远程虚拟康复训练在骨科的应用

远程医疗是21世纪的一场新兴的信息产业革命，它将给人类社会带来极大的社会效益和经济效益。虚拟现实(virtual re-ality，VR)作为一种高科技手段，已经在一些生物医学领域得到成功应用，在医学教学、疾病诊断、手术模拟、康复医疗等方面逐渐显现出其重要性。随着计算机技术的飞速发展，在骨科的康复训练中将远程医疗和虚拟现实结合起来，进行远程虚拟康复(telerehabilitated virtual reality)已成为可能。     

五维力反馈虚拟手术装置的优化设计

虚拟手术是虚拟现实技术在医学领域的重要应用,医生借助虚拟手术系统与虚拟环境进行交互,可以进行手术规划、手术培训和远程手术.虚拟手术系统中的力反馈设备是其重要组成部分,也是制约当前虚拟手术发展的瓶颈问题之一.力反馈技术可以使医生获得与虚拟对象交互产生的力觉,如同进行真实手术操作一样,可以使训练更真实、准确、可靠.虚拟手术系统的开发和利用可以节约培训医务人员的成本和时间.文章主要介绍了一套用于虚拟手术系统的五自由度力反馈装置,该装置不仅能跟踪入手的五维运动而且能输出五维的触觉力.以自行设计的装置为研究对象,分析其设计不完善的方面,重点分析了减速比对装置响应速度滞后的影响,并在分析的基础上对该装置进行了设计优化.     

上肢康复训练机器人虚拟环境建模技术

目的:以往基于虚拟环境的康复训练系统大多数强调视觉反馈,实验针对单自由度上肢康复训练机器人系统,建立康复训练的人机交互虚拟环境,在训练过程中利用力反馈和视觉反馈为患者提供暗示和帮助,并验证其可行性。方法:单自由度上肢康复训练机器人系统可以绕轴心进行反复的圆弧运动,对实际运动和虚拟环境中的路径进行映射,建立三个不同级别的康复训练虚拟环境模型。患者通过机械臂跟踪虚拟环境中的引导小球,并控制虚拟小球的运动,患肢的运动结果以视觉反馈的形式显示在屏幕上。同时,在规划路径周围构建虚拟力势场,根据实际运动与预测运动的位置误差为患者提供相应的力反馈,提示并帮助患者向正确的方向运动。利用该系统对一名健康女性进行初步的实验研究。结果:①虚拟环境实现了患肢的实际运动到虚拟运动的映射,患者可通过机械臂控制虚拟物体的运动。②当患肢实际运动与预测的位置存在误差时,虚拟环境可以通过训练机械臂为患者提供力反馈。结论:利用该思路构建的虚拟环境可以实现康复训练过程中的力觉和视觉交互,为患者提供及时的暗示和帮助,在康复训练机器人领域有一定的应用前景。     

认知障碍的远程康复进展

在美国 ,每年有七百万脑外伤患者 ,其中 10 %属中等程度外伤 ,严重者占 5 %～ 7% ,经积极救治后 ,大多数患者要接受出院回家的现实。即使运动功能恢复良好 ,脑损伤患者也会长期存在不同程度的认知与行为障碍[1] 。面对这些问题 ,患者家属往往束手无策 ,医护人员也是处于进退两难的境地。通过互联网建立的远程康复系统很好地解决了这个问题 ,使医院与社区、家庭人员之间的面对面沟通与交流成为现实。远程康复 ,特别是远程认知康复在国外发展迅速 ,方兴未艾[2 4] 。本文就国外远程康复及有关进展予以介绍并探讨。远程认知功能评估脑部损伤后…     

