US20090131225A1 - Rehabilitation systems and methods - Google Patents

Abstract

The present invention integrates an actuated tilting rehabilitation table, video tracking of the patient arm and opposite shoulder, a low-friction forearm support with grasping force sensing, remote data transmission and additional weighing means, one or more large displays, a computer and a plurality of simulation exercises, such as video games. The patient can be monitored by a local or remote clinician. The table tilts in order to increase exercise difficulty due to gravity loading on the patients arm and shoulder. In one embodiment, the present the invention includes an actuated tilting table which tilts in four degrees of freedom.

Description

CROSS REFERENCE TO RELATED APPLICATION
• This application claims the benefit of U.S. Provisional Patent Application No. 60/964,861 filed Aug. 15, 2007, the entirety of which is hereby incorporated by reference into this application.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention is a device, system and method for providing rehabilitation to several types of patients in a rehabilitation hospital or outpatient clinic. The approach integrates an actuated tilting rehabilitation table, video tracking of the patient's arm and opposite shoulder, a low-friction forearm support with grasping force sensing, remote data transmission and additional weighing means, one or more large displays, a computer and a plurality of video games.
• 2. Description of Related Art
• A training system for arm rehabilitation is described in Yu-Luen Chen et al, “Aid Training System for Upper Extremity Rehabilitation,” 2001 Proceedings of the EMBS International Conference, Istanbul, Turkey. Patients exercise on a special table that incorporates reed relays and a hand support (“arm skate”) with small underside wheels. The movement of the arm in the arm skate on the supporting table is detected by the interaction of the magnet incorporated in the arm skate with the relays integrated in the table. A computer presents a variety of patterns on its monitor, which the patient needs to replicate to improve arm coordination, with performance data stored by the computer in a clinical database. The table is horizontal and does not use virtual reality simulations.
• Another training system that uses a forearm support on a table for rehabilitation purposes is described by some of the inventors of the present specification in Kutuva et al., “The Rutgers Arm: An Upper-Extremity Rehabilitation System in Virtual Reality,” Proceedings of the Fourth International Workshop on Virtual Rehabilitation (IWVR'05), pp. 94-103, Catalina Island, Calif., September 2005. The table has a low-friction surface and a forearm support has a low-friction underside (made of TEFLON®studs). The tracking of the forearm movement is done by a magnetic tracker (Fastrack, Polhemus Inc.), with a sensor mounted on the forearm support, and an emitter mounted on the table away from the patient. Patients exercise sitting at the table and looking at a computer monitor, while playing a plurality of virtual reality games. The games are designed to improve motor coordination, as well as dynamic arm response. The table does not tilt.
• Several tilting tables exist commercially and are used in rehabilitation. They are meant for people who have low blood pressure and who get dizzy when they stand up. Tilting tables are also used for the rehabilitation of patients who have to lie down for a long period of time. The person lies face up on a padded table with a footboard and is held in place with a safety belt. The table is tilted so that the angle is very slowly increased until the person is nearly upright. By slowly increasing the angle, the patients blood vessels regain the ability to constrict.
• A study describes development of a sensorized tilt table which measures and displays the knee bent angle and pressure for each foot during exercise in real time, as described in Kimet et al. “An Intelligent Tilt Table for Paralytic Patients,” 3^rdKuala Lumpur International Conference on Biomedical Engineering, Kuala Lumpur, Malaysia, 2006. It is expected that the patient's exercising effect can increase by monitoring these two values during exercise. Tilt tables are known for providing tilting manually or using an electrical motor, such as in a Rehab Electric Tilt Table manufactured by Cardon Rehab.
• An automated stepping training developed with the tilting table is described in Colombo et al. “Novel Stepping Mechanism: Design Principles and Clinical Application,” Rehabilitation Robotics, ICORR 2005. Unlike the previous tilting tables it exercises the feet in stepping. No virtual reality simulation is incorporated and tilting is done manually, rather than determined by a simulation.
