力反馈远程康复训练虚拟驾驶系统的软件设计

背景：国内随着人口老龄化现象加剧,对康复训练的需求日益迫切。机器人技术与康复医学理论、网络通讯技术相结合的康复训练机器人能够有效解决传统康复训练的缺点与不足,已成为康复领域的研究热点。 目的：针对上肢运动功能障碍患者康复训练需要,设计了一套用于远程康复训练的力反馈虚拟驾驶软件系统。 方法：采用异步流式套接字模型进行网络通讯,ADO数据库管理技术进行信息管理,虚拟现实技术构建虚拟驾驶环境。采用数据库管理技术取代传统的基于文件的数据处理技术提高了系统信息管理效率;患者端虚拟驾驶环境的构建增加了康复训练的趣味性;且具有直观清晰的数据和视频显示界面。 结果与结论：该系统具有直观清晰的实时视频和数据显示界面、高效的数据管理技术、有趣的虚拟驾驶环境等特点,为临床应用奠定了基础。     

虚拟微创心脏手术中力觉信息的采集

利用等强度梁和步进电机模拟真实手术中的穿透过程,针对心脏瓣膜微创手术进行了不同穿透速度的力采集实验,获得了虚拟手术中力反馈的真实信息,也为建立虚拟人手术专家系统提供了有效的数据。实验记录了穿透曲线,发现当穿透力高于10 mm/s时心脏瓣膜的穿透力出现了峰谷交替出现的曲线;而低于这个速度时候并无明显的峰谷区别。还有一个明显的现象,穿透力随着穿透速度的增加而增加。实验数据为力反馈设备提供了实际的反馈曲线,并可以用于计算试验软组织对象的材料特性,为计算机仿真模拟提供材料参数。     

虚拟影像术前计划系统在神经外科的临床应用研究

目的探讨三维立体虚拟影像术前计划系统在神经外科常规手术中的应用价值。方法应用Radio Dexter虚拟影像术前计划系统对颅内肿瘤及椎管内肿瘤等15例神经外科常规手术病例进行术前计划操作。结果15例病例均成功进行了术的计划操作。该系统形成的三维立体虚拟影像清晰、逼真，并可进行多种模拟操作，能更清楚、准确地显示手术区域解剖结构及毗邻关系。本组无严重并发症．无死亡病例。结论三维立体虚拟影像术前计划系统能够提高神经外科手术的精确性．降低手术创伤及手术风险，值得推广应用。     

1000/基于PC机上颅颌面虚拟手术仿真平台的初步建立及应用

目的: 在普通个人计算机上初步建立了数字化可视颅颌面虚拟手术仿真平台并探讨其应用。方法: 应用薄层CT扫描数据集，利用Mimics软件对336层，层厚为0.7mm的CT二维图像数据进行分析处理。结果：初步建立了数字化可视颅颌面虚拟手术仿真平台，并在此平台上切割模拟其外科手术。结论：在普通计算机上应用Mimics软件初步建立了数字化可视颅颌面虚拟手术仿真平台，并对其应用进行了探讨，为科研、教学及临床手术规划提供了方便、快捷、直观的方法，为虚拟手术设计在普通计算机上的广泛应用迈出了重要的一步。     

基于真实CT数据骨科虚拟手术计划在髋臼骨折手术中的运用

背景：骨科虚拟手术计划有助于提高外科医生的手术精确性。 目的：探索计算机术前模拟手术技术在骨盆、髋臼骨折的治疗中的应用方法及临床价值。 方法：对13例骨盆及髋臼骨折患者进行螺旋CT影像扫描,将其DICOM数据输入个人计算机中Mimics软件,使用分割方法,于内固定前建立计算机模拟手术过程。 结果与结论：骨块分割出来和提取关节表面模型的平均时间为45 min(30~70 min),操作者可进行骨折复位与固定时间平均为28 min(16~45 min)。计划13例手术入路,最终12例完全采用,12例完全采用了模拟手术固定方法,1例部分采用了计划固定方法;螺钉数与术前计划一致的有10例患者,螺钉长度与术前计划一致的有8例,固定钢板与术前计划一致的11例。随访CT显示关节面解剖复位6例(46%),7例(54%)满意,没有螺钉穿入关节腔。说明通过计算机术前模拟手术,可以制定准确的手术方案,为指导实际手术提供数据支持。     

