Abstract
Hemiparesis or weakness on one side of the body, due to traumatic brain injury or stroke requires long-term expensive therapy to recover from either mild or severe motor impairment in the upper and lower limbs. Medical research has shown that timely scientific therapy can help regain most of the basic motor movements, while finer motor coordination requires a longer time. The most crucial factor is access to trained therapists and neuro-rehab centers equipped with state-of-the-art assistive systems for upper/lower limb exercises. Physiotherapy exercises can be accessed at dedicated rehabilitation centers or hospitals fitted with expensive clinically tested equipment or with gym equipment modified for specific exercises. Access to clinical rehabilitation therapy for economically poor patients and importantly rural population is sparse in India. They are forced to move to towns or cities with their families for a duration ranging from 3-6 months for therapy sessions disrupting the families and adding to their financial burden. Additionally, the current sessions are unmotivating requiring a doctor or a therapist to constantly monitor their progress.
The research presented in this thesis aims to address some of the above-mentioned issues. The systems designed and tested as part of this work focus on regaining basic limb movements for stroke/spinal cord injury patients. The idea originates from integrating games and use of bio-feedback control systems
to provide an immersive virtual environment while recording the limb movement progress using wearable or embedded sensors. The analyzed data collected from the gameplay and sensors are remotely accessed by doctors/therapists for monitoring the patient. Three exergame systems i.e. playing games while engaged in physical exercise, were designed, developed and tested on patients. To address joint contracture hemiparesis or increased hypersensitivity in the lower limb extremity, an exergame called Run was designed. A crucial step to regain strength and balance in the lower limbs is the ability to transfer weight from one leg to the other as well as muscle control required to position a foot forward or backward. With these movement requirements, an avatar controlled by the patient is made to run, collect coins and avoid collision with intermittent obstacles. When the avatar collides with an obstacle, he/she needs to perform a particular foot movement exercise to move ahead. The signals to control the gameplay are collected from the sensors positioned to detect the transfer of weight from one lower extremity to another Hypertonia and apraxia (difficulty in arm movement) are two other conditions developed after a stroke. The damage after a stroke leaves muscles and the peripheral nerves incapable of receiving motor signals from the spinal cord. Over time, the muscle tone reduces, and the patient is unable to lift or move the arm. In many cases, the arm and fingers do not respond to external stimulation. Post-stroke, there is an urgency is to recover muscle tone and control with rigorous exercise. Towards this, a game and a sensors circuit were designed, developed and implemented. The game titled Catch, has a simple user graphical interface and requires the patient/player to control a virtual basket to catch apples dropping from a tree. The first step is to swing the arm in an arc of 30-150 degrees over proximity sensors followed by the tactile pressure of the fingers on an object. Embedded pressure sensors were used to collect the applied pressure from the fingers. The signals from the sensors are used to control the game. Motivation is considered a major factor for rehabilitation post stroke. To examine the influence of spirituality and religious experiences in neuro-rehabilitation exercises, a game simulating a famous pilgrim
centre was developed. It has also been reported that Post-Stroke Depression (PSD) can impair recovery and religious faith is reported to have a strong positive influence. Hence, the third exergame called Temple Steps was designed and developed. The game had two versions, one with the temple as a theme wherein the participant climbs the stairs to reach the main deity and the second version with trekking as the theme. To test participants motivation stemming from belief, both the versions were used
for comparative analysis. The physical interface used was a basic gym stair exercise machine to which sensors and controls for navigation were fitted. Neuropathic pain resulting from conditions such as phantom limb, stroke or chronic regional syndrome Type 1 can be treated with mirror therapy. The last phase of my research was to test the working of Dr. Ramachandrans mirror box on stroke patients. There is no consensus on its working and speculation
often lacks the neuroscientific proof. So, a mirror box fitted with cameras, leap motion, and mayo band was developed for measuring the strength of peripheral nervous system signal to the muscle in the aff