A systematic review: Virtual-reality-based techniques for human exercises and health improvement.

Virtual Reality (VR) has emerged as a new safe and efficient tool for the rehabilitation of many childhood and adulthood illnesses. VR-based therapies have the potential to improve both motor and functional skills in a wide range of age groups through cortical reorganization and the activation of various neuronal connections. Recently, the potential for using serious VR-based games that combine perceptual learning and dichoptic stimulation has been explored for the rehabilitation of ophthalmological and neurological disorders. In ophthalmology, several clinical studies have demonstrated the ability to use VR training to enhance stereopsis, contrast sensitivity, and visual acuity. The use of VR technology provides a significant advantage in training each eye individually without requiring occlusion or penalty. In neurological disorders, the majority of patients undergo recurrent episodes (relapses) of neurological impairment, however, in a few cases (60-80%), the illness progresses over time and becomes chronic, consequential in cumulated motor disability and cognitive deficits. Current research on memory restoration has been spurred by theories about brain plasticity and findings concerning the nervous system's capacity to reconstruct cellular synapses as a result of interaction with enriched environments. Therefore, the use of VR training can play an important role in the improvement of cognitive function and motor disability. Although there are several reviews in the community employing relevant Artificial Intelligence in healthcare, VR has not yet been thoroughly examined in this regard. In this systematic review, we examine the key ideas of VR-based training for prevention and control measurements in ocular diseases such as Myopia, Amblyopia, Presbyopia, and Age-related Macular Degeneration (AMD), and neurological disorders such as Alzheimer, Multiple Sclerosis (MS) Epilepsy and Autism spectrum disorder. This review highlights the fundamentals of VR technologies regarding their clinical research in healthcare. Moreover, these findings will raise community awareness of using VR training and help researchers to learn new techniques to prevent and cure different diseases. We further discuss the current challenges of using VR devices, as well as the future prospects of human training.

Design of a Single-Material Complex Structure Anthropomorphic Robotic Hand.

In the field of robotic hand design, soft body and anthropomorphic design are two trends with a promising future. Designing soft body anthropomorphic robotic hands with human-like grasping ability, but with a simple and reliable structure, is a challenge that still has not been not fully solved. In this paper, we present an anatomically correct robotic hand 3D model that aims to realize the human hand's functionality using a single type of 3D-printable material. Our robotic hand 3D model is combined with bones, ligaments, tendons, pulley systems, and tissue. We also describe the fabrication method to rapidly produce our robotic hand in 3D printing, wherein all parts are made by elastic 50 A (shore durometer) resin. In the experimental section, we show that our robotic hand has a similar motion range to a human hand with substantial grasping strength and compare it with the latest other designs of anthropomorphic robotic hands. Our new design greatly reduces the fabrication cost and assembly time. Compared with other robotic hand designs, we think our robotic hand may induce a new approach to the design and production of robotic hands as well as other related mechanical structures.

Muscle Tissue Labeling of Human Lower Limb in Multi-Channel mDixon MR Imaging: Concepts and Applications.

With increasing resolutions and number of acquisitions, medical imaging more and more requires computer support for interpretation as currently not all imaging data is fully used. In our work, we show how multi-channel images can be used for robust air masking and reliable muscle tissue detection in the human lower limb. We exploit additional channels that are usually discarded in clinical routine. We use the common mDixon acquisition protocol for MR imaging. A series of thresholding, morphological, and connectivity operations is used for processing. We demonstrate our fully automated approach on four subjects and present a comparison with manual labeling. We discuss how this work is used for advanced and intuitive visualization, the quantification of tissue types, pose estimation, initialization of further segmentation methods, and how it could be used in clinical environments.

Torso Crowds.

We present a novel dense crowd simulation method. In real crowds of high density, people manoeuvring the crowd need to twist their torso to pass between others. Our proposed method does not use the traditional disc-shaped agent, but instead employs capsule-shaped agents, which enables us to plan such torso orientations. Contrary to other crowd simulation systems, which often focus on the movement of the entire crowd, our method distinguishes between active agents that try to manoeuvre through the crowd, and passive agents that have no incentive to move. We introduce the concept of a focus point to influence crowd agent orientation. Recorded data from real human crowds are used for validation, which shows that our proposed model produces equivalent paths for 85 percent of the validation set. Furthermore, we present a character animation technique that uses the results from our crowd model to generate torso-twisting and side-stepping characters.

Automatic measurement and visualization of focal femoral cartilage thickness in stress-based regions of interest using three-dimensional knee models.