• All of the above tilting-table based systems are for rehabilitation of the legs. The tilting tables described above do not incorporate virtual reality simulations and do not store/upload clinical data automatically. They have a single degree of freedom (the tilting angle).
• Systems for rehabilitating the arms are known, and are based on force feedback joysticks (such as those manufactured by Logitech or Microsoft), or various types of planar or 3D robots. Examples of planar robots are the MIT Manus or those described in Colombo et al., “Upper Limb Rehabilitation and Evaluation of Stroke Patients Using Robot-Aided Techniques”, Rehabilitation Robotics, 515-518 (2005). Other examples of 3D robots are the Reo robot manufactured by Motorika, N.J., or the Haptic Master manufactured by FCS, Holland.
• Other upper limb rehabilitation systems have been described. U.S. Pat. No. 7,204,814 describes an orthotic system that performs predefined or user-controlled limb movements, collects data regarding the limb movement, performs data analysis and displays the data results, modifies operational parameters based on the data to optimize the rehabilitative process performed by the system. A force sensor data, torque data and angular velocity data can be collected using an external actuating device.
• U.S. Patent Application Publication No. 2007/0060445 describes a method and apparatus for upper limb rehabilitation training of coordinated arm/forearm, forearm/forearm, and grasping movements comprising a non-robotic, passive support, an arm/forearm sensor, gripping device and sensor. A computer processes measurements of movements to control a graphical representation of the arm/forearm and grasping movements in interaction with a virtual environment.
• It is desirable to provide a device, system and method for rehabilitation of an upper limb in which an activated tilting table provides a plurality of degrees of freedom and grasping force is sensing integrated into a video tracking system.
SUMMARY OF THE INVENTION
• The present invention integrates an actuated tilting rehabilitation table, video tracking of the patient arm and shoulder, a low-friction forearm support with grasping force sensing, remote data transmission and additional weighing means, one or more large displays, a computer and a plurality of simulation exercises, such as video games. The patient can be monitored by a local or remote clinician. Online storage of data obtained by the rehabilitation tilting table can be provided. Additionally, the table surface can be constructed as a graphics display making a separate display unnecessary.
• In one embodiment, a patients arm rests on a forearm support that has infrared LEDs. The patient wears similar LEDs on the opposite shoulder, and an infrared video camera is used to track the patients arm movement on the table. The table tilts in order to increase exercise difficulty due to gravity loading on the patients arm. In one embodiment, the present the invention includes an actuated tilting table which tilts in four degrees of freedom. A large display, facing the patient presents a sequence of rehabilitation games with which the patient interacts by moving the arm resting on the low-friction support, on the table surface.
• The invention will be more fully described by reference to the following drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a schematic diagram of a tilting rehabilitation table system being used by a patient.
• FIG. 2 is a schematic diagram of the tilting rehabilitation table system.
• FIG. 3 is a schematic diagram in which a top surface of the tilting table is provided at an increased angle from the patient.
• FIG. 4 is a schematic diagram in which the top surface of the tilting table is provided at an increased right angle from the patient.
• FIG. 5 is a schematic diagram of actuators of the tilting rehabilitation table system used with the tilting table.
• FIG. 6 is a detailed view of a top joint assembly connecting an actuator shaft to the top surface of the tilting table.
• FIG. 7 is a detailed view of a bottom joint assembly connecting an actuator shaft to the bottom surface of the tilting table.
• FIG. 8 is a side elevation view of patient wearing the forearm support assembly used in the tilting rehabilitation table system.
• FIG. 9 is a schematic diagram of an underside of a forearm support assembly of the tilting rehabilitation table.
• FIG. 10 is a view of the patient wearing a shoulder harness assembly used in the tilting rehabilitation table system.
• FIG. 11 is a schematic diagram of an alternate embodiment of the tilting table.
• FIG. 12 is a schematic diagram of an alternate embodiment of the tilting table where top surface is a display.
• FIG. 13 is a system block diagram for the tilting rehabilitation table system.
• FIG. 14 is a schematic diagram of a patient baseline screen displayed by the tilting rehabilitation table system.