远程康复系统中的多维数据采集

康复资源分布的严重不平衡性体现在康复服务的技术资源、设备资源和人才资源集中在大、中城市和富裕地区,而康复服务的主要对象———残疾人却大部分居住在相对偏远和不发达的地区。随着网络技术和网上临床工程的进展,远程康复的研究与应用为解决或降低这种不平衡性提供了新的、有效的途径。1远程康复系统的构成基本的远程康复系统由残疾人、现场设备和当地医师、远程专家组构成。其中,残疾人是系统的服务对象,具有很强的个体化特征;现场设备用来采集残疾人的失能信息,具体的设备通常包括摄像机、麦克风、数据坐垫、数据手套等;当地医师可以…     

基于因特网的认知远程康复治疗系统的构建

本文介绍基于因特网的认知远程康复治疗系统的建设,包括总体构思、系统的组成、系统实现所采用的关键技术、系统的功能设计、患者与医生不同角色的权限划分以及网上就医流程。该系统适合我国国情,将成为认知康复开辟新途径,有助于解决远离医院居住、行动不便的患者就医难,以及专业治疗人员缺乏等问题,亦有助于推动我国认知康复的普及与发展。     

基于虚拟网络计算技术的远程放射学诊断系统的建立

目的 建立基于虚拟网络计算技术、遵从DICOM协议的远程放射学诊断系统。方法 运用VC++6.0、Leadtools开发包、VNC源码在Windows 2000操作系统中开发。结果 本系统在Internet网和广域网环境下成功地实现了远程放射学影像的采集、浏览、处理、诊断与书写图文报告功能,在实际应用中取得了良好的效果。结论 基于VNC技术开发的远程放射学系统交互速度快、实时性强、影像清晰度好,在低带宽的网络条件下也能具备优异的速度和性能。本系统能够提升放射诊断学的信息化与网络化水平,促进放射学的远程交流,具有广阔的应用前景和推广价值。     

远程康复及其在香港的发展

远程医疗 (telemedicine)经过 3 0多年的发展 ,从运用电话、传真、无线电通信到静止图像和实时交互电视技术 ,以及虚拟现实和远程机器人等一系列新的通信技术和电子学技术 ,其发展速度与规模令人惊讶[1] 。 2 0 0 3年 3～ 7月 ,在严重急性呼吸道综合征突发期间 ,远程教育、视像会议起到了不容忽视的作用。远程康复也不例外[2 4] 。其可能应用的领域包括 :①在功能障碍者或残疾者、家庭成员或照顾者、康复专业人员或临床专家之间通过视像会议 (video -conferencing)的形式进行交流、追踪和随访 ,并解答存在的问题 ;②帮助患者制定ADL计划…     

肾俞穴针刺的力反馈研究

背景：采用以计算机为核心的各种技术,将针灸专家正确有效的针刺方法,生成逼真的视觉、听觉、触觉一体化的计算机虚拟环境进行模拟针刺,能够极大增强操作者的真实感,减少临床针刺意外的发生。目的：构建虚拟肾俞穴针刺力反馈仿真系统。方法：通过力反馈设备,录取针灸名师的肾俞穴针刺手法,融入数字化虚拟人体。运用虚拟现实技术,在融合了肾俞穴信息的三维数字人体上,根据肾俞穴下各组织的物理特性,分析针刺过程中针体与组织的相互作用力,建立力学模型模拟针体受力,并通过力反馈设备真实地传递给操作者。结果与结论：初步实现了肾俞穴虚拟针刺力反馈仿真,使可视化的针灸虚拟人具有可现场模拟肾俞穴进针的触觉再现。肾俞穴针刺力反馈研究,为融合视觉、触觉和力反馈信息一体化的虚拟针刺作了初步探索,为针刺教学提供了一种动态的一对一仿真手段。     

