By Dawn Brazell
Public Relations

Herbert Pinckney settles in to punch some ducks in the video game, Duck Duck Punch, letting researcher Michelle L. Woodbury, Ph.D., get him scanned in to create his avatar arm.

Stroke survivor Herbert Pinckney tries to earn points on a video game as Dr. Michelle Woodbury offers encouragement.

His 11 grandchildren would think the game way too easy, but for Pinckney it's Olympic-caliber work. Having had a stroke about eight months ago, he struggles to lift his arm. He's trying to score points by knocking over a series of ducks on the screen. The level gets harder as some seagulls begin flying across. Woodbury, an occupational therapist and research director of the upper extremity motor function lab in MUSC's Center for Rehabilitation Research in Neurological Conditions, allows him to use his other arm to assist.

"Bend and get that duck. Can you get that duck? That's a tough one," she said, encouraging his competitive streak.
Pinckney is making history, both personally, in regaining lost mobility in his impaired left side, and medically. He became the first participant in a feasibility study aimed at the development of the first generation of games designed to help a segment of stroke patients for whom very few therapy options exist.

Woodbury, who still is recruiting for the study, praises Pinckney and points out the huge difference in his ability since he first started. She said she's been amazed by early results that suggest patients are benefitting more than was expected.

The innovative virtual reality system is the brainchild of an ongoing collaboration between Woodbury and the research teams of Larry Hodges, Ph.D., the endowed chair and director of the Clemson School of Computing.

Using a low-cost motion tracking device, a stroke patient's real world arm movement is translated into virtual world arm movements. Patients see the avatar arm from the same perspective as they see their own arm and are able to control the avatar arm with their own arms. Although the patient's actual arm movement may be small, the avatar arm responds with full reaching motions in the virtual world to play an interactive virtual game.

Woodbury controls what the ratio of real to virtual arm movement is based on the patient's degree of disability. For example, this threshold may be set so that a patient may need only five degrees of voluntary elbow extension to control the avatar. As the patient improves, this threshold can change to require 10 degrees.

Patients are given the illusion of performing full normal reaching movements and accomplishing specific tasks. This is exciting given new research that is showing the advantage of activating and reorganizing the neural networks in the brain that have been affected by illness and injury to enhance rehabilitation, she said.

"This is never in place of a therapist," she said of the game, "but this gives a therapist another tool for the toolbox. The virtual enviroment offers things the real world can't. In the virtual world, we make the world easier for them."

The video game simulates full range of motion for a stroke survivor with limited motion. To see a video, visit http://bit.ly/MUSC_Virtual_Reality.

Eventually, therapists will be able to send their patients home with a Kinect game that will challenge them in a fun way and reinforce therapy being done in the clinic. She has enjoyed collaborating with Hodges and his group, although they've had to be patient with each other at times in translating the respective jargon of their fields.

Woodbury also is working with a group of 10 volunteers from the gaming community for the study and has been amazed by their contributions about how to make the game more entertaining. They are incorporating their comments to improve future generations of the game.

Hodges said his expertise is in the design, implementation and testing of virtual environment software. Teaming with application content experts to understand and contribute to solutions that support their clinical goals is both challenging and rewarding.

"Many of my graduate students chose to study computer science with me because they wanted to build solutions that address real-world problems."

He has been doing collaborative research with clinical partners since 1993 and has supervised the design and implementation of virtual environments for use in the treatment of balance disorders, anxiety disorders, post-traumatic stress disorder in Vietnam Veterans and for pain distraction with pediatric cancer patients. He has talented graduate students who are committed to building computing systems that have a positive impact on society, he said.

For his team that means seeing if their virtual environments are helpful to clinicians and resolving the numerous technical issues that crop up.

"Building real systems causes us to address computing challenges in animation, geometric modeling, motion tracking, artificial intelligence, software engineering and real-time rendering."

It's all worth it, though.

"The continued decline in cost and increase in performance of computers, tablets, smart phones and interface devices such as the Kinect is opening up vast opportunities for new clinical collaborations."

Dr. Michelle Woodbury

Woodbury certainly is thrilled.

It enhances her ability to use her extensive stroke rehabilitation experience and is the culmination of a type of project she has always wanted to do. Her study pairs occupational therapy with use of the game and in three weeks, Pinckney just about doubled his movement range.

The majority of the 795,000 people annually affected by stroke cannot resume daily activities because of the impairment in their motor abilities in their upper extremities. Current neurorehabilitation occupational and physical therapy programs incorporate intensive, repetitive practice of meaningful tasks to improve this movement and function.

Task-practice interventions are based on contemporary neuroscientific studies showing that high-dose repetitive practice of the tasks of reaching, grasping and manipulation tasks improves the excitability of the damaged cortex and can improve recovery.

Unfortunately, it is estimated that only about 25 percent of stroke survivors have enough function to do this type of therapy. Virtual reality can change that scenario.

She grins. Plus, they get to punch ducks.

"They love it, and they think it's fun. It's fun to do something they can't do anymore."

For more information:
Visit http://www.SCresearch.org to find out more about the study: A Virtual Reality Environment for Post-Stroke Upper Extremity Motor Rehabilitation.