• FIG. 15A is a schematic diagram of a virtual scene displayed by the tilting rehabilitation table system.
• FIG. 15B is a schematic diagram of a virtual scene displayed by the tilting rehabilitation table system.
• FIG. 15C is a schematic diagram of a virtual scene displayed by the tilting rehabilitation table system.
• FIG. 16A is a schematic diagram of a virtual scene displayed by the tilting rehabilitation table system.
• FIG. 16B is a schematic diagram of a virtual scene displayed by the tilting rehabilitation table system.
• FIG. 17 is a schematic diagram of a virtual scene displayed by the tilting rehabilitation table system.
DETAILED DESCRIPTION
• Reference will now be made in greater detail to a preferred embodiment of the invention, an example of which is illustrated in the accompanying drawings. Whenever possible, the same reference numerals will be used throughout the drawings and the description to refer to the same or like parts.
• FIGS. 1 and 2 illustrate tiltingrehabilitation table system1. Tiltingrehabilitation table system1 incorporates tilting table2 which hastop surface3 andunderside surface4.Top surface3 can be a U-shaped, symmetrical, low-friction surface.Underside surface4 can have a U-shape. For example, lowtop surface3 can be made of carbon fiber, or other durable and light material, covered by a low-friction coating. Suitable low-friction coatings include TEFLON® sheets.Underside walls14 extend upwardly fromunderside surface4.
• Patient5 sits inchair6 and restsarm7 to be rehabilitated in low-friction forearm support25.Patient5 exercises while watchingdisplay8 placed at the opposite side of tilting table2. Preferably,display8 is a large display having dimensions of at least about 9 ft by 6 ft.Video camera9 is attached tovertical support10.Vertical support10 can be U-shaped and rigid.Vertical support10 extends from and is attached totop surface3. This arrangement allowsvideo camera9 to view tilting table2 andpatient5 simultaneously.Video camera9 can be a conventional digital camera.Infrared filter11 can be attached to lens12 ofvideo camera9.LEDs13 are mounted at the corners oftop surface3 and can be wired to direct current source (not shown). For example, three LEDs can be used for providing calibration ofvideo camera9.Vertical support10 is mounted totop surface3 such that it keeps the same relative orientation regardless oftilt angle15 oftop surface3, thereby making re-calibration ofvideo camera9 unnecessary oncetilt angle15 changes during a rehabilitation session.
• Computer16 rendersexercise simulation17 and displays them ondisplay8. For example, exercisesimulation17 can be an animated or virtual reality sequence.Computer16 is preferably a multi-core PC workstation.Computer16 also receives input fromvideo camera9.Computer16runs tracking software18 and communicates withcontroller19.Controller19 activatesactuators20 to provide tilt oftop surface3.Computer16 is connected toInternet66 and transparently uploadsclinical data67 to remoteclinical database server68.Remote computer181 connected toclinical database server68 overInternet66 is used to executeremote graphing software180.
• FIG. 3 shows the orientation oftop surface3 andcamera support10 whentilt angle15 is increased to move the angle away frompatient5. Increasedtilt angle15 makes in/out movements ofarm7 more difficult.
• FIG. 4 shows a different tilt oftop surface3, in which tiltangle15 is to the right ofpatient5. This tilt angle makes arm movements from left-to-right more difficult than those whentop surface3 is horizontal. Other tilt angles15 can be used when the left side oftop surface3 is tilted up or when the side closer topatient5 is tilted up. These make more difficultcorresponding arm7 movements, such as right-left or out-in, respectively. In one embodiment,top surface3 can be tilted in four degrees of freedom.
• Tilt angle15 is produced by two ormore actuators20 placed undertop surface3, as shown inFIG. 5.Actuators20 are preferably linear electrical actuators.Actuators20 are positioned undertop surface3. Eachactuator20 includesbase21 and translatingshaft22. Translatingshaft22 is connected totop surface3 by topjoint assembly23.Base21 is connected tounderside walls14 with bottomjoint assembly30.Actuators20 are controlled bycontroller19.Controller19 can be a multi-channel micro-controller such as those which are available commercially.Controller19 in turn receives commands fromcomputer16 runningexercise simulation17. In one embodiment, fiveactuators20 can be used and the amount of translation ofactuator shaft22 providestilt angle15 which can be varied from about 0 degrees (horizontal) to about 30 degrees. The moretop surface3 is tilted, the larger the effect gravity has due to the weight ofarm7 ofpatient5 and offorearm support25 and theharder exercise simulation17 is to perform.