虚拟内镜在神经外科的应用

虚拟现实在医学领域正发挥其独有的作用,以其无创、高度仿真、可重复利用等优点迅速在各临床领域发展起来。虚拟内镜作为虚拟现实技术之一已经在肛肠外科、肝胆外科、耳鼻喉科等得到了广泛应用。在神经外科方面,虚拟内镜也具有其独特的优势。传统的神经外科手术需由术者依照CT或MRI二维影像凭借经验想象合成三维效果,对解剖结构复杂的病例则可能发生较大的偏差。虚拟内镜为上述问题提供了优秀的解决方案,可在手术前显示操作部位的内部结构、重要血管及神经的毗邻关系,为制定手术计划、安全高效的开展手术操作提供了有力的技术支持。本文拟就国内外虚拟内镜在神经外科的应用作一综述。     

脑穿刺手术模拟训练系统的实验研究

目的通过建立虚拟脑穿刺手术模型进行神经外科手术培训。方法利用虚拟现实技术建立正常成年人脑形态三维图形,机械臂操作系统建立脑穿刺手术模型,计算机实时显示穿刺针进针线路、角度和位置。选择低年资外科医师进行模拟训练。结果医师培训前模拟脑室穿刺平均成功率40%,穿刺实际路径与理想路径夹角(穿刺夹角)为(0.12±0.08)°;经模拟训练后穿刺平均成功率94%,穿刺夹角为(0.09±0.03)°。培训后模拟穿刺成功率较培训前显著性提高(P0.01),穿刺夹角明显缩小(P0.01)。结论虚拟现实技术建立的脑穿刺手术模型,为神经外科临床医师快速、熟练掌握脑穿刺手术技巧,提供安全、有效的辅助训练手段。     

Dexotroscope手术计划系统在颅脑手术中的应用及评估

目的使用Dexotroscope手术计划系统,了解其性能及其对临床制定手术计划以及实施手术的帮助。方法临床病人30例,将其术前CT、MRI扫描的原始资料直接输入Dexotroscope计划系统的工作站,进行相应的处理,包括重建、融合、分割等,模拟手术全过程。结果手术中所见病变与周边神经、血管、颅骨的关系与手术前模拟完全符合。动脉瘤夹闭时间和齿状突磨除时间明显缩短,并发症减少,且术后Karnofsky评分改善。结论Dexotroscope手术计划系统能使术者对病人影像资料从三维、动态化的角度有更深入的理解。应用该系统可在术前制定精确而详细的手术计划,并可模拟手术经过,提前了解手术的难易程度,同时它也是极其理想的临床培训和教学工具。     

Dextroscope虚拟现实手术规划系统在神经外科的应用

目的应用手术规划系统，探索虚拟现实技术在神经外科的应用价值和方法。方法术前采集10例颅内深部病变患者的CT、MRI、CTA、MRA、DSA影像资料输入Dextroscope工作站进行图像融合处理和三维重建，在虚拟影像上观察病变与周围组织的空间关系，设计手术入路、模拟手术过程进行骨窗开颅、颅骨磨除及肿瘤切除，并与实际术中所见进行比较。结果术中所见病变与周边重要神经血管结构的空间关系和病变解剖细节与术前模拟完全吻合，减少了手术时间。通过手术模拟，术者得以提前预演手术经过，为优化治疗方案创造了条件。结论虚拟现实手术规划系统有助于术前诊断、制定详细的手术计划、预先评价手术难度，提高手术安全性。是医疗教学和训练的得力工具。     