肾俞穴针刺的力反馈研究

背景：采用以计算机为核心的各种技术,将针灸专家正确有效的针刺方法,生成逼真的视觉、听觉、触觉一体化的计算机虚拟环境进行模拟针刺,能够极大增强操作者的真实感,减少临床针刺意外的发生。目的：构建虚拟肾俞穴针刺力反馈仿真系统。方法：通过力反馈设备,录取针灸名师的肾俞穴针刺手法,融入数字化虚拟人体。运用虚拟现实技术,在融合了肾俞穴信息的三维数字人体上,根据肾俞穴下各组织的物理特性,分析针刺过程中针体与组织的相互作用力,建立力学模型模拟针体受力,并通过力反馈设备真实地传递给操作者。结果与结论：初步实现了肾俞穴虚拟针刺力反馈仿真,使可视化的针灸虚拟人具有可现场模拟肾俞穴进针的触觉再现。肾俞穴针刺力反馈研究,为融合视觉、触觉和力反馈信息一体化的虚拟针刺作了初步探索,为针刺教学提供了一种动态的一对一仿真手段。     

医学图像三维重建系统的关键技术研究与设计

背景:医学影像三维可视化技术将二维断层图像转化为三维图像,有利于提高医疗规划的准确性,是当今医学领域研究的热点,在诊断医学、手术规划、模拟仿真等领域都有重要的应用.目的:利用二维医学图像序列重建出三维模型的关键技术,对可视化系统进行总体设计.方法;首先研究现有三维重建技术,包括预处理技术,图像分割和配准可视化算法.其次给出了系统体系结构设计图,各模块中应用到各种三维重建关键技术.结果与结论:根据现有关键技术的研究,选用OpenGL作为可视化开发工具,设计了一种基于PC机的三维医学图像可视化系统.     

Examining the usability of a virtual reality driving simulator

The current study examined specific aspects of usability of a newly developed VR driver rehabilitation (VR-DR) system. Measures of user feedback and user comfort were examined among 54 participants: 33 individuals with acquired brain injury (20 with traumatic brain injury and 13 with cerebral vascular accident) and 21 healthy controls. All participants were administered the VR-DR and completed the VR-DR User Feedback Questionnaire. To examine group differences, a one-way analysis of variance was performed, comparing the user feedback total score between the three groups. The results indicated that the two clinical populations (traumatic brain injury and cerebral vascular accident) varied from the nonclinical population (healthy controls). A standard multiple regression analysis revealed that age was the only significant participant factor that contributed to the differences in user feedback ratings. Finally, consistent across the three groups, a distinct relationship was found between the self-reported user rating and the onset of simulation sickness. The current findings indicate that individuals with traumatic brain injury and cerebral vascular accident provided less favorable user feedback ratings than healthy controls in the use of a new VR-DR system. This difference was not accounted for by differences in gender, education, or cognitive status and was only slightly accounted for by age. Delineating these various aspects of user feedback can assist in identifying potential confounds in VR-DR performance and help refine the application of the VR-DR for clinical decision making.     

Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness

Purpose: A motivational surrounding is desirable in stroke rehabilitation considering the need to train repetitively to improve balance, even after discharge from rehabilitation facilities. This review aims to investigate whether it is feasible to combine virtual reality (VR) which allows exercising in game-like environments with tele-rehabilitation in a community-dwelling stroke population.

Methods: Literature searches were conducted in five databases, for example, PubMed and the Cochrane Library. Randomized controlled trial (RCT) and non-RCT investigating feasibility and effectiveness of VR-based tele-rehabilitation were included. Based on the risk of bias and study design, methodological quality is ranked according to the GRADE guidelines.

Results: Seven studies (n?=?120) were included, of which four are RCTs. Evidence regarding therapy adherence and perceived enjoyment of VR, as well as a cost–benefit of tele-rehabilitation emphasizes feasibility. Equal effects are reported comparing this approach to a therapist-supervised intervention in the clinical setting on balance and functional mobility.

Conclusions: Tele-rehabilitation could be a promising tool to overcome burdens that restrict accessibility to rehabilitation in the future. VR can increase motivation allowing longer and more training sessions in community-dwelling stroke survivors. Therefore, combining the benefits of both approaches seems convenient. Although evidence is still sparse, functional improvements seem to be equal compared to a similar intervention with therapist-supervision in the clinic, suggesting that for cost-efficient rehabilitation parts of therapy can be transferred to the homes.

