1. Virtual Rehabilitation Coach for Traumatic Brain Injury Patients (BME 273: Oral Presentation #4) Erwin Yap, David Weinberg Adviser: Dr. Joseph Cheng Vanderbilt University 2010.03.23 BME 272 | 1/26/2009 | © 2009 Vanderbilt University. All rights reserved. 1

2. Presentation Outline 2  1. Background & Overview of TBI  2 Proposed design of TBI rehab coach  3. Characterization of TBI rehab coach  4. Current Progress and Future Work

3. Motivation: Traumatic Brain Injury -Major cause of disabilities and death worldwide. -1.4 million are affected in the US, 50000 die, 235000 are hospitalized, 1.1 million go through extensive rehabilitation therapy. -5.3 million Americans currently have a long-term or lifelong need. -$60,000 direct and indirect costs occurred due to lost of productivity. -We want to create an open source rehabilitation tool using interactive virtual environments.

4. Motivation: Traumatic Brain Injury cdc.gov [b]

5. Motivation: Traumatic Brain Injury Comparison of Annual Incidence of Leading Injuries and Diseases cdc.Gov [a]

6. Motivation: Physiology of a TBI

8. Categories of TBI with symptoms Mild (75%, $17 Billion cost/yr) Post traumatic amnesia (PTA) < 1 hour Loss of consciousness (LOC) < 30 min Postconcussion syndrome possible Moderate (12.5%) PTA 30 min to 24 hours LOC 1 to 24 hours Severe (12.5%, $600,000 to $1,875,000 / person) PTA > 1 day LOC > 24 hours

9. Purpose To develop an open source 3D virtual rehabilitation tool to help improve working memory function of TBI patients.

10. Previous Methods of Rehabilitation Making lists Practical Exercises Use of datebooks Taking notes Use of visual simulation Special watches Examples?

11. Improving Cognitive Function After Brain Injury: The Use of Exercise and Virtual Reality by Madeleine Grealy Experiment set-up: Patients with cognitive problems were in a bike and asked to sheer to directions or participate in a race. Significant improvements were seen in learning, both auditory and visual as well as the digit symbol tests. There was a lack in improvement on the complex figure and logical memory tasks indicated that the improvement in learning is associated to the working memory.

12. Task Performance in Virtual Environments Used for Cognitive Rehabilitation After Traumatic Brain Injury by Christiansen Experiment Set-up: A virtual kitchen was developed in which a meal preparation task involving multiple steps could be performed. The total score during the 2 nd trial is higher which means people improved cognitive functions after learning the 1 st time.

13. Our Method – Virtual Rehabilitation Coach Prompt the user with procedural tasks Regain Executive Skills VRC will be tailored to the user’s level of injury Over time, specificity of the module will be decreased to challenge the user to sequence steps in a task. (ie: assembly of a gun)

14. Focus Group – US Army Soldiers coming back with brain injury, specifically the ones with working memory impairments 6 out of 10 soldiers returning from the “Global War on Terror” are diagnosed with TBI. 10-20% of Iraq veterans, or about 150,000-300,000 have suffered TBI during the war. In war, most of the brain injury is caused by bullets or sharpnel hitting the head and the neck. It can also be caused by mortar or roadside blasts. In 2009, Department of Defense passed a bill which provides $300 million for TBI research & treatment

15. Data Collection Subject Sample and Population 40 students at Vanderbilt university with normal executive function Each user will participate in a total of 5 trials VRC assessment (time of task completion) General Questionnaire – Rate the VRC prototype

16. DESIGN INDICATORS

17. Programming Software Alice 3D Engine

18. Current Progress Created a full prototype. Created a rehab evaluation for our prototype.

19. Prototype

28. Protoype

30. Prototype

34. TBI rehab evaluation

35. More progress Finishing a hardware equivalent of the prototype. Creating a point system for the task.

36. Design Indicators Difficulty Level Timer Point system Combination of tasks How instructions are presented

37. Performance Indicators Percentage of steps completed with a 100% accuracy Time required for step to step completion Maximum number of steps for the system to be useful.

38. Timeline By March 30th We get consent from participants. Prepare for the teleconference scheduled on April 1, 2010 with Dr. David Twillie to know the needs of TBI patients. We’ll show him the prototype and see if he thinks the virtual idea is feasible. By April 6 th Create more tasks based on Dr. Twillie and Dr. Cheng’s recommendation. Test prototype with the participants.

39. References [1] Cdc.gov [2] Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006. [3] Mangus P and Clemmens D, A tale of two cities, Facets Magazine, vol. Fall/Winter pp.26-27, 2006 [a] http://www.cdc.gov/ncipc/factsheets/tbi.htm [b] http://www.cdc.gov/ncipc/tbi/Causes.htmhttp://www.cdc.gov/ncipc/tbi/Causes.htm [c] Okie, M.D., Susan. “Traumatic Brain Injury in War Zone.” Perspective (2005): 2043-2047. June 2009. <http://www.wramc.amedd.army.mil/Patients/ healthcare/psychology/clinic/VTCFellowshipProgram >.

40. References [c] Okie, M.D., Susan. “Traumatic Brain Injury in War Zone.” Perspective (2005): 2043-2047. June 2009. <http://www.wramc.amedd.army.mil/Patients/ healthcare/psychology/clinic/VTCFellowshipProgram >. [d] Functional Assessment of Individuals with Cognitive Disabilities: A Desk Reference for Rehabilitation