The present description relates generally to telehealth-mediated physical rehabilitation.
The adoption of telehealth rapidly accelerated due to the global COVID19 pandemic disrupting communities and in-person healthcare practices. Telehealth also helps make healthcare more equitable by helping patients overcome obstacles related to geography, time, finances, and access to technology. Moreover, telehealth has been found to be effective in musculoskeletal practices, having demonstrated outcomes and patient satisfaction comparable to in-person care. While telehealth had initial benefits in enhancing accessibility for remote treatment, physical rehabilitation has been heavily limited due to the loss of hands-on evaluation tools. Immersive virtual reality (iVR) offers an alternative medium to video conferencing. Stand-alone head-mounted display systems are becoming more affordable, user friendly, and accessible to many users at once. Further, such virtual experiences can be built with privacy protocols that satisfy healthcare regulations. The systems use low-cost motion tracking methods to match user movement in the real world to that in the virtual environment. An advantage iVR offers over videoconferencing is the ability for patients and therapists to meet in a three-dimensional, interactive virtual environment.
However, metrics for remote evaluation using iVR have not yet been established. Further, upper limb kinematics, particularly of the shoulder joint, may be difficult to evaluate. For example, the structure of the shoulder allows for tri-planar movement that cannot be estimated by simple single plane joint models.
In one example, the issues described above may be at least partially addressed by a system, comprising: an immersive virtual reality (iVR) system, the iVR system including a headset and a hand-held controller, and machine readable instructions executable to: predict joint kinematics using a machine learning model based on motion data received from the iVR system during gameplay of a virtual reality-guided exercise with the iVR system. In this way, remote physical rehabilitation may be provided with clinically meaningful evaluation metrics.
As one example, the machine learning model may be trained using joint angles and joint torques determined via biomechanical simulation from data obtained via an optical motion tracking system. For example, the optical motion tracking system may comprise a plurality of reflective markers positioned at anatomical landmarks and a plurality of cameras that may track positions of the reflective markers over time. Further, the machine learning model may comprise a plurality of separate models for different parameters of the joint kinematics. The plurality of separate models for the different parameters of the joint kinematics may comprise an elevation plane angle model, an elevation angle model, an elevation plane torque model, an elevation torque model, and a rotation torque model, for example. As another example, the machine learning model may be trained using an extreme gradient boost algorithm, an artificial neural network, a convolutional neural network, a long short-term memory, and/or a random forest. As a result, the system may accurately predict the joint kinematics using the low-cost iVR system, thus increasing patient access to clinically meaningful remote physical rehabilitation.
It should be understood that the summary above is provided to introduce in simplified form a selection of concepts that are further described in the detailed description. It is not meant to identify key or essential features of the claimed subject matter, the scope of which is defined uniquely by the claims that follow the detailed description. Furthermore, the claimed subject matter is not limited to implementations that solve any disadvantages noted above or in any part of this disclosure.
The following description relates to systems and methods for predictive shoulder kinematics via immersive virtual reality (iVR), such as using the system shown in
Turning now to the figures,
The virtual reality-guided exercise 102 is a game that guides the user through a series of movements selected to aid rehabilitation, as will be elaborated upon below with respect to
In contrast, the machine learning-based processing method 206 includes a low-resolution motion capture system 222 that further includes the one or more hand-held controllers 124 and the headset 126. The low-resolution motion capture system 222 also may be referred to herein as an iVR system 222. The low-resolution motion capture system 222 may be an off-the-shelf iVR system, such as the HTC Vive. For example, the low-resolution motion capture system 222 may use one or more sensors to track a position and rotation (e.g., angles with respect to the x, y, and z axes, referred to as roll, pitch, and yaw) of the one or more hand-held controllers 124 in 3D world space. Similarly, one or more sensors may track a position of the headset 126 in 3D world space, which may affect an image shown to a user via the headset 126. For example, the headset 126 may include an immersive display, and as the user moves their head and changes the position of the headset 126 in 3D word space, the image shown on the immersive display may change accordingly. Further, an indicator of the position of the one or more hand-held controllers 124 may also be shown on the immersive display, such as the orb 106 described above with respect to