• FIG. 6 shows a detailed view of topjoint assembly23 which connectsactuator shaft22 to the underside oftop surface3. Topjoint assembly23 has horizontal rotating joint26 and vertical rotating joint27 which together produce two degrees of freedom for topjoint assembly23. The axis of rotation of horizontal rotating joint26 is perpendicular to the axis of rotation of vertical rotating joint27. Horizontal rotating joint26 is attached to the underside oftop surface3 usingplate28 andbolts29.
• FIG. 7 shows a detailed view of bottomjoint assembly30, which connectsbase21 to the inner side ofunderside walls14. Bottomjoint assembly30 has horizontal rotating joint31 and vertical rotating joint32 which together produce two degrees of freedom for bottomjoint assembly30. The axis of rotation of horizontal rotating joint31 is perpendicular to the axis of rotation of vertical rotating joint32. Vertical rotating joint32 is attached to the inner side ofunderside walls14 through plate33 andbolts34.
• A side view of thepatient5 sitting inchair6 and using offorearm support assembly25 used bypatient5 is shown inFIG. 8.Forearm7 andwrist35 ofpatient5 are secured toforearm support base36 using a plurality ofstraps37. For example, straps37 can be formed of a hook and loop material of VELCRO®.Forearm support base36 can be made of a lightweight material such as plastic, and is hollow.Pressure sensor41 measures the air pressure inside hollowcompliant element44. A suitable hollowcompliant element44 can be a rubber ball. Grasping forces45 exercised by fingers46 ofpatient5 are measured.Video camera9 shown inFIG. 1views LED assembly42 which is formed of twoinfrared LEDs50 mounted onplastic support51 for providing data on arm movements and rotation.LED assembly42 in turn is mounted on movable assembly52. Movable assembly52 rotates onhinges53 attached toforearm support base36. Movable assembly52 rotates open to allowforearm7 to be placed on forearm supporttop surface54. Forearm supporttop surface54 is preferably made of a compliant material (such as plastic foam), for increased comfort.Forearm support base36 haschambers39,76 and77.Chamber39 can be used to incorporate electronics assembly40 to which is connectedpressure sensor41. Output ofpressure sensor41 is processed by electronics assembly40. Electronics assembly40 includes an analog-to-digital converter47 and wireless transmitter48. Transmitter48 can be a conventional wireless Bluetooth® type transmitter. Transmitter48 communicates withreceiver49 incorporated incomputer16, as shown inFIG. 2.Computer16 can changeexercise simulation17 according to grasping forces45 ofpatient5.Computer16 can also changeexercise simulation17 based onforearm7 position/orientation given byvideo camera9. For example, exercisesimulation17 can be rehabilitation games.LED assembly42 and electronics assembly40 are connected tobattery43 inchamber77.Chamber76 ofbase36 can be used to allow the addition of modular weights56. The addition of modular weights56 toforearm support base36 allows an increased difficulty ofexercise simulation17. The difficulty of performingexercise simulation17 is increased with the increase in modular weights56, with the increase in tiltingangle15, and with the number and level ofexercise simulation17.
• FIG. 9 is a view of the underside of theforearm support assembly25.Underside surface38 offorearm support25 has a plurality oflow friction studs55.Low friction studs55 are preferably made of TEFLON®.
• FIG. 10 showsshoulder harness assembly57 worn bypatient5 onshoulder58 opposite toarm7 being rehabilitated.Shoulder harness assembly57 incorporatesshoulder LED59 wired tobattery60.Shoulder LED59 is an infrared LED for providing data on compensatory movements ofpatient5.Harness assembly57 is formed ofadjustable segments61.Segments61 are preferably formed of a hook and loop material, such as VELCRO®.Video camera9 takes images ofshoulder LED59.Tracking software18 running oncomputer16 determines whenpatient5 is doing undesirable compensatory leaning movements.Tracking software18 can be adjusted by a therapist to be more sensitive, or less sensitive to leaning ofpatient5.
• FIG. 11 illustrates an alternate embodiment of tilting table62 for use with two forearm supports25.Top surface3 has aU-shape cutout63 allowingpatient5 to be seated centrally to table axis64.Patient5 moves twoarms7 while supported by two low-frictionforearm support assemblies25. This allows training of both arms simultaneously, with benefits to recovery ofpatient5. In one embodiment,patient5 also wears oneshoulder harness57, as it is sufficient to detect the leaning of the shoulder opposite to thedisabled arm7.Video camera9views LEDs42 on bothforearm support assemblies25, as well asLEDs59 on oneshoulder harness assembly57.Forearm support assembly25 is modified such that the number ofinfrared LEDs42 differs between the twoforearm support assemblies25. For example threeLEDs42 will be on the left-arm forearm support73, while the right-arm support71 still has twoLEDs42 as previously described inFIG. 8. This allows trackingsoftware18 to differentiate between left arm and right arm movements.Tracking software18 tracks twoarms7 in real time. Data from trackingsoftware18 is used bycomputer16 to run two-arm exercise simulation17. In this embodiment, the same type ofactuators20 as shown inFIG. 5, can be used in this embodiment. Preferably, fouractuators20 are used in this embodiment.