• Implications for rehabilitation

• The use of tele-rehabilitation could be a promising tool to overcome burdens that restrict the access of stroke survivors to long-term rehabilitative care.

• VR-based interventions are game-like and therefore seem to provide a motivational environment which allows longer exercise sessions and greater adherence to therapy.

     

检验科多台全自动生化分析仪网络数据管理系统的开发与应用

目的开发检验科多台自动生化分析仪网络数据管理系统,实现资源共享.方法应用Microsoft SQL2000建立数据库,按数据活跃程度和操作预测将其分为四种不同状态,建立客户机/服务器加单机本地数据库相结合的数据库.结果建立了检验科自动生化分析仪网络数据管理系统,经一年运行效果良好.结论本系统客户机/服务器加单机本地数据库相结合的数据库的方案能有效地满足检验科生化室网络数据库的实时性要求.     

一种组合式远程康复训练机器人的研制:适用性及其安全性

背景:国内对康复机器人的研究起步比较晚,辅助型康复机器人的研究相对较多,而康复训练机器人的研究相对较少,医工跨学科的结合有待加强,国内的康复器械远远不能满足市场对智能化、人机工程化的康复机器人的需求.目的:针对国内康复专家少而患者较多这一问题,将遥操作机器人技术与康复医疗器械相结合,以期研制一种基于力反馈的组合式远程康复训练机器人系统.方法:充分考虑到患者的安全性,采用磁流变阻尼器加上直流电机的模式,设计了一种组合式机械臂,将遥操作机器人技术应用于肢体残障者的康复训练,使患者可以根据康复治疗师的远程设定进行康复锻炼,并将虚拟现实技术与康复训练相结合,把枯燥的康复训练变成轻松有趣的游戏.结果及结论:该系统的服务对象是上肢有运动障碍的患者,通过对机械臂的拆卸和组合,可给患者提供康复需要的不同训练模式和治疗方案;运用计算机网络技术可使患者根据康复医师的远程设定进行康复训练;身临其境的虚拟现实技术显著提高了康复训练的积极性与效果.实验结果表明,所研制的远程康复训练机器人系统具有良好的适用性和安全性.     

Development of a wheelchair virtual driving environment: trials with subjects with traumatic brain injury

Spaeth DM, Mahajan H, Karmarkar A, Collins D, Cooper RA, Boninger ML. Development of a wheelchair virtual driving environment: trials with subjects with traumatic brain injury.

Objective

To develop and test a wheelchair virtual driving environment that can provide quantifiable measures of driving ability, offer driver training, and measure the performance of alternative controls.

Design

A virtual driving environment was developed. The wheelchair icon is displayed in a 2-dimensional, bird's eye view and has realistic steering and inertial properties. Eight subjects were recruited to test the virtual driving environment. They were clinically evaluated for range of motion, muscle strength, and visual field function. Driving capacity was assessed by a brief trial with an actual wheelchair. During virtual trials, subjects were seated in a stationary wheelchair; a standard motion sensing joystick (MSJ) was compared with an experimental isometric joystick by using a repeated-measures design.

Setting

Subjects made 2 laboratory visits. The first visit included clinical evaluation, tuning the isometric joystick, familiarization with virtual driving environment, and 4 driving tasks. The second visit included 40 trials with each joystick.

Participants

Subjects (n=8; 7 men, 1 woman) with a mean age of 22.65±2y and traumatic brain injury, both ambulatory and nonambulatory, were recruited.

Interventions

The MSJ used factory settings. A tuning program customized the isometric joystick transfer functions during visit 1. During the second visit, subjects performed 40 trials with each joystick.

Main Outcome Measure

The root mean square error (RMSE) was defined as the average deviation from track centerline (in meters) and speed (in m/s).