As elaborated herein, the virtual reality-guided exercise 102 guides the user through rehabilitation-relevant movements via the immersive display of the headset 126. The high-resolution motion capture system 208 and the low-resolution motion capture system 222 both track the motions of the user as the user performs the movements. Data from the high-resolution motion capture system 208 is processed via a biomechanical simulation 214 that outputs training features 216 for joint parameters, including joint angles 218 and joint torques 220. The training features 216 may be input into a machine learning model 238 of the machine learning-based processing method 206, as will be elaborated below. Shoulder joint parameters will be described herein, although the system 200 could be similarly used to determine parameters for other joints. For example, the virtual-reality guided exercise 102 may guide the user through shoulder rotation (SR), side arm raise (SAR), forward arm raise (FAR), external rotation (ExR), abducted rotation (AbR), mixed press (MxdPr), and mixed circles (MxdCr) movements, as will be further described with respect to
The high-resolution motion capture system 208 is considered the gold standard for accuracy and precision in motion tracking but is often restricted to laboratory environments due to its size and expense. Therefore, data from the high-resolution motion capture system 208 may be used to generate accurate training data via the biomechanical simulation 214. To collect the training data, positions of the plurality of reflective markers 112, as captured by the IR cameras 210, are used as inputs into the biomechanical simulation 214 for inverse kinematics. For example, the biomechanical simulation 214 may be an inverse kinematics tool of OpenSim software that incorporates an upper body model. The biomechanical simulation 214 positions the model to best fit the data from the plurality of reflective markers 112 at each time frame, such as by finding the model pose that minimizes the sum of weighted squared errors of the markers, as shown in
where SE is the squared error, m are the plurality of reflective markers 112, uc are a set of unprescribed coordinates, xiexp is the experimental position of marker i, xi is the position of the corresponding model marker, qiexp is the experimental value for coordinate j, wi are the marker weights, w; are the coordinate weights, and q=qjexp for all prescribed coordinates j.
Inverse dynamics may be used to determine net forces and torques at each joint (e.g., the joint torques 220). For example, the inverse dynamics may be a tool within the biomechanical simulation 214 that uses results from the inverse kinematics tool and external loads applied to the model using classical equations of motion, such as Equation 2:
where q, {dot over (q)}, {umlaut over (q)} ∈N are the vectors of generalized position, velocities, and accelerations, respectively; M(q)∈
NxN is the system mass matrix; C(q, {dot over (q)})∈
N is the vector of Coriolis and centrifugal forces; G(q)∈
N is the vector of gravitational forces; and π∈
N is the vector of generalized forces. The model's motion is defined by the generalized positions, velocities, and accelerations to solve for a vector of generalized forces.
In the example shown in
The data processing 228 may include data cleaning, feature selection, interpolation, and batch generation. The low-resolution motion capture system 222 and the high-resolution motion capture system 208 collect data at different frequencies, and thus interpolation is used to synchronize data to a common timeline. The collected data is scanned for any outliers or missing values so that it may be corrected if any are detected. The data is cropped into smaller segments, which are later randomized for training the machine learning model 238. This randomization provides more generalizable results rather than training on single data set that is in chronological order.
An illustrative example of the data processing 228 and model building via the machine learning model 238 will now be described. The illustrative example uses 540 game trials of the virtual reality-guided exercise 102, each recorded for 60 seconds at 120 Hz to generate a data set of approximately 3.89 million instances (e.g., arm positions). A set of 54 (10%) randomly selected trials are selected as a test set to test the final models. The remaining 60 second recordings are split into segments of 3 seconds. These shorter segments may be used to prevent the model from learning patterns in the movements due to the repetitive nature of some of the movements. Each segment is randomly placed into the training or validation set such that the overall data is split into 80% training (e.g., using data produced via the offline processing method 204), 10% validation, and 10% test.
There are many types of machine learning models available that each use different types of data and prediction methods. Typically, these machine learning models perform regression, clustering, visualization, or classification and can use probabilistic methods, rule-based learners, linear models (e.g., neural networks or support vector machines), decision trees, instance-based learners, or a combination of these. The type of input data may be taken into consideration to select the approach used for the machine learning model 238 in order to determine what type of prediction is needed (e.g., binary classification, multiclass classification, regression, etc.), identify the types of models that are available, and consider the pros and cons of those models. Examples of elements to consider are accuracy, interpretability, complexity, scalability, time to train and test, prediction time after training, and generalizability.
