With a $1,8-million grant from the National Institutes of Health (NIH), the team has come up with quite an assortment of new applications. Some are designed to make stroke survivors stack, push or pour liquid out of three-dimensional objects in immersive environments, while other tasks force them to pick up objects and move them through cyberspace corridors without bumping into walls or falling into booby traps.
"Haptics, which adds the sense of touch to 3D computing, lets stroke patients interact with virtual worlds by feel", stated Margaret McLaughlin, an IMSC investigator and professor of communication at the USC Annenberg School for Communication. "The big advantage is that we can control the environment and design cyber tasks that target each patient's impairment."
Margaret McLaughlin, who is a co-editor of Touch in Virtual Environments, works with researchers at the Keck School of Medicine of USC to design the new haptics technologies. "The technology got its start in commercial gaming, with the debut of inexpensive, non-immersive versions using force-feedback joysticks and steering wheels that vibrated as the driver sped along a video racetrack", she stated. "But in university laboratories, the availability of more sensitive, high-end devices that could render touch sensations in three dimensions quickly led to applications in more serious pursuits."
Haptics interfaces began to emerge in such fields as medical and surgical training programmes, flight school, tele-operations and scientific visualization. In 2004, NIH saw a need for the technology among stroke survivors, according to principal investigator Thomas McNeill, professor of cell and neurobiology, neurology and neurogerontology at the Keck School, and awarded USC and the University of Texas, Austin, a grant to pursue the work.
"More than 700.000 people suffer a stroke each year and nearly 450.000 survive with some form of neurologic impairment or disability", Thomas NcNeill stated. Those numbers will grow, he added, as the population ages and obesity and heart disease increase, making innovative rehabilitation programmes "a national priority" in the next 50 years.
A group of interdisciplinary faculty and Ph.D. students in IMSC's Haptics and Virtual Environments Lab including Margaret McLaughlin, Albert "Skip" Rizzo, Younbo Jung, Wei Peng, Shih-Ching Yeh and Weirong Zhu, went to work on the applications.
"Designing one is very much like creating an aircraft simulator to test and train pilots", stated Albert Rizzo, who is currently a research scientist at USC's Institute for Creative Technologies. "But now we've created simulations that can assess and rehabilitate a stroke patient under a range of stimulus conditions. These are conditions that aren't easily deliverable or controllable in the real world."
The haptics interfaces have descriptive names, such as "space tube", "pincher" or "mutual touch", which tell users what they do. In addition, each cyber task targets specific eye-motor co-ordination skills and measures the user's movements in real time.
"Pincher" is designed for two-fingertip contact with virtual objects, according to Shih-Ching Yeh and Weirong Zhu, both computer programmers and graduate students in the Annenberg School of Communications. The interface works like this. The user dons a pair of stereoscopic goggles and puts a thimble on the forefinger; the thimble is connected to a robotic force-feed device, called a PHANToM. The stylus of a second PHANToM is affixed to the thumb. The two PHANToMs provide the sensation of force to the user's fingertips as (s)he tries to pick up a three-dimensional cube and squeeze it small enough to fit through a narrow hole on the computer screen.
Another emerging interface is a "mutual touch" task for hand-reaching and grasping exercises. This therapeutic environment utilizes a "cyber grasp" exoskeleton, which fits over an instrumented data glove, to measure the position and orientation of the hand in a three-dimensional space.
"The glove allows patients to feel the sensation of a solid object in their palms", stated Shih-Ching Yeh, who develops some of the "special effects" computer graphics for these interfaces. "Among the tasks they might be able to perform are picking up a glass and inverting it to pour the liquid out or picking up books and stacking them on appropriate shelves."
The interfaces give physical therapists precise control over a stroke patient's exercise programme, which is key to recovery, according to Younbo Jung, another member of the team and a graduate student in communications. "We can tailor rehabilitative tasks, like pouring milk out of a glass, to each patient, depending on what level of impairment they have sustained", Margaret McLaughlin added. "We also get information on their performance instantly, which helps the therapist to design a rehabilitative programme of increasing difficulty."
In pilot studies at the USC Keck School, led by Carolee Winstein, professor of biokinesiology and physical therapy and co-principal investigator on the NIH grant, and Ph.D. student Jill Stewart, stroke patients are trying out these prototypes. So far, they have reported "overall satisfaction" with all of the new cyber tasks, according to Margaret McLaughlin. In one instance, a volunteer was "extremely enthusiastic about the space tube task and said she wanted to use the system at home".
That is critical to post-stroke recovery. "It's not easy to keep patients motivated and engaged in daily, repetitive exercises", Margaret McLaughlin stated, "so if they are enjoying the tasks, they're likely to do better during rehabilitation."