WO2018124940A1 - Method for the rehabilitation of patients in different stages of central or peripheral nervous system diseases using virtual reality - Google Patents

Abstract

A method for the rehabilitation of patients in different stages of central or nervous system diseases using virtual reality relates to the field of medicine, and more particularly to neurology, and can be used in the rehabilitation of patients in different periods after presentation of a disease of the central or peripheral nervous system or of the musculoskeletal system. The proposed technical solution is directed toward producing the following technical result: enabling patients to regain arm movement and walking ability after damage to the central or peripheral nervous system, as well as in the event of musculoskeletal disorders, using virtual reality. This aim is achieved in that a method for the rehabilitation of patients in different stages of central or nervous system diseases using virtual reality involves a virtual environment with control elements and sensory interaction, wherein the range of a virtual movement is adjusted on the basis of information obtained from recording sensors, and the patient is provided with the sensation of tactile and proprioceptive contact with virtual objects and the sense of having performed a complete movement by means of the use of the optic and auditory canals and devices which provide proprioceptive and tactile stimulation of the limb receptors.

Description

 Method for the rehabilitation of patients in various stages of central or peripheral nervous system disorders using virtual reality

The invention relates to medicine, namely to neurology and can be used in the rehabilitation of patients at various times after the pathology of the central, peripheral system or musculoskeletal system.

 A known method and system for treating neuromotor dysfunction according to US201361774207P 20130307 comprising a first component supply signal is configured to provide peripheral stimulation of pulse signals in the peripheral part of the body, a second component supply signal is configured to transmit a pulse signal of stimulation of the motor cortex in the motor cortex of a zone The direct current signal-providing component is configured to provide direct current spinal stimulation of the signal in the neural pinnomozgovoy node and the controller component is configured to control timing pulse signals and peripheral stimulation pulse motor cortex stimulation signal.

 But this method does not provide a feeling of uprightness and does not allow the patient to act on objects of virtual reality.

There is a method of rehabilitation of patients in the acute stage of a stroke using biological feedback and virtual reality according to the patent of the Russian Federation .422432971 with a priority of 04/02/2010, publ. November 10, 2011, where they use biological feedback (BFB) and virtual reality, for which they install glasses and a virtual reality helmet on the patient’s head, install motion sensors on the patient’s head, trunk and pelvic area, download software consisting of a virtual environment and controls, and directional training of coordinated movements of the head, trunk and pelvic area through a virtual reality environment and motion sensors. The underwater world is used as a virtual environment, and the dolphin is used as a virtual control object. The sensitivity and symmetry of the control movements is regulated depending on the condition of the patient and his ability to move. BFB is carried out ^: through the optic canal in the associated (through the eyes of a dolphin) and dissociated (through the eyes of an external observer of his actions) state. The method provides restoration of control of basic arbitrary movements of the trunk, head and neck, in this group of patients. This method is aimed at restoring control of the basic voluntary movements of the body, head and neck, and not limbs. This method does not provide restoration of the movement of arms and legs and does not give the patient a feeling of uprightness, and the patient can not act on objects of virtual reality, but can only see them, and also this method does not allow the patient to use biological feedback from the first person, using multisensor analyzers i.e. visual, auditory, skin-kinesthetic.

 The closest in technical essence is the system and methods for overcoming gravity-induced dysfunctions in case of limb paresis described in patent US 2006079817 A1, 04/13/2006. The invention relates to the field of rehabilitation and / or physiotherapy in the treatment of injuries and / or diseases using a tactile system that is used to educate and / or assist a person with neurological problems. In this area, the invention promotes an auxiliary robotic device in combination with a three-dimensional virtual reality workspace. This method involves the use of a virtual environment with controls and touch interaction on a virtual object.

 In this patent, rehabilitation is based on overcoming gravity and resistance, and this method is based on teaching the patient how to use strength and how to compensate for the erroneous position of the talus or limbs on

^' r

 physical level.

 The proposed technical solution is aimed at obtaining the following technical result: ensuring the restoration of arm movement and patient walking functions against the background of damage to the central or peripheral nervous system, as well as in the pathology of the musculoskeletal system using virtual reality.

The problem is solved due to the fact that the method of rehabilitation of patients in various stages of disorders of the central or peripheral nervous system using virtual reality includes a virtual environment with controls and sensory interaction on a virtual object, and based on the information received from the recording sensors, the volume of virtual movements is adjusted , and by means of using the visual, auditory canal and devices producing proprioceptive and tactile stimulus limb receptors, provide the patient with a sense of tactile and proprioceptive contact with virtual objects and a sense of completeness of the movement. For the rehabilitation of patients in various stages of disorders of the central or peripheral nervous system using virtual reality, the patient is provided with a device that creates a virtual reality of the environment. The type of device is determined by the doctor on the basis of the patient’s condition or they either install a helmet and virtual reality goggles on the patient’s head, or place it in a virtual reality room. Download the necessary program, consisting of a virtual environment with controls aimed at restoring active movements in the patient's limbs. Install devices that have a proprioceptive and tactile effect on limb receptors, as well as devices that register electromyographic (EMG), electroencephalographic (EEG) or biological signals. Electroencephalography signals are recorded by electrodes located on the patient’s head and demonstrate a change in the action potential arising in the neurons of the brain, and electromyography signals evaluating the electric potential arising from muscle contraction. Based on the treated signals, the volume of virtual movements is adjusted. With a pronounced motor pathology and significant power paresis, the patient is in passive contact with the virtual environment and does not directly affect virtual reality objects. As the strength grows and the range of motion in the limbs is restored, the patient begins to have a direct impact on the objects of virtual reality. As a virtual environment, for the restoration of walking functions, for example, a forest-park environment is used, where the patient can arbitrarily choose the direction of the walk and the pace of movement. To practice the lost motor skills of the basic movements of the upper limbs, for example, a virtual kitchen table and kitchen items are used, and the object of control is the patient's virtual limbs when viewed from the first person. Sensory interaction with objects of virtual reality is carried out through the visual and auditory canal, as well as tactile and proprioceptive stimulation, while associating with a virtual avatar, which allows the patient to achieve a sense of tactile contact with virtual reality objects, as well as to achieve maximum cognitive and emotional immersion in virtual reality. Based on the signals received from the EEG and EMG, and depending on the patient’s ability to move, the volume of control virtual movements is regulated in such a way that gives a sense of completeness movements, such as kicking the ball. The intensity of the impact on the ball is regulated depending on the changes in the EEG and EMG signals. Feeling tactile contact allows you to register the fact of touching the object, and enables the patient, using multisensory communication, to perform technological and other tasks similar to those performed by the healthy person with the same actions. This gives the patient a sense of completeness of the movement performed in reality, despite the fact that the limb can only move slightly or not at all at the initial stage of rehabilitation. Restore active movements in the limbs using the virtual reality environment with controls! through sensory interaction with virtual objects, it occurs due to the activation of secondary motor centers and associative zones of the cerebral cortex to form new motor formulas of movement (motor engrams) that enable activation of certain muscle groups to carry out successful and planned movements, taking into account the presence of affected parts of the nervous system. New neural networks are being formed that are responsible for movement in the cerebral cortex and lead to restoration of movement.