In the present example, the machine learning model 238 uses gradient boosting and a decision tree to perform a supervised multiple regression task because there are multiple input variables and the input and output data are already known and numeric. The decision tree 242 includes a simple predictive model including bagging, random forest, boosting, and gradient boosting. Extreme Gradient Boosting (XGBoost) builds upon all of these methods to increase speed and performance. XGBoost may be used because of its ability to accurately train on the specific type of input data as well as its built in regularization methods (e.g., LASSO and Ridge) to ensure the machine learning model 238 does not over-fit the data. Alternatively, other algorithms may be used, such as Artificial Neural Networks (ANNs), Convolutional Neural Networks (CNNs), Long Short-Term Memory (LSTM), and Random Forests. In the present example, the machine learning model 238 may comprise six models to produce joint and torque predictions, as specified in Table 1 below.
Shoulder elevation describes rotation about the horizontal axis of the glenohumeral joint, elevation plane describes rotation about the vertical axis of the glenohumeral joint, and shoulder rotation describes rotation about the longitudinal axis of the humerus. Data from the biomechanical simulation 214 may be interpolated to match the collection frequency of the low-resolution motion capture system 222. The number of estimators may be set to 5,000, and the max depth may be set to 10 as values higher than this may provide little if any improvement. To prevent overfitting, early stopping rounds may be used for each model. As such, the training may stop and use the model of best fit (e.g., as determined via a loss function) if the model does not improve within five epochs. The validation data may be used after each epoch of training to determine if the training should be stopped due to no more improvement (known as early stopping). The training and validation will be further described with respect to
Continuing with
The model may be evaluated using mean absolute error (MAE) to compare each model's prediction to the results from the biomechanical simulation 214 for the unseen test set, such as by using Equation 3:
where n is the number of data points, y is the prediction of the model, and x is the value obtained from the biomechanical simulation 214. Unlike the validation data, the test set is not processed by the machine learning model 238 until the training is complete. Instead, the test data is used to check how accurately the trained machine learning model 238 predicts on unseen data, such as using the MAE approach described above.
For example, the data from the high-resolution motion capture system 208 in the unseen test data set may be used to determine joint angles and torques in the biomechanical simulation 214. The averages and standard deviations of joint angles and joint torques of the biomechanical simulation 214 can be seen in Table 2 below. The MAE comparing the results from the biomechanical simulation 214 and the machine learning model 238 for the unseen test data set is shown in Table 3. As an example, the trained machine learning model 238 may generate predictions in runtime at an average rate of approximately 0.74 milliseconds (ms) for a single instance of inputs, making the machine learning model 238 both quick and highly accurate. For example, as shown in Table 3 below, the MAE was found to be less than 0.78 degrees for joint angles and less than 2.34 Nm for joint torques, indicating that the motion of the iVR system 222 provides enough input for accurate prediction using the machine learning model 238. Specifically, the rotation and position of the hand-held controller 124, along with the trained arm's wrist weight (e.g., from the weighted arm strap 110 of
Thus, once trained and validated, the machine learning model 238 may be used to predict joint angles and torques of a subject wearing only the low-resolution capture system 222 and without additional input from the offline processing method 204.
Further, it may be understood that each of the offline processing method 204 and the machine learning-based processing method 206 may be executed by one or more processors operatively coupled to one or more memories (e.g., a tangible and non-transient computer readable medium). As used herein, the term “tangible computer readable medium” is defined to include any type of computer readable storage and to exclude propagating signals. Additionally or alternatively, the example methods and systems may be implemented using coded instruction (e.g., computer readable instructions) stored on a non-transitory computer readable medium such as a flash memory, a read-only memory (ROM), a random-access memory (RAM), a cache, or any other storage media in which information is stored for any duration (e.g., for extended time periods, permanently, brief instances, for temporarily buffering, and/or for caching of the information). Memory and processors as referred to herein can be standalone or integrally constructed as part of various programmable devices, including for example, computers or servers. Computer memory of computer readable storage mediums as referenced herein may include volatile and non-volatile or removable and non-removable media for a storage of electronic-formatted information, such as computer readable program instructions or modules of computer readable program instructions, data, etc. that may be stand-alone or as part of a computing device. Examples of computer memory may include (but are not limited to) RAM, ROM, EEPROM, flash memory, CD-ROM, DVD-ROM or other optical storage, magnetic cassettes, magnetic tape, magnetic disc, or other magnetic storage devices, or any other medium which can be used to store the desired electronic format of information and which can be accessed by the processor or processors or at least a portion of a computing device.
