SHEBA Israel
The Virtual Reality Training Facility : A World-Class Breakthrough in Rehabilitation MedicineThe Rehabilitation Hospital at the Sheba Medical Center is a leader in developing new technologies for advanced orthopedic and neurological rehabilitation. The hospital adapts the latest advances in Israeli high technology for rehabilitation medicine, allowing for a speedier and more successful recovery rate for many patients.
Among the innovative medical technologies pioneered in the Sheba Rehabilitation Hospital are the Virtual Reality Training Facility, the Computerized Motion Analysis Laboratory, and the Isokinetic Laboratory.
The Virtual Reality Training Facility incorporates the latest advancements in computerized technology, sensors and video analysis to speed the rehabilitation of patients who have lost a leg, for example, through immersion in a fully reactive virtual and physical environment
This one-of-its-kind facility – the only such facility in clinical use worldwide – uses simulation technologies to provide patients with walking and running experiences that he/she will confront in the outside world -- without the need of being physically present at a real location.
Computer Assisted Rehabilitation Environment The facility employs a pioneering technology called Computer Assisted Rehabilitation Environment (CAREN). A breakthrough multi-sensory system for diagnostics, rehabilitation, evaluation and registration of human balance characteristics and movement control, the system enables the creation of a variety of experiences in a controlled and repeatable environment by using several virtual reality principals.
CAREN combines a motion platform (that enables manipulation of the surface on which the person is standing), a three-dimensional large-screen video projection, a real-time motion capture system, and graphics workstation.
The system simulates daily activities like taking a walk in an urban environment, driving a car, hiking up and down a mountain or driving a boat in order -- forcing the patient to learn how to balance himself and react to all situations. While standing on a new prosthetic leg, for example, such situations can be very challenging. Moreover, the system allows the patient to control and influence the surface he/she is standing on, in a dynamic and active way.
A powerful computer system directs the motion platform. Movements of the platform are performed in synchronization with images on the 3-D video screen set in front of the patient. Through motion sensors, the system monitors patient movements. Then, through the use of a real-time motion capture system, the computer responds to the patient’s movements.
These conditions demand total concentration and awareness of posture, balance and locomotion, and thus new and unexplored possibilities unfold. Therapists can thus measure and scrutinize a patient’s progress in real-life situations, and empower their patients with new balance and motion strategies.
Dramatic Rehabilitation Benefits Training in the Virtual Reality Training Facility has been shown to have many dramatic benefits, including:
• more precise and appropriate diagnostic analysis, and evidence based evaluation and intervention -- all of which decrease the time needed for successful rehabilitation and provide for a more complete rehabilitation process
• more exact and faster fitting of orthotics for paraplegics and quadriplegics, and of prosthetics for both upper and lower extremity amputees
• speedier shrinking of amputated limbs, allowing for more exact fitting of orthotics and accelerated training programs in running, walking and other everyday movements
• a supportive and private environment in which patients can regain their confidence and self-esteem in a controlled setting that gives them immediate feedback
• better ability to deal with post-traumatic emotional problems, since the system helps patients process the traumatic experience and improve their self-confidence
Patients that benefit from training in the Virtual Reality Training Facility, include:
• Patients with motion disturbances such as: Parkinson's, Stroke, Multiple Sclerosis
• Amputees: Improvement of prosthetic fitting, balance, gait and high performance skills (sports and recreation)
• Spinal Cord Injury (Paraplegia & Quadriplegia): Mobility in challenging environments, balance (in wheelchair or standing), and gait
• Behavioral: treatment of phobias (lift, height, flight) as well as Post Traumatic Stress Disorder (re-living the traumatic experience in a controlled and safe environment)
These manifold rehabilitation possibilities, and the proven treatment successes, have attracted wide attention. Rehabilitation experts from the U.S., U.S. Armed Forces, Canada, Asia, and many countries in Europe have visited the facility and sent their personnel for training at the Sheba facility.
The facility is extensively used to rehabilitate wounded personnel of the Israel Defense Forces. (See here for a brief film from Israel television news about the rehabilitation in the Virtual Reality Training Facility of a high-ranking IDF officer).
The Virtual Reality Training Facility was adapted for clinical use in rehabilitation medicine by Dr. Tzaki Siev-Ner, head of Orthopedic Rehabilitation at Sheba. The facility is operated by Yotam Bahat and Orit Elion of the Sheba Orthopedic Rehabilitation physiotherapy department.
VIRTUAL REALITY IS THERAPY FOR INJURIES
Sun Feb 11, 2007 9:02pm ET
Reuters
By Corinne Heller
RAMAT GAN, Israel, Feb 12 (Reuters) - A new system is using virtual reality scenes of surfing and jogging to help physiotherapy patients improve their balance and, for some, even to learn to walk again. Doctors hope the Computer Assisted Rehabilitation Environment (CAREN), developed by motion simulation company MOTEK, can help 26-year-old Ido Borovsky walk with more confidence on a foot whose nerves were damaged. Borovsky, hit in the left leg by shrapnel in an anti-tank missile attack in Lebanon last summer, was put through the paces at Chaim Sheba Medical Center near Tel Aviv.
Watching a virtual choppy sea on the screen in front of him and to the sound of dance music, Borovsky moved up and down on two steps on a round platform -- motions that steered a boat through the waves.
"They put the platform in a way that I will walk mostly on my injured foot," he said.
Technicians can control the size of the waves and windspeed, monitoring patients' movements and vital signs through sensors stuck to their bodies.
"Ooh, that hurt!" joked a technician, as Borovsky accidently steered his boat through a numbered marker on a buoy instead of manoeuvering around it.
The system, which has a $600,000 price tag, was developed by MOTEK, a motion simulation company that has most of its operations in the Netherlands. It has been used for research in other countries, but Israel is the first place where CAREN has been incorporated into medical treatments, said Oshri Even-Zohar, who founed MOTEK with a Dutch partner 10 years ago.
Virtual reality has been used in medicine before. In the United States, virtual reality helps patients overcome phobias such as the fear of flying by simulating the sights and sounds of the experiences. Similar methods have been used in the United States to help combat soldiers returning from war to overcome post-traumatic stress, and to distract cancer patients during their chemotherapy treatments.
PATIENTS AS JOYSTICKS
But virtual reality treatments that incorporate physical movement are new, said Dr. Itzhak Zivner, whose department has treated about 100 patients using CAREN since it was installed two years ago. "(By) being immersed in a virtual environment, we are distracting them from their pain," Zivner said, describing patients as virtual joysticks as they navigate through scenes on the screen. Most patients undergo about three sessions a week, each lasting up to 30 minutes, and are also treated with conventional physiotherapy. The virtal reality system has produced better and faster results and patients found it more enjoyable, he said.
CAREN can also help the disabled "multitask." While moving along a road and side-stepping bumps along the way, Borovsky also uses his hands, attached to sensors, to "hit" two balls darting wildly across the screen. Such exercises, involving injured and non-injured limbs, can be used to distract patients from their disabilities or pain, and benefit people suffering from Parkinson's Disease or recovering from strokes, Zivner said.
However, patients can hit a "plateau," or reach a stage where there is little to no improvement. While CAREN can help Borovsky better manoeuver with his injured leg, it cannot speed up the natural healing process of his injured foot.
The people in charge of the SHEBA CAREN lab:
