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WO2018124940A1 - Procédé de réhabilitation de malades à divers stades de troubles du système nerveux central ou périphérique à l'aide de la réalité virtuelle - Google Patents

Procédé de réhabilitation de malades à divers stades de troubles du système nerveux central ou périphérique à l'aide de la réalité virtuelle Download PDF

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Publication number
WO2018124940A1
WO2018124940A1 PCT/RU2017/000962 RU2017000962W WO2018124940A1 WO 2018124940 A1 WO2018124940 A1 WO 2018124940A1 RU 2017000962 W RU2017000962 W RU 2017000962W WO 2018124940 A1 WO2018124940 A1 WO 2018124940A1
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virtual
patient
virtual reality
rehabilitation
patients
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English (en)
Russian (ru)
Inventor
Александр Владимирович Захаров
Василий Федорович ПЯТИН
Сергей Сергеевич ЧАПЛЫГИН
Александр Владимирович КОЛСАНОВ
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A61H1/02—Stretching or bending or torsioning apparatus for exercising

Definitions

  • 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.
  • 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.
  • 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.
  • 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
  • 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 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.
  • 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.
  • EMG electromyographic
  • EEG electroencephalographic
  • the patient 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • the patient moves in a passive state, i.e. does not regulate the direction and speed of movement.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • the patient 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.
  • 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.
  • 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.
  • the patient 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.
  • 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.
  • a program was launched that showed the patient movement on the football field.
  • 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.
  • 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.
  • the end of the classes on the neurotransmitter the patient restored most of the motor skills necessary to restore the locomotor function of walking.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Pain & Pain Management (AREA)
  • Epidemiology (AREA)
  • Rehabilitation Therapy (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Rehabilitation Tools (AREA)

Abstract

L'invention concerne un procédé de réhabilitation de malades à divers stades de troubles du système nerveux central ou périphérique à l'aide de la réalité virtuelle, et se rapporte au domaine de la médecine, notamment de la neurologie, et peut être utilisée lors de la réhabilitation de patients à différentes périodes après l'apparition d'une pathologie du système nerveux central ou périphérique ou de l'appareil locomoteur. Cette solution technique a pour but de produire le résultat technique suivant: assurer un rétablissement du mouvement des bras et des fonctions de la marche de patient dans le cadre d'une atteinte du système nerveux central ou périphérique, ainsi que lors de pathologies du système locomoteur en utilisant la réalité virtuelle. Cet objectif est atteint grâce à un procédé de réhabilitation de malades à divers stades de troubles du système nerveux central ou périphérique à l'aide de la réalité virtuelle qui utilise un milieu virtuel avec des éléments de commande et une interaction par capteurs; sur la base des informations reçues par des capteurs d'enregistrement, on effectue un ajustement du volume des mouvements virtuels, et par des moyens d'utilisation de canal visuel et auditif et de dispositifs produisant une stimulation proprioceptive et tactile des récepteurs des extrémités, on donne au patient une sensation de contact tactile et proprioceptif avec les objets virtuels et une sensation d'exécution d'un mouvement effectué.
PCT/RU2017/000962 2016-12-29 2017-12-22 Procédé de réhabilitation de malades à divers stades de troubles du système nerveux central ou périphérique à l'aide de la réalité virtuelle Ceased WO2018124940A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
RU2016152265 2016-12-29
RU2016152265A RU2655200C1 (ru) 2016-12-29 2016-12-29 Способ реабилитации больных в различных стадиях нарушений центральной или периферической нервной системы с использованием виртуальной реальности

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Cited By (1)

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CN112085169A (zh) * 2020-09-11 2020-12-15 西安交通大学 肢体外骨骼辅助康复脑-肌电融合感知的自主学习与进化方法

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3901961A4 (fr) * 2019-06-17 2022-08-10 Limited Liability Company Sensomed Complexe matériel-logiciel pour le rétablissement de patients souffrant de troubles cognitifs des extrémités supérieures après un avc
CN111124102B (zh) * 2019-10-24 2024-01-05 上海市长宁区天山中医医院 混合现实全息头显四肢和脊柱运动康复系统及方法
RU2741215C1 (ru) 2020-02-07 2021-01-22 Общество с ограниченной ответственностью "АйТи Юниверс" Система нейрореабилитации и способ нейрореабилитации
RU2766044C1 (ru) * 2021-11-16 2022-02-07 Федеральное государственное бюджетное образовательное учреждение высшего образования "Самарский государственный медицинский университет" Министерства здравоохранения Российской Федерации Способ формирования фантомной карты кисти у пациентов с ампутацией верхней конечности на основе активации нейропластичности

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US20090131225A1 (en) * 2007-08-15 2009-05-21 Burdea Grigore C Rehabilitation systems and methods
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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112085169A (zh) * 2020-09-11 2020-12-15 西安交通大学 肢体外骨骼辅助康复脑-肌电融合感知的自主学习与进化方法
CN112085169B (zh) * 2020-09-11 2022-05-20 西安交通大学 肢体外骨骼辅助康复脑-肌电融合感知的自主学习与进化方法

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