Further still, one or both of the offline processing method 204 and the machine learning-based processing method 206 may be implemented by one or more networked processors or computing devices. Such communicative connections may include, but are not limited to, a wide area network (WAN); a local area network (LAN); the internet; a wired or wireless (e.g., optical, Bluetooth, radio frequency) network; a cloud-based computer infrastructure of computers, routers, servers, gateways, etc.; or any combination thereof associated therewith that allows the system or portions thereof to communicate with one or more computing devices. As an illustrative example, data acquired by the low-resolution motion capture system 222 may be wirelessly transmitted to one or more computing devices, and the one or more computing devices may perform the data processing 228 and/or input the processed data into the machine learning model 238.
Turning now to
The plurality of virtual reality-guided movements 300 include a shoulder rotation (SR) movement 302, a side arm raise (SAR) movement 304, a forward arm raise (FAR) movement 306, an external rotation (ExR) movement 308, an abducted rotation (AbR) movement 310, a mixed press (MxdPr) movement 312, and a mixed circles (MxdCr) movement 314, such as mentioned above. For each movement, an anatomical model shows how an arm 316 moves with respect to a torso 318 to follow the butterfly 104 with the hand-held controller 124 (e.g., by placing the orb 106 on the butterfly 104, as shown to the user via the headset 126), such as described with respect to
For the SR movement 302, the butterfly 104 moves from a position A to a position C along a path 320. The path 320 is linear and may be parallel to a ground surface, for example. Further, the path 320 is perpendicular to an axis of rotation 322. For example, the shoulder joint may rotate around a position B that is located between the position A and the position C on the path 320. For the SAR movement 304, the butterfly 104 moves from a position A, through a position B, and to a position C along a path 324. The path 324 is curved between the position A and the position C. Further, the position A is below the torso 318, while the position C is above the torso 318. The SAR movement 304 is a lateral arm movement, to the side of the torso 318, whereas the FAR movement 306 is in front of the torso 318. For the FAR movement, 306, the butterfly 104 moves from a position A, through a position B, and to a position C along a path 326. Similar to the path 324 of the SAR movement 304, the path 326 is curved, and the butterfly 104 begins below the torso 318 (e.g., at the position A) and ends above the torso 318 (e.g., at the position C). Further, for each of the SR movement 302, the SAR movement 304, and the FAR movement 306, the arm 316 is substantially straightened and unbent at the elbow.
In contrast, for each of the ExR movement 308 and the AbR movement 310, the arm 316 is bent approximately 90 degrees at the elbow. For the ExR movement 308, the butterfly 104 moves from a position A at the left side of the torso 318, through a position B, and to a position C on the right side of the torso 318 along a path 328, causing the shoulder to rotate about an axis or rotation 330. The path 328 is linear and may be parallel to the ground surface and perpendicular to the axis of rotation 330. For the AbR movement 310, the butterfly 104 moves from a position A that is below the torso 318, through a position B, and to a position C that is above the torso 318 along a path 332. The path 332 is on the right side of the torso 318 so that the arm 316 does not move across the torso 318 during the AbR movement 310. Further, the path 332 may be perpendicular to the ground surface and perpendicular to, for example, the path 328 of the ExR movement 308.
The MxdPr movement 312 includes a plurality of paths that each begin at an origin 334. The butterfly 104 moves from the origin 334 to a position A along a first path 336, from the origin 334 to a position B along a second path 338, from the origin 334 to a position C along a third path 340, from the origin 334 to a position D along a fourth path 342, and from the origin 334 to a position E along a fifth path 344. For example, the butterfly 104 may return from the position A to the origin 334 along the first path 336 before moving from the origin 334 to the position B along the second path 338, etc. until returning to the origin 334 from the position E. For example, the MxdPr movement 312 may guide the arm 316 from a bent to a substantially straightened position at a plurality of different angles (e.g., according to each of the plurality of paths).
The MxdCr movement 314 includes a plurality of circular (or elliptical) paths. For example, the butterfly 104 may move from an origin 346 along a first path 348, which sweeps from in front of the torso 318 to the back of the torso 318 before returning to the origin 346. The butterfly may then move from the origin 346 along a second path 350, which may be a substantially circular path in front of the torso 318.