Dextroscope虚拟现实技术在颅底肿瘤手术中的应用

目的 探索Dextroscope在颅底肿瘤个体化手术人路设计及术中对脑血管保护作用.方法 64例颅底肿瘤患者随机分成实验组和对照组,每组分别为32例.实验组术前使用Dextrescope系统设计手术,对照组不使用该系统.记录手术切除肿瘤程度,比较两组手术后脑血管损伤并发症,以及术后KPs评分.结果 手术全切率:实验组83%,对照组77%;血管损伤并发症:实验组3例,对照组为7例(P<0.05);KPS评分:实验组91.75±8.1,对照组85.6±9.4(P<0.05).结论 利用Dextroscope进行颅底肿瘤术前计划,有助于个体化手术入路设计,有利于减少手术中脑血管的损伤,改善手术后KPS.     

机器人在微创外科手术中的应用

背景：微创外科手术机器人具有稳定性好、操作灵活、运动精准、手眼协调等特点,是微创手术未来发展的方向。目的：分析微创外科手术机器人的现状,探讨微创外科手术机器人的关键技术。方法：分别从体外手术机器人与体内手术机器人等方面,详细分析和介绍了国内外近年来的主要研究成果,并对微创外科手术机器人的力反馈、主从控制策略等关键技术进行了探讨。结果与结论：综合国内外微创外科机器人的研究情况来看,微型体内手术机器人是手术机器人领域的研究热点,特别是微型机器人的灵巧性设计、手术机器人的定位、运动规划与控制、操作力的实时测量与力反馈等关键技术。主从操控技术是手术机器人进行遥操作和微操作的关键环节。     

Interfacing a haptic robotic system with complex virtual environments to treat impaired upper extremity motor function in children with cerebral palsy

Objective: To investigate the ability of the New Jersey Institute of Technology Robot Assisted Virtual Rehabilitation (NJIT-RAVR) system training to elicit changes in upper extremity (UE) function in children with hemiplegia secondary to cerebral palsy.

Methods: Nine children (mean age 9 years, three males) participated in three pilots. Subjects trained 1 hour, 3 days a week for 3 weeks. Two groups performed this protocol as their only intervention. The third group also performed 5–6 hours of constraint-induced movement therapy.

Results: All subjects participated in a short programme of nine, 60-minute training sessions without adverse effects. As a group, subjects demonstrated statistically significant improvements in Melbourne Assessment of Unilateral Upper Limb Function Test, a composite of three timed UE tasks and several measurements of reaching kinematics. Several subjects demonstrated clinically significant improvements in active shoulder abduction and flexion as well as forearm supination.

Conclusion: Three small pilots of NJIT-RAVR training demonstrated measurable benefit with no complications, warranting further examination.     

Delivering word retrieval therapies for people with aphasia in a virtual communication environment

Background: Delivering therapy remotely, via digital technology, can enhance provision for people with aphasia. EVA Park is a multi-user virtual island that can be used for such delivery. The first EVA Park study showed that daily language stimulation delivered via the platform improved functional communication and was positively received by users. This paper reports two single case studies, evaluating its capacity to deliver targeted language interventions. The first employed therapy for noun retrieval, using cued picture naming and modified Sematic Feature Analysis. The second employed modified Verb Network Strengthening Treatment (VNeST).

Aims: This study aimed to determine if treatment delivery was feasible in EVA Park, as assessed by participant compliance, treatment fidelity and participants’ views. It explored the impact of the therapies on treated and untreated word production, connected speech and functional communication.

Methods & Procedures: Two participants with aphasia each received 20 sessions of individual therapy in EVA Park, delivered over 5 weeks. Feasibility was assessed by measuring compliance with the therapy regime, recording and checking the fidelity of 20% of treatment sessions, and using post-therapy interviews to explore participant views. Treatment outcomes were evaluated via repeated measures single case designs, in which assessments were administered twice before therapy, immediately post therapy and 5 weeks later. Outcome measures included Object Picture Naming (study 1), Sentence Elicitation Pictures (study 2), Naming 84 items from the Object and Action Naming Battery (study 2), Narrative Production (Study 2), the Northwestern Assessment of Verb and Sentences: Argument Structure Production Test (Study 2) and Communication Activities of Daily Living – 2 (Study 1 and 2).