PURPOSE: Thinning of cartilage is a common manifestation of osteoarthritis. This study addresses the need of measuring the focal femoral cartilage thickness at the weight- bearing regions of the knee by developing a reproducible and automatic method from MR images. METHODS: 3D models derived from semiautomatic MR image segmentations were used in this study. Two different methods were examined for identifying the mechanical loading of the knee articulation. The first was based on a generic weight-bearing regions definition, derived from gait characteristics and cadaver studies. The second used a physically based simulation to identify the patient-specific stress distribution of the femoral cartilage, taking into account the forces and movements of the knee. For this purpose, four different scenarios were defined in our 3D finite element (FE) simulations. The radial method was used to calculate the cartilage thickness in stress-based regions of interest, and a study was performed to validate the accuracy and suitability of the radial thickness measurements. RESULTS: Detailed focal maps using our simulation data and regional measurements of cartilage thickness are given. We present the outcome of the different simulation scenarios and discuss how the internal/external rotations of the knee alter the overall stress distribution and affect the shape and size of the calculated weight-bearing areas. The use of FE simulations allows for a patient-specific calculation of the focal cartilage thickness. CONCLUSION: It is important to assess the quantification of focal knee cartilage morphology to monitor the progression of joint diseases or related treatments. When this assessment is based on MR images, accurate and robust tools are required. In this paper, we presented a set of techniques and methodologies in order to accomplish this goal and move toward personalized medicine.

Assessment of cartilage contact pressure and loading in the hip joint during split posture.

PURPOSE: Given the crucial role of the mechanical behavior in the degenerative process of the hip joint, analyzing the contact mechanics in the articular layers during physical activities could contribute to understanding the pathology. Indeed, the development process of hip osteoarthritis generally evolves over a long time period, and therefore analyzing the mechanical behavior of the hip joint during extreme repetitive movements will be helpful to analyze degeneration causes. The aim of the study was to investigate the link between the excessive movements and the development of hip osteoarthritis. METHODS: To individualize the analysis, we used a subject-specific and noninvasive approach based on finite element analysis and magnetic resonance imaging (MRI) data. The contact pressure distribution and loading conditions on the acetabular cartilage were assessed on eleven professional dancer subjects performing a split movement. This movement is frequently practiced (repetitive) by dancers during their daily exercises. Moreover, split postures are mostly characterized by high anatomical angles with subluxation (excessive). To ensure the motion accuracy, MRI data of the subjects were acquired in neutral and split positions performed inside the MRI scanner. Based on the reconstructed bone models from the MRI data, a motion tracking approach was used to compute the transformation between the two poses. To evaluate the contact during the split movement and to quantify the role of the labrum in the hip joint mechanics, additional simulations of two daily activities (walking and stand-up) were performed. Finally, a clinical study based on morphological and radiological analysis of the subjects was performed and validated by orthopedic surgeons and radiological experts to evaluate the proposed approach. RESULTS: The reconstructed split movement was characterized by high anatomical angles with a subluxation on the left hip. Consequently, strong deformations and pressures were observed during the simulation. The comparison of the simulation results of split posture and daily activities showed higher pressure and lower contact area during extreme movements. Moreover, the presence of labrum absorbed part of load and consequently decreased the predicted contact pressure and contact area on the acetabular cartilage. CONCLUSION: The comparison of the simulation results of the split posture and daily activities, as well as the correlation between the results of the analysis on extreme movement results and the clinical analysis performed by medical experts, strongly suggests that repetitive extreme movement could lead to early hip osteoarthritis.

Facial Position and Expression-Based Human-Computer Interface for Persons With Tetraplegia.

A human-computer interface (namely Facial position and expression Mouse system, FM) for the persons with tetraplegia based on a monocular infrared depth camera is presented in this paper. The nose position along with the mouth status (close/open) is detected by the proposed algorithm to control and navigate the cursor as computer user input. The algorithm is based on an improved Randomized Decision Tree, which is capable of detecting the facial information efficiently and accurately. A more comfortable user experience is achieved by mapping the nose motion to the cursor motion via a nonlinear function. The infrared depth camera enables the system to be independent of illumination and color changes both from the background and on human face, which is a critical advantage over RGB camera-based options. Extensive experimental results show that the proposed system outperforms existing assistive technologies in terms of quantitative and qualitative assessments.

A computational approach to calculate personalized pennation angle based on MRI: effect on motion analysis.