Turning now to
As shown in
The vertical displacement of the hand-held controller 124 introduced in
As can be seen in
This is exemplified in
As shown in the first graph 602, the shoulder elevation angles predicted using the machine learning model and data gathered via an iVR system (e.g., the iVR system 222 of
In this way, an off-the-shelf iVR system paired with machine learning may accurately provide predictive kinematics for evaluating rehabilitative exercises. As a result, the iVR system may be utilized for telehealth, thereby alleviating the loss of in-person evaluation methods through remote estimation of range-of-motion and joint torques. Accurate and consistent measurement of range-of-motion is fundamental to monitoring recovery during physical therapy, and measuring upper limb kinematics is one of the most challenging problems in human motion estimation. Because the shoulder cannot be estimated by simple single plane joint models, the present disclosure addresses this complex problem with a low-cost solution that can be used both in a clinic and at a patient's home. The present disclosure illustrates that off-the-shelf iVR headsets can be employed for motion analysis in comparison to complex and expensive optical motion capture methods, which rely on expensive equipment and accurate placement on anatomical landmarks. By providing a low cost, easy to use, and accurate system for remote rehabilitation, patients may provide more frequent measurements from their homes, enabling therapists to have a more detailed remote patient analysis in guiding physical rehabilitation. Overall, patients may be empowered by being able to complete at-home guided exercises at a time that works with their schedule over a longer duration. As a result, positive recovery outcomes may be increased.
The technical effect of using a machine learning model to predict joint kinematics during guided exercises based on data acquired with an immersive virtual reality system, the machine learning model trained based on data acquired via an optical motion tracking system, is that physical rehabilitation may be accurately monitored via telehealth.
The disclosure also provides support for a system, comprising: an immersive virtual reality (iVR) system, the iVR system including a headset and a hand-held controller, and machine readable instructions executable to: predict joint kinematics using a machine learning model based on motion data received from the iVR system during gameplay of a virtual reality-guided exercise with the iVR system. In a first example of the system, the machine learning model is trained using joint angles and joint torques determined via biomechanical simulation using data obtained via an optical motion tracking system. In a second example of the system, optionally including the first example, the machine learning model comprises a plurality of separate models for different parameters of the joint kinematics. In a third example of the system, optionally including one or both of the first and second examples, the plurality of separate models for the different parameters of the joint kinematics comprise one or more of an elevation plane angle model, an elevation angle model, an elevation plane torque model, an elevation torque model, and a rotation torque model. In a fourth example of the system, optionally including one or more or each of the first through third examples, the machine learning model is trained using an extreme gradient boost algorithm, an artificial neural network, a convolutional neural network, a long short-term memory, and/or a random forest.
The disclosure also provides support for a method, comprising: training a machine learning model using biomechanical simulation parameters generated using data from a high-resolution motion capture system, and predicting joint parameters via the machine learning model by inputting data from a low-resolution motion capture system into the machine learning model. In a first example of the method, the low-resolution motion capture system includes an immersive virtual reality (iVR) headset and a hand-held controller, and where predicting the joint parameters via the machine learning model by inputting data from the low-resolution motion capture system into the machine learning model comprises inputting a rotation and a position of the hand-held controller into the machine learning model. In a second example of the method, optionally including the first example, the data from the high-resolution motion capture system and the data from the low-resolution motion capture system are both obtained during a series of exercises guided by a game displayed via the iVR headset. In a third example of the method, optionally including one or both of the first and second examples, the joint parameters comprise a shoulder joint torque and a shoulder joint angle. In a fourth example of the method, optionally including one or more or each of the first through third examples, training the machine learning model comprises training the machine learning model using an extreme gradient boost algorithm.
The following claims particularly point out certain combinations and sub-combinations regarded as novel and non-obvious. These claims may refer to “an” element or “a first” element or the equivalent thereof. Such claims should be understood to include incorporation of one or more such elements, neither requiring nor excluding two or more such elements. Other combinations and sub-combinations of the disclosed features, functions, elements, and/or properties may be claimed through amendment of the present claims or through presentation of new claims in this or a related application. Such claims, whether broader, narrower, equal, or different in scope to the original claims, also are regarded as included within the subject matter of the present disclosure.
The present application claims priority to U.S. Provisional Application No. 63/265,145 entitled “SYSTEMS AND METHODS FOR PREDICTIVE SHOULDER KINEMATICS OF REHABILITATION EXERCISES THROUGH IMMERSIVE VIRTUAL REALITY”, and filed on Dec. 8, 2021. The entire contents of the above-listed application is hereby incorporated by reference for all purposes.
This invention was made with Government support under Grant No. 1521532, awarded by the National Science Foundation. The Government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind |
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PCT/US2022/081202 | 12/8/2022 | WO |
Number | Date | Country | |
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63265145 | Dec 2021 | US |