Results

Data analysis from the first 8 subjects showed no statistically significant differences between joysticks. RMSE averaged .12 to .21m; speed averaged .75m/s. For all tasks and joysticks, driving in reverse resulted in a higher RMSE and more virtual collisions than forward driving. RMSE rates were greater in left and right turns than straight and docking tasks.

Conclusions

Testing with instrumented real wheelchairs can validate the virtual driving environment and assess whether virtual driving skills transfer to actual driving.     

Effect of force-feedback treatments in patients with chronic motor deficits after a stroke

OBJECTIVE: To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced. DESIGN: The study design was a single-blind, randomized, controlled trial. Chronic stroke subjects participated in a 6-wk, thrice-weekly, force-feedback program of either the upper paretic limb (n = 13) or the lower paretic limb (n = 12). Baseline and postintervention assessments of the performance of both the upper and the lower limb were measured for each subject, the untreated paretic limb of each group serving as a control for the other group. RESULTS: With the exception of the handgrip force, strength measurements of the treated limb increased after completion of the treatment. The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb. In contrast, gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb, whereas the scores in the Fugl-Meyer test for the lower limb and the timed up-and-go test did not increase for either group after treatment. CONCLUSION: The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity.     

急危重症虚拟实验室的设计与开发

虚拟现实技术已逐渐进入到医学教育领域,有着广阔的应用前景。本文根据急危重症实验教学的需要,利用现代计算机技术、多媒体技术和虚拟现实技术,针对急救技能的操作要点及难点,同时考虑到学生的学习兴趣,设计、研发了相关软件和项目,构建了急危重症虚拟实验室。     

The driving advisement system: a computer-augmented quasi-simulation of the cognitive prerequisites for resumption of driving after brain injury

No other activity so starkly pits the needs of the individual recovering from brain injury against the protection of society than does operating a motor vehicle. Cognitive abilities (e.g., response to complex processing demands, impulse control, ability to sustain performance, mental flexibility, and judgment), while evident only indirectly, are essential to performance, yet few are well sampled in currently used assessment procedures, which, instead, emphasize visuo-motor coordination and reaction time. In response to this need, a computerized quasi-simulation, the Driving Advisement System (DAS), was developed and is introduced here. The DAS incorporates a set of computer-based tasks for use by professionals charged with rendering advice concerning cognitive abilities necessary for driving safely. Normative data on DAS measures were obtained from a group of over 60 safe drivers free of significant neurological impairment. Preliminary validation findings are summarized. A sample DAS-generated report for a brain-injury survivor, who sought to resume driving, is used to illustrate the graphic norm-referenced presentation of an individual's performance together with self-appraisal ratings.     

Comparison of virtual wheelchair driving performance of people with traumatic brain injury using an isometric and a conventional joystick

Mahajan H, Spaeth DM, Dicianno BE, Collins DM, Boninger ML, Cooper RA. Comparison of virtual wheelchair driving performance of people with traumatic brain injury using an isometric and a conventional joystick.

Objective

To compare wheelchair driving performance in a driving simulator using a conventional joystick and an isometric joystick.

Design

Randomized, cohort study.

Setting

A research facility based in a hospital or in an independent living center.

Participants

Participants (N=20; 12 men, 8 women; mean age ± SD, 30.62±10.91y) who were at least 1 year post-TBI.

Interventions

Driving performance using an isometric joystick compared with a conventional movement joystick.

Main Outcome Measures

Average trial completion time, and trajectory-specific measures measured orthogonal to the center of driving tasks: root mean squared error, movement offset, movement error, and number of significant changes in heading.

Results

After statistically controlling for driving speed, participants were able to complete the driving tasks faster with an isometric joystick than while using a conventional movement joystick. Compared with the conventional joystick, an isometric joystick used for driving forward demonstrated fewer driving errors. During reverse driving the conventional joystick performed better.

Conclusions

The customizable isometric joystick seems to be a promising interface for driving a powered wheelchair for individuals with TBI.