PURPOSE: Muscles are the primary component responsible for the locomotion and change of posture of the human body. The physiologic basis of muscle force production and movement is determined by the muscle architecture (maximum muscle force, [Formula: see text], optimal muscle fiber length, [Formula: see text], tendon slack length, [Formula: see text], and pennation angle at optimal muscle fiber length, [Formula: see text]). The pennation angle is related to the maximum force production and to the range of motion. The aim of this study was to investigate a computational approach to calculate subject-specific pennation angle from magnetic resonance images (MRI)-based 3D anatomical model and to determine the impact of this approach on the motion analysis with personalized musculoskeletal models. METHODS: A 3D method that calculates the pennation angle using MRI was developed. The fiber orientations were automatically computed, while the muscle line of action was determined using approaches based on anatomical landmarks and on centroids of image segmentation. Three healthy male volunteers were recruited for MRI scanning and motion capture acquisition. This work evaluates the effect of subject-specific pennation angle as musculoskeletal parameter in the lower limb, focusing on the quadriceps group. A comparison was made for assessing the contribution of personalized models on motion analysis. Gait and deep squat were analyzed using neuromuscular simulations (OpenSim). RESULTS: The results showed variation of the pennation angle between the generic and subject-specific models, demonstrating important interindividual differences, especially for the vastus intermedius and vastus medialis muscles. The pennation angle variation between personalized and generic musculoskeletal models generated significant variation in muscle moments and forces during dynamic motion analysis. CONCLUSIONS: A MRI-based approach to define subject-specific pennation angle was proposed and evaluated in motion analysis models. The significant differences obtained for the moments and muscle forces in quadriceps muscles indicate that a personalized approach in modeling the pennation angle can provide more individual details when investigating motion behaviors in specific subjects.

Coupling strategies for multi-resolution deformable meshes: expanding the pyramid approach beyond its one-way nature.

PURPOSE: With higher resolutions, medical image processing operations like segmentation take more time to calculate per step. The pyramid technique is a common approach to solving this problem. Starting with a low resolution, a stepwise refinement is applied until the original resolution is reached. METHODS: Our work proposes a method for deformable model segmentation that generally utilizes the common pyramid technique with our improvement, to calculate and keep synchronized all mesh resolution levels in parallel. The models are coupled to propagate their changes. It presents coupling techniques and shows approaches for synchronization. The interaction with the models is realized using springs and volcanoes, and it is evaluated for the semantics of the operation to share them across the different levels. RESULTS: The locking overhead has been evaluated for different synchronization techniques with meshes of individual resolutions. The partial update strategy has been found to have the least locking overhead. CONCLUSION: Running multiple models with individual resolutions in parallel is feasible. The synchronization approach has to be chosen carefully, so that an interactive modification of the segmentation remains possible. The proposed technique is aimed at making medical image segmentation more usable while delivering high performance.

The Use of Videogames as Complementary Therapeutic Tool for Cognitive Behavioral Therapy in Bulimia Nervosa Patients.

Although cognitive behavioral therapy (CBT) has been demonstrated to be the most effective approach for the treatment of bulimia nervosa (BN), there is lack of studies showing whether a combination with a serious video game (SVG) might be useful to enhance patients' emotional regulation capacities and general outcome. The aims of this study were (a) to analyze whether outpatient CBT + SVG, when compared with outpatient CBT - SVG, shows better short-term outcome; (b) to examine whether the CBT + SVG group is more effective in reducing emotional expression and levels of anxiety than CBT - SVG. Thirty-eight patients diagnosed as having BN according to DSM-5 criteria were consecutively assigned to two outpatient group therapy conditions (that lasted for 16 weekly sessions): 20 CBT + SVG versus 18 CBT - SVG. Patients were assessed before and after treatment using not only a food and binging/purging diary and clinical questionnaires in the field of eating disorders but also additional indexes for measuring anger expression and anxiety. Regarding the post-treatment psychometric measures, most of the mean differences (Eating Disorder Inventory-2, Symptom Checklist-Revised, State-Trait Anxiety Index, and partially State-Trait Anger Expression Inventory) achieved moderate to high effect size (d > 0.5), in the sense that CBT + SVG obtained the best results compared with the CBT - SVG group. Regarding therapy outcome (dropout, partial remission, and total remission), CBT + SVG showed better results and a moderate effect size emerged for the comparison of the risk of dropout during the treatment, being higher for CBT - SVG compared with CBT + SVG (44.1 percent versus 20.0 percent, d = 0.54). Although the sample size in our study was low, and consequently results should be considered with caution, we have obtained promising findings suggesting that in the short-term CBT + SVG might be a good option not only for improving emotional dysregulation and approaching the current limitations of CBT - SVG in BN but also for enhancing the therapy adherence of patients.

Human Motion Capture Data Tailored Transform Coding.