A method of rehabilitation of patients in various stages of disorders of the central or peripheral nervous system using virtual reality to restore movement in the lower and upper limbs is as follows. Occupation takes place in a rehabilitation room. The terms of rehabilitation are not limited (any duration of the disease, which entailed a violation of the locomotor function of the upper and lower extremities). The patient is in a sitting position in a chair to restore movement in the lower extremities. The patient is placed on the head with virtual reality glasses, electroencephalographic sensors, electromyographic sensors are installed on the affected leg of the patient, on the thigh and lower leg. In the projection of the plantar surfaces of the feet, four pneumocuffs are installed on each plantar surface. A program is launched showing the patient a park area where he can move along walkways for a walk. At the initial stage, the patient moves in a passive state, i.e. does not regulate the direction and speed of movement. Moreover, each virtual step of the patient is synchronized with the sequential inflation of pneumocuffs on the same side, which gives the patient a tactile sensation of contact with the track for a walk in virtual reality. The duration of classes is 10-15 minutes, daily in the morning, for a total of up to 7-10 sessions. Further, the patient is invited to imagine the movement of a paralyzed limb, namely, to make an intention to take a step or choose a direction of movement, by choice. This intention is associated with the sound signal, in order to accurately temporarily fix the beginning of planning. In this case, the EEG is recorded and a classifier is built, which in the future will give a control signal for choosing the direction of movement in the virtual environment or the beginning of the virtual movement of the affected limb. After training the classifier (program on the computer), the patient can independently choose the direction of movement and take a step with the affected limb only if he thought about it. EMG registers minimal muscle contractions on the affected limb and provides a control signal for regulating walking speed in virtual reality. Moreover, the higher the amplitude of the EMG signal, the greater the speed of movement in virtual reality. All this is necessary to enhance cognitive and sensory immersion in virtual reality and accelerate motor rehabilitation. In the presence of sensory impairment or after a long time after a lesion of the central or peripheral nervous system, in addition to the additional devices described above, a robotic exoskeleton is mounted on the affected limb with several degrees of freedom allowing passive movements in the hip, knee and ankle joints. The patient will already be supported in an upright position (due to a special hanging device) on the treadmill. The EEG and EMG control signals, in addition to the effect on ¹ action, occurring in a virtual environment will regulate the movement of exoskeleton servos, adjusting the changes in the angles in the hip, knee and ankle joints, as well as their angular velocity. In another case, the patient can not install virtual reality glasses and demonstrate the virtual environment in a specially equipped virtual reality room, showing the patient the same park environment. To restore movement in the upper limbs, the patient is placed in a sitting position in a chair at the table. Virtual reality glasses, electroencephalographic sensors are installed on the patient’s head, electromyographic sensors are installed on the affected arm of the patient, on the shoulder and forearm. A program is launched demonstrating to the patient a kitchen table with appliances that he can move around the virtual table, pick up. At the initial stage, the patient is in a passive state and observes the friendly movements of virtual hands that perform manipulations with cutlery imitating food intake, i.e. does not regulate the direction and speed of movement. Duration of classes for 10-15 minutes, daily in the morning, for a total of up to 7-10 sessions. Further, the patient is invited to imagine the movement with a paralyzed hand. This intention is associated with the sound signal, in order to accurately temporarily fix the beginning of planning. In this case, the EEG is recorded and a classifier is built, which in the future will give a control signal for choosing the direction of movement in the virtual environment or the beginning of the virtual movement of the affected limb. After training the neural network, the patient alone can move the affected limb only if he thought about it, while the program will “finish” the movement in the virtual environment until it is complete, for example, bring a spoon or glass to the mouth of a virtual avatar. EMG registers minimal muscle contractions on the affected limb and provides a control signal to control the speed and select the item that the patient wants to take at a given moment from the virtual table. Moreover, the higher the amplitude of the EMG, the greater the speed of movement in virtual reality. All this is necessary to enhance cognitive and sensory immersion in virtual reality and accelerate motor rehabilitation. In the presence of sensory impairment or after a long time after a lesion of the central or peripheral nervous system, the patient, in addition to the additional devices described above, is equipped with a robotic exoskeleton on the affected limb with several degrees of freedom allowing passive movements in the shoulder, elbow and wrist joints. The patient may be in a sitting or standing position independently or due to a special verticalizing device, if there is a pronounced decrease in strength in the lower extremities. EEG and EMG signals, in addition to influencing the actions taking place in a virtual environment, will regulate the movement of exoskeleton servos, adjusting the angles in the shoulder, elbow and wrist joints, as well as their angular velocity. In another case, the patient can not install virtual reality glasses, but demonstrate a virtual environment in a specially equipped virtual reality room, showing the patient an already more complicated room environment where he can interact with objects that are in it, not only household ones, such as housekeeping, but also professional car driving, work on the machine, etc. Patient N, 64 years old. Entered the neurological department for patients with acute cerebrovascular accident September 30, 2016 with a diagnosis “Acute cerebrovascular accident - ischemic stroke in the basin of the right middle cerebral artery from 09/30/2016.” At the time of admission in neurological status, the patient had pronounced motor disorders in the form of left leg plegia. The patient received therapy within the framework of the federal standard for the provision of medical care to patients with acute cerebrovascular accident. From the fifth day after the occurrence of a stroke, the patient began rehabilitation measures. By this time, the patient with outside help could sit for 10-15 minutes. Questioning the patient at the moment on the scale of motor activity (Berg scale) was 1 point. The patient's self-care is completely impaired. Since that time, the patient has also started therapy using virtual reality with a demonstration of walking from the first person on a horizontal surface with a tactile sense of step. For this, the department staff delivered the patient in a wheelchair to the medical rehabilitation room. The patient was in a wheelchair during rehabilitation. Virtual reality glasses were put on the patient’s head, legs were placed on the feet, namely, pneumocuffs were installed on the feet, with four pneumatic chambers on each leg. Then, a program was launched that showed the patient movement on the football field. At the same time, each step of the virtual avatar was associated with the sequential inflation of pneumocuffs installed on the plantar surface of the foot, which gave the patient tactile sensations of the step. The duration of rehabilitation took from 10 minutes at the beginning of the course, up to 15 minutes after its completion. In total, seven sessions were held with the patient every day. By the end of rehabilitation on a neurotracer, the patient was able to complete most of the tasks when questioning on the Berg scale. In this case, the patient could sit on his own, change the chair from bed, get out of bed, stand safely for at least 2 minutes and lift an object from the floor. Thus, by the end of the classes on the neurotransmitter, the patient restored most of the motor skills necessary to restore the locomotor function of walking.

Claims

 8 Formula A method for the rehabilitation of patients at various stages of central or peripheral nervous system disorders using virtual reality includes a virtual environment with controls and sensory interaction on a virtual object, characterized in that, based on the information received from the recording sensors, the volume of virtual movements is adjusted and the means of using visual , auditory canal and devices producing proprioceptive and tactile stimulation of limb receptors, obes they make the patient feel tactile and proprioceptive contact with virtual objects and a sense of completeness of the movement.