Virtual-environment-based telerehabilitation in patients with stroke

We describe a telerehabilitation system that has been developed in our laboratory, and initial results following use of the system on 2 patients with stroke. The system allows a therapist in a remote location to conduct treatment sessions, using a virtual-environment-based motor-training system, with a patient who is located at home. The system consists of a patient computer with motion-capture equipment and video camera, a therapist computer with video camera, and virtual-environment software that is synchronized over a high-speed Internet connection. The patient's movements are animated within the context of a virtual scene as she attempts to imitate a prerecorded movement, while the therapist can direct and monitor the activity in real time, as displayed in the animated virtual scene and via videoconference. The design, technical testing, and clinical feasibility testing of the system are reported. Results from the first 2 stroke patients to use the system indicate that patients made significant gains in upper-extremity function as measured by standard clinical tests and by their subjective report. As well, both patients demonstrated gains on quantitative kinematic measures of upper-extremity trajectories performed in the real world, indicating transfer of training from VE to real-world performance.