• FIG. 12 illustrates an alternate embodiment of tilting table2. In this embodiment,top surface3 is alsodisplay69. For example, display69 can be similar to commercially available thin organic LED (OLED) displays. In this embodiment, the tracking offorearm7 may be performed byinfrared camera9, or through a touch-sensitive layer70 incorporated indisplay69. In this case thedisplay69 is a touch sensitive screen such as those available commercially. In caseoverhead camera9 is used,forearm support assembly25 is modified as shown inFIG. 11.Actuator assembly20 can be connected to frame72 borderingdisplay69 and to supportingsurface4. A low-frictiontransparent film75 can be retrofitted to display69, to prevent scratching by theforearm support assemblies71 and73 that sit on it.
• A system block diagram for the tiltingrehabilitation table system1 is illustrated inFIG. 13. Each rehabilitation session starts with session startblock78. Session start block78 loads the patient's ID and otherclinical data67 forarm7 to be rehabilitated.Session start block78 transfers control to the session scheduler block79 which sets the structure of a rehabilitation session, for example, number, type and order of exercises, as well as the difficulty level settings. Session scheduler block79 is structured such that it applies a customized treatment depending on progress of patient5 (the order of the particular session being done out of the prescribed number of sessions). Session scheduler block79 begins by startingsession baseline80 which measures the performance ofpatient5 in that day.Session baseline80 is stored transparently byclinical database server68 and can be used to track progress ofpatient5 over the sequence of rehabilitation sessions.Patient5 progress can be graphed usingremote graphing application180 running onremote computer181. It is envisioned thatremote computer181 communicates with clinical database server overInternet66.Session baseline80 is also used to fine-tune the “gains” of exercise simulation blocks81,82 and83, such that in virtual reality movements are amplified and success assured even for very limitedreal arm7 movements. Exercise simulation blocks81,82 and83 can performexercise simulation17.Intelligent agent block84 monitors the patient progress and can automatically varytilt angle15 to assist/resist movement.Intelligent agent block84 can controlactuators20 through theircontroller19 connected tocomputer16 running exercise simulation blocks81,82 and83.Actuators20 provide data to exercise simulation blocks81,82 and83 such that virtual table (not shown) in the scene mimics tilt of tilting table2.Video camera9 detects the position ofLEDs50 at the top offorearm support assembly25 and sends the information to trackingsoftware18 run bycomputer16.Tracking software18 extracts arm position information and body leaning information and transmits this data to exercise simulation blocks81,82 and83. This data is then used to animate in real time an avatar of the patient's hand(s) (not shown).Manual emergency switch85, when pressed by attending therapist and/orpatient5 triggers an end to the rehabilitation session throughsoftware block86.
• FIG. 14 illustrates an example ofpatient baseline screen87 displayed indisplay8 or ondisplay69.Patient5 is asked to move thearm7 in large circles to colorvirtual representation88 of therehabilitation table surface3. The surface ofcolored area89 increases with the movement ofvirtual sphere90 which responds to the movements offorearm support assembly25. Size and shape ofcolored area89 are a measure of the ability ofpatient5 that day. Extent ofmovement91 in the left/right (horizontal) direction and extent ofmovement92 in the in/out direction are used to adjust the rehabilitation exercise simulation blocks81,82 and83.Baseline screen87 also showstilt angle15 at whichbaseline80 was taken.
• FIG. 15A shows an embodiment of rehabilitationexercise simulation block81 with a virtual world representation having tiltedtable avatar88.Virtual sphere94 is shown ontable surface93 together with avirtual target rectangle95. An ideal path betweenvirtual sphere94 andvirtual target rectangle95 is visualized by path shown as dottedline96. The placement ofvirtual target rectangle95 andvirtual sphere94 ontable surface88 is such that it requires patient5 to movearm7 close to extent ofmovement91 and extent ofmovement92 ofbaseline87.Patient5 is asked to pick upvirtual sphere94 with asemi-transparent hand avatar98 and place it in virtualtarget rectangle area95. In order to graspvirtual sphere94,transparent hand avatar98 has to overlapvirtual sphere94 andpatient5 squeezescompliant element44 onforearm support assembly25, as shown inFIG. 1. Real movement ofpatient5 is tracked byvideo camera9 andcomputer16 shows acorresponding trace97 ontable surface88.