Human motion capture (mocap) is a widely used technique for digitalizing human movements. With growing usage, compressing mocap data has received increasing attention, since compact data size enables efficient storage and transmission. Our analysis shows that mocap data have some unique characteristics that distinguish themselves from images and videos. Therefore, directly borrowing image or video compression techniques, such as discrete cosine transform, does not work well. In this paper, we propose a novel mocap-tailored transform coding algorithm that takes advantage of these features. Our algorithm segments the input mocap sequences into clips, which are represented in 2D matrices. Then it computes a set of data-dependent orthogonal bases to transform the matrices to frequency domain, in which the transform coefficients have significantly less dependency. Finally, the compression is obtained by entropy coding of the quantized coefficients and the bases. Our method has low computational cost and can be easily extended to compress mocap databases. It also requires neither training nor complicated parameter setting. Experimental results demonstrate that the proposed scheme significantly outperforms state-of-the-art algorithms in terms of compression performance and speed.

Human-Like Behavior Generation Based on Head-Arms Model for Robot Tracking External Targets and Body Parts.

Facing and pointing toward moving targets is a usual and natural behavior in daily life. Social robots should be able to display such coordinated behaviors in order to interact naturally with people. For instance, a robot should be able to point and look at specific objects. This is why, a scheme to generate coordinated head-arm motion for a humanoid robot with two degrees-of-freedom for the head and seven for each arm is proposed in this paper. Specifically, a virtual plane approach is employed to generate the analytical solution of the head motion. A quadratic program (QP)-based method is exploited to formulate the coordinated dual-arm motion. To obtain the optimal solution, a simplified recurrent neural network is used to solve the QP problem. The effectiveness of the proposed scheme is demonstrated using both computer simulation and physical experiments.

Fall detection based on body part tracking using a depth camera.

The elderly population is increasing rapidly all over the world. One major risk for elderly people is fall accidents, especially for those living alone. In this paper, we propose a robust fall detection approach by analyzing the tracked key joints of the human body using a single depth camera. Compared to the rivals that rely on the RGB inputs, the proposed scheme is independent of illumination of the lights and can work even in a dark room. In our scheme, a pose-invariant randomized decision tree algorithm is proposed for the key joint extraction, which requires low computational cost during the training and test. Then, the support vector machine classifier is employed to determine whether a fall motion occurs, whose input is the 3-D trajectory of the head joint. The experimental results demonstrate that the proposed fall detection method is more accurate and robust compared with the state-of-the-art methods.

Explicit and implicit emotional expression in bulimia nervosa in the acute state and after recovery.

Expression of emotional state is considered to be a core facet of an individual's emotional competence. Emotional processing in BN has not been often studied and has not been considered from a broad perspective. This study aimed at examining the implicit and explicit emotional expression in BN patients, in the acute state and after recovery. Sixty-three female participants were included: 22 BN, 22 recovered BN (R-BN), and 19 healthy controls (HC). The clinical cases were drawn from consecutive admissions and diagnosed according to DSM-IV-TR diagnostic criteria. Self reported (explicit) emotional expression was measured with State-Trait Anger Expression Inventory-2, State-Trait Anxiety Inventory, and Symptom Check List-90 items-Revised. Emotional facial expression (implicit) was recorded by means of an integrated camera (by detecting Facial Feature Tracking), during a 20 minutes therapeutic video game. In the acute illness explicit emotional expression [anxiety (p<0.001) and anger (p<0.05)] was increased. In the recovered group this was decreased to an intermediate level between the acute illness and healthy controls [anxiety (p<0.001) and anger (p<0.05)]. In the implicit measurement of emotional expression patients with acute BN expressed more joy (p<0.001) and less anger (p<0.001) than both healthy controls and those in the recovered group. These findings suggest that there are differences in the implicit and explicit emotional processing in BN, which is significantly reduced after recovery, suggesting an improvement in emotional regulation.

Arm movement speed assessment via a Kinect camera: a preliminary study in healthy subjects.

BACKGROUND: Many clinical studies have shown that the arm movement of patients with neurological injury is often slow. In this paper, the speed of arm movements in healthy subjects is evaluated in order to validate the efficacy of using a Kinect camera for automated analysis. The consideration of arm movement appears trivial at first glance, but in reality it is a very complex neural and biomechanical process that can potentially be used for detecting neurological disorders. METHODS: We recorded hand movements using a Kinect camera from 27 healthy subjects (21 males) with a mean age of 29 years undergoing three different arbitrary arm movement speeds: fast, medium, and slow. RESULTS: Our developed algorithm is able to classify the three arbitrary speed classes with an overall error of 5.43% for interclass speed classification and 0.49% for intraclass classification. CONCLUSIONS: This is the first step toward laying the foundation for future studies that investigate abnormality in arm movement via use of a Kinect camera.

Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa.

Although standard psychological treatments have been successful in treating several core features in eating disorders (ED), other characteristics such as emotional regulation or impulsivity appear to be more resistant to change. There is a growing body of evidence to support the efficacy of cognitive remediation for cognitive and emotional difficulties in ED. Playmancer/ Islands is a video game (VG) designed to specifically treat mental disorders, characterized by problems in impulse control. The objective of the game is to increase self-control over emotions, decision making and behaviours. The aim of this study is to describe the results from a consecutive series of nine bulimia nervosa patients who were treated with the VG in addition to cognitive behaviour therapy (CBT). The outcomes included clinical and psychopathological questionnaires, and physiological measures were obtained during the VG. Emotional regulation improved, heart rate variability increased, and respiratory rate and impulsivity measures reduced after the treatment. These findings suggest that VG training may enhance treatment for ED.

Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers.

PURPOSE: To understand why professional female ballet dancers often complain of inguinal pain and experience early hip osteoarthritis (OA). Goals were to examine clinical and advanced imaging findings in the hips of dancers compared with those in a matched cohort of nondancers and to assess the femoral head translation in the forward split position using magnetic resonance imaging (MRI). METHODS: Twenty professional female ballet dancers and 14 active healthy female individuals matched for age (control group) completed a questionnaire on hip pain and underwent hip examination with impingement tests and measurement of passive hip range of motion (ROM). All had a pelvic 1.5 T MRI in the back-lying position to assess femoroacetabular morphologic features and lesions. For the dancers, additional MR images were acquired in the split position to evaluate femoroacetabular congruency. RESULTS: Twelve of 20 dancers complained of groin pain only while dancing; controls were asymptomatic. Dancers' passive hip ROM was normal. No differences in α neck angle, acetabular depth, acetabular version, and femoral neck anteversion were found between dancers and controls. MRI of dancers while performing splits showed a mean femoral head subluxation of 2.05 mm. MRI of dancers' hips showed labral tears, cartilage thinning, and herniation pits, located in superior and posterosuperior positions. Lesions were the same for symptomatic and asymptomatic dancers. Controls had proportionally the same number of labral lesions but in an anterosuperior position. They also had 2 to 3 times fewer cartilage lesions and pits than did dancers. CONCLUSIONS: The results of our study are consistent with our hypothesis that repetitive extreme movements can cause femoral head subluxations and femoroacetabular abutments in female ballet dancers with normal hip morphologic features, which could result in early OA. Pathologic changes seen on MRI were symptomatic in less than two thirds of the dancers. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging.

OBJECTIVE: To determine the prevalence of femoroacetabular impingement (FAI) of the cam or pincer type based on magnetic resonance imaging (MRI) in a group of adult female professional ballet dancers, and to quantify, in vivo, the range of motion (ROM) and congruence of the hip joint in the splits position. MATERIALS AND METHODS: Institutional review board approval and informed consent from each volunteer were obtained. Thirty symptomatic or asymptomatic adult female professional ballet dancers (59 hips) and 14 asymptomatic non-dancer adult women (28 hips, control group) were included in the present study. All subjects underwent MRI in the supine position, while, for the dancers, additional images were acquired in the splits position. Labral abnormalities, cartilage lesions, and osseous abnormalities of the acetabular rim were assessed at six positions around the acetabulum. A morphological analysis, consisting of the measurement of the α angle, acetabular depth, and acetabular version, was performed. For the dancers, ROM and congruency of the hip joint in the splits position were measured. RESULTS: Acetabular cartilage lesions greater than 5 mm were significantly more frequent in dancer's hips than in control hips (28.8 vs 7.1%, p = 0.026), and were mostly present at the superior position in dancers. Distribution of labral lesions between the dancers and the control group showed substantially more pronounced labral lesions at the superior, posterosuperior, and anterosuperior positions in dancers (54 lesions in 28 dancer's hips vs 10 lesions in 8 control hips). Herniation pits were found significantly more often (p = 0.002) in dancer's hips (n = 31, 52.5%), 25 of them being located in a superior position. A cam-type morphology was found for one dancer and a retroverted hip was noted for one control. Femoroacetabular subluxations were observed in the splits position (mean: 2.05 mm). CONCLUSION: The prevalence of typical FAI of the cam or pincer type was low in this selected population of professional ballet dancers. The lesions' distribution, mostly superior, could be explained by a "pincer-like" mechanism of impingement with subluxation in relation to extreme movements performed by the dancers during their daily activities.