting players close to the Red Planet are designed to teach them how to use their bionic prostheses. Players walk around the station, perform minor tasks, coordinate cargo, and shoot. For different types of rehabilitation there are different types of game characters: an engineer, a scientist, and a spacecraft pilot.

A player uses the same muscles that control the bionic prostheses to control the processes of the game. Special sensors capture the forearm muscle tension and transmit data to the program. The players see a natural hand and a futuristic prosthesis, which they move, flex and bend the hand, take and carry objects thanks to the proper work of the muscles of the remaining part of the amputated limb. In the future, this is how players will control their bionic prosthesis in the real world. 

Though their game ATTILAN, “Motorica” implemented one of the most innovative and modern methods of preparing patients for prosthetics. But in medical rehabilitation, virtual reality technologies have been applied in other directions for a long time. For example, to restore impaired motor functions due to brain damage. Such rehabilitation is often necessary for people who have experienced a stroke or other vascular diseases that have caused damage to the brain. 

“Istok-Audio Group” is a leader in Russia in the development and supply of rehabilitation and medical equipment and assistive devices for people with hearing disorders. The scope of the company’s work is increasing and today extends to people with all ICD diseases. One of the new developments of “Istok-Audio Group” is the virtual rehabilitation program “Devirta.Delfi”.

“Devirta.Delfi” is virtual cyberspace with its own 3D world, to immerse into which, much like in ATTILAN, a user needs a VR headset and biofeedback system. Here, the technology is even more interactive: the patient’s computer avatar repeats human movements in the virtual world, which creates the feeling of real interaction with the surrounding space and adds motivation. 

Medical rehabilitation in the form of simple daily training is prescribed to those who survived brain injury. “Devirta.Delfi” controls their process and allows the patient to see the result of their efforts, feeling like the main character of every activity.

“Rehabunculus” is a service provided today by specialists of Research Center Of Neurology and “Intelligence and Innovations” company. It works in a similar way. When they created this simulator, the developers stopped at virtual space, and did not go as far as a biofeedback system. Unlike “Devirta.Delfi”, “Rehabunculus” does not require any sensors, it is easier to use but it serves the same purpose of providing the required amount of everyday physical activity.

“The possibilities provided by virtual reality allow us to put to use certain peculiarities of the human body, like neuroplasticity,” explains the CEO of LLC “Intelligence and Innovations” and “Rehabunculus” Project Head Egor Tokunov. “Specially selected technologies and algorithms improve the efficacy of rehabilitation and force the body to work in the right way. Virtual reality makes a person with locomotor disabilities believe that they can do more than they can in real life and increases motivation for rehabilitation activities.”

Doctors and developers from the Samara State Medical University went much further, transferring the usual VR rehabilitation into neurorehabilitation. The neurostimulator RevivR puts you back on your feet again, both literally and figuratively. In the virtual world created by SSMU programmers, people with severe locomotor disabilities can walk again, see their legs, hear steps, and even feel each of them. In addition to image and sound, the stimulator provides tactile support. 

During the rehabilitation session, a VR headset is put on the patient’s head. Pneumatic cuffs that simulate the pressure of the ground surface you feel when walking are placed on the patient’s feet. In the VR headset, the patient sees himself upright from a first-person perspective and moves independently. The illusory perception of movement activates certain muscle groups that stimulate brain activity. 

Research in medical rehabilitation indicates that neural connections can be restored using video game stimulation of brain activity. This recovery is possible due to neuroplasticity. ReviVR is the key feature for activating this mechanism. 

The same team of SSMU developed another neurostimulator with a completely different task, but with the same mission to help people with disabilities. ReviMOTION is developed for children with cerebral palsy or other locomotor disorders. 

Rehabilitation with the ReviMOTION neurostimulator is even more like a video game. With its help, patients perform a course of training in a playful way. Correctly performed movements make the virtual character move and go through level after level. 

At the same time, using the optical tracking and movement analytics provided in the stimulator, the attending physician can track the patient’s progress, while the integrated information-analytical system will help the physician “guide” the patient from session to session during the entire rehabilitation process. 

“We proved the effectiveness through the first clinical trial at one of the centers”, said Alexander Zakharov, Docent of the Department of Neurology and Neurosurgery SSMU. “Now we have connected dozens of such medical centers in Russia. No one in the world has conducted such extensive studies on the effectiveness of this technology for the restoration of lower limb movement. We plan to justify the effectiveness of VR rehabilitation in other pathologies.” 

The experience of Russian and foreign rehabilitation practice demonstrates that solutions based on virtual reality technologies are capable of helping people suffering from health problems to recover and adapt, improve coordination, balance, and control of their body. It’s been proven that the characteristics of movements performed in real space have no meaningful difference from movements in a virtual environment. As a result, even at an early stage of rehabilitation, a person gains more confidence in their actions and abilities, and the skills learned in the VR space are easier to transfer to real space. 

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