• FIG. 15B shows an alternate embodiment ofexercise simulation block81 of the pick-and-place exercise in whichideal path96 shown as a straight dotted line. This corresponds to in/out movements ofarm7. This process is repeated a number of times, with the trial (repetition)number190 and the total arm movement (endurance)191 corresponding to these repetitions being displayed insimulation81. Other placements ofvirtual target rectangle95 andvirtual sphere94 can be used with correspondingideal path specifications96. The difficultyexercise simulation block81 such as a pick-and-place exercise, is varied by makingvirtual target rectangle95 smaller and by requiringpatient5 to make more pick-and-place movements. Forpatient5 capable of exerting finger forces45, difficulty is further increased by elevating the threshold of finger grasping forces45 detected by theforearm assembly25 inFIG. 8 at which level correspondinghand avatar98 can capturevirtual sphere94.
• FIG. 15C shows bundle oftraces99 displayed byexercise simulation block81 at the end of exercises after a number of pick-and-place movements were completed. In this embodiment, bundle oftraces99 corresponds to repeated pick-and-place movements ofarm7 in the left-right-left direction. The tightness of bundle oftraces99 is indicative of the motor control abilities that day forpatient5.
• FIG. 16A shows an embodiment ofexercise simulation block82 referred to “Breakout 3D”. This exercise depictsball100,paddle101, and array ofcubes102, all located onplay board103.Paddle101 is used to bounceball100 towardscubes102 with one cube being destroyed for each bounce ofball100 off ofpaddle101.Ball100 can bounce off of threesides104 ofplay board103, or offmultiple cubes102, but is lost if it missespaddle101. In an alternate embodiment, paddle101 can move mostly left-right, within the lower portion ofplay board103, delineated by dashedline105. The difficulty ofexercise simulation block82 is set by the number ofavailable balls100, the speed ofballs100, and the size ofpaddle101. The higher the speed ofball100, the smaller the size ofpaddle101, and the fewer the number ofavailable balls100, the harder the Breakout 3D ofexercise simulation block82 game is. The goal of the Breakout 3Dexercise simulation block82 is to destroy allcubes102 with the available number ofballs100. The Breakout 3D ofexercise simulation block82 is designed to improve hand-eye coordination and cognitive anticipatory strategies ofpatient5.
• FIG. 16B is another embodiment of the Breakout 3D ofexercise simulation block82, in whichboard103 is rotated to show array ofcubes102 to one side of the scene. In thisexample paddle101 moves mostly vertically in the scene, within the area to the right ofdotted line105, requiring corresponding in-out-in movements ofarm7.
• FIG. 17 is an embodiment ofexercise simulation block83 called “Treasure Hunt”. The scene depicts desertedisland106 with line ofstones107 on top ofvirtual sand108. The shape of line ofstones107 replicates the shape of baseline surfacecolored area89. There are a number ofvirtual treasures chests109 insidesand108 surrounded by line ofstones107.Patient5 controlsvirtual shovel110 with which to removesand108 coveringtreasure chests109. Every time anew treasure chest109 is foundscore111 displayed in the scene is increased. In order to find anew treasure chest109shovel110 has to be moved insand108 that overlapstreasure chest109. If trackingsoftware18 detects leaning ofpatient5treasure chest109 is not revealed even ifshovel110 is in the correct position and score111 is not increased. At higher level of difficulty, a sand storm occurs. Part of the already uncoveredtreasure chests109 are covered again bysand108 requiring more movement ofarm7 ofpatient5arm7 to uncovertreasure chest109 again. The Treasure Huntexercise simulation block83 is timed and remainingtime112 is displayed at the top of the scene.Patient5 attempts to uncover all oftreasure chests109 in the allowed amount oftime112. This exercise is aimed at increasing arm endurance ofpatient5. In other embodiments, other simulation exercises can be played bypatient5.
• It is to be understood that the above-described embodiments are illustrative of only a few of the many possible specific embodiments, which can represent applications of the principles of the invention. Numerous and varied other arrangements can be readily devised in accordance with these principles by those skilled in the art without departing from the spirit and scope of the invention.