Outcomes & Results: Feasibility results were excellent. Both participants were fully compliant with the therapy regime. There was at least 90% fidelity with the treatment protocols, and participant views were positive. Outcomes varied across the studies. The noun therapy significantly improved the naming of treated words, with good maintenance. Lexical gains were less evident on the Sentence Elicitation Pictures used in the VNeST study. Neither study demonstrated generalisation to untreated words, connected speech or functional communication.

Conclusions: Two treatment approaches, designed for face-to-face delivery, could be delivered remotely in EVA Park. Outcomes for the noun treatment were comparable to previous evaluations. Comparisons with previous research were more challenging for VNeST, owing to differences in methodology. Further evaluations of other treatment approaches are warranted.     

Prism adaptation improves chronic visual and haptic neglect: a single case study

Visuomotor adaptation to rightward displacing optical prisms is known to induce temporary improvements in the symptoms of left visual neglect. We report a 74 year-old woman with severe and chronic neglect of nine months duration, who underwent three weekly sessions of prism adaptation. Substantial improvements were obtained on tests of visual neglect (cancellation, copying and bisection). Improvement was also observed on a spatial judgement task, with no explicit visual component, in which CS was required to locate the centre of a haptically explored circle. These observations confirm that brief periods of prism exposure can benefit even chronic neglect disorders. Moreover, the improvement observed on the haptic task supports the belief that this procedure can influence higher levels of spatial representation.     

Neglect assessment as an application of virtual reality

OBJECTIVE: In this study a cancellation task in a virtual environment was applied to describe the pattern of search and the kinematics of hand movements in eight patients with right hemisphere stroke. METHODS: Four of these patients had visual neglect and four had recovered clinically from initial symptoms of neglect. The performance of the patients was compared with that of a control group consisting of eight subjects with no history of neurological deficits. RESULTS: Patients with neglect as well as patients clinically recovered from neglect showed aberrant search performance in the virtual reality (VR) task, such as mixed search pattern, repeated target pressures and deviating hand movements. The results indicate that in patients with a right hemispheric stroke, this VR application can provide an additional tool for assessment that can identify small variations otherwise not detectable with standard paper-and-pencil tests. CONCLUSION: VR technology seems to be well suited for the assessment of visually guided manual exploration in space.     

Assessment of post‐stroke extrapersonal neglect using a three‐dimensional immersive virtual street crossing program

Kim DY, Ku J, Chang WH, Park TH, Lim JY, Han K, Kim IY, Kim SI. Assessment of post‐stroke extrapersonal neglect using a three‐dimensional immersive virtual street crossing program
Acta Neurol Scand: 2010: 121: 171–177.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To investigate the potential of our newly developed three‐dimensional immersive virtual reality (VR) program modeled on a real street crossing as an assessment tool for extrapersonal neglect in stroke patients. Methods – Thirty‐two patients with right‐hemispheric stroke (neglect group, 16; non‐neglect group, 16) were enrolled. The deviation angle, reaction time, left‐to‐right reaction time ratio, visual and auditory cue rates, and failure rate were evaluated during missions to keep a virtual avatar safe from a traffic accident in the VR program. The line bisection test and letter cancellation test were also evaluated. Results – The deviation angle, left‐to‐right reaction time ratio, left visual and auditory cue rates and left failure rate in the VR program showed significant differences between the two groups (P < 0.05). Depending on the direction of approach of the virtual car, the left parameters were significantly higher than the right parameters in the neglect group (P < 0.05). In the neglect group, the line bisection test correlated significantly with the deviation angle (P < 0.05). None of the other virtual reality parameters significantly correlated with the paper and pencil tests. Conclusion – Post‐stroke neglect in the extrapersonal space can be easily and safely detected and measured using our three‐dimensional immersive virtual street crossing program.