Claims (23)

1. A system for rehabilitation comprising:

a tilting table, said tilting table adapted to be movable at a tilt angle in one or more degrees of freedom;

a forearm support adapted for receiving a forearm of a user, said forearm support being movable on said tilting table;

an animated or virtual reality sequence forming an exercise simulation being displayed on a display; and

tracking means for tracking movements of said forearm upon interaction of said user with said exercise simulation.

2. The system ofclaim 1 wherein said tilting table has a top surface having a U-shape.

3. The system ofclaim 1 wherein said tracking means comprises a video camera and tracking software for tracking output from said video camera.

4. The system ofclaim 1 wherein said tilting table is movable in four degrees of freedom.

5. The system ofclaim 1 wherein said tilting table has a top surface and said display is part of said top surface of said tilting table.

6. The system ofclaim 5 further comprising a touch sensitive layer in said display.

7. The system ofclaim 5 wherein said tracking means comprises a video camera, said video camera is positioned beneath said display.

8. The system ofclaim 1 further comprising:

one or more actuators connected to said tilting table, said one or more actuators moving said tilting table at said tilt angle.

9. The system ofclaim 1 wherein said actuators are connected to an underside of a top surface of said tilting table with a top joint assembly, said top joint assembly including a horizontal rotating joint and a vertical rotation joint to produce two degrees of freedom.

10. The system ofclaim 1 wherein said actuators are connected to an underside of a bottom surface of said tilting table with a bottom joint assembly, said bottom joint assembly including a horizontal rotating joint and a vertical rotation joint to produce two degrees of freedom.

11. The system ofclaim 1 further comprising:

a hollow compliant element and pressure sensor means for measuring grasping forces of the user when grasping said hollow compliant means.

12. The system ofclaim 1 wherein said video camera is mounted with a vertical support to provide the same relative orientation regardless of the tilt angle and further comprising:

one or more LEDs coupled to a respective corner of a top surface of said tilting table for providing calibration of said video camera.

13. The system ofclaim 12 further comprising:

a pair of second LEDs positioned on said forearm support for providing data on arm movements and rotation.

14. The system ofclaim 1 further comprising:

a harness assembly adapted for attachment to a shoulder of a user, a LED being coupled to said harness assembly, said LED providing data on compensatory movements of the arm of the user.

15. The system ofclaim 1 wherein a pair of said forearm supports are used in said system, each said forearm support receiving a respective forearm of the user.

16. The system ofclaim 15 wherein one or more first LEDs are positioned in a first forearm support of said pair and one or more second LEDs are positioned on a second forearm support of said pair, wherein the number of said first LEDs is different than the number of said second LEDs.

17. The system ofclaim 1 wherein said exercise simulation includes an avatar and further comprising:

means for measuring a baseline of said user; and

means for mapping said measured baseline with said exercise for tuning said exercise simulation and providing mapping between real movement of said user and movement of said avatar during said exercise simulation.

18. The system ofclaim 17 wherein said exercise simulation includes a virtual representation of a rehabilitation surface, the arm of the user is adapted to move in circles over said virtual rehabilitation surface wherein a corresponding colored area is displayed on said virtual rehabilitation surface.

19. The system ofclaim 17 wherein said exercise simulation includes a virtual sphere and a virtual target area, the arm of the user picks up the virtual sphere and places it in the virtual target area, the arm of the user is moved to the extent of the baseline.

20. The system ofclaim 19 wherein a trace of the arm movements of the user is displayed in the exercise simulation.

21. The system ofclaim 17 wherein the exercise simulation includes virtual objects in the shape of the baseline, virtual targets are uncovered by moving the arm of the user.

22. The system ofclaim 17 wherein the exercise simulation includes a virtual reality array of cubes, virtual reality ball and virtual reality paddle, the user hits the virtual reality ball towards the virtual reality cubes with the virtual reality paddle, each said virtual reality cube is destroyed for each bounce of said virtual reality ball on said virtual reality cube.

23. A method for rehabilitation comprising the steps of:

providing a forearm support adapted for receiving a forearm of a user on a tilting table, said tilting table adapted to be movable in one or more degrees of freedom;

displaying an animated or virtual reality sequence on a display; and

tracking movements of the forearm interaction with said exercise simulation.

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