Name: measuring the kinematics of daily living movements with motion capture systems in virtual reality
Uploaded: 2018-04-05T14:00:00
Description: The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based ...

K.S. and A.L. contribute equally. This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT &#38; Future Planning (NRF-2016R1D1A1B03931389).

All experimental procedures described here were approved by the Institutional Review Board of Hanyang University, according to the Declaration of Helsinki (HYI-15-029-2). 6 healthy controls (4 males and 2 females) and 6 MCI patients (3 males and 3 females) were recruited from a tertiary medical center, Hanyang University Hospital.
1. Recruit Participants
<ol>
	<li>Recruit MCI patients (i.e., impaired IADL capabilities) and healthy controls (i.e., normal IADL capabilities) a...

<ol>
	<li>Reppermund, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impairment+in+instrumental+activities+of+daily+living+with+high+cognitive+demand+is+an+early+marker+of+mild+cognitive+impairment:+the+Sydney+Memory+and+Ageing+Study.">Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment: the Sydney Memory and Ageing Study.</a> Psychol. Med. 43 (11), 2437-2445 (2013).</li><li>Graf, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Lawton+instrumental+activities+of+daily+living+scale.">The Lawton instrumental activities of daily living scale.</a> Am. J. Nurs. 108 (4), 52-62 (2008).</li><li>Gold, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+examination+of+instrumental+activities+of+daily+living+assessment+in+older+adults+and+mild+cognitive+impairment.">An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment.</a> J. Clin. Exp. Neuropsychol. 34 (1), 11-34 (2012).</li><li>Jekel, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mild+cognitive+impairment+and+deficits+in+instrumental+activities+of+daily+living:+a+systematic+review.">Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review.</a> Alzheimers. Res. Ther. 7 (1), 17 (2015).</li><li>Suchy, Y., Kraybill, M. L., Franchow, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Instrumental+activities+of+daily+living+among+community-dwelling+older+adults:+discrepancies+between+self-report+and+performance+are+mediated+by+cognitive+reserve.">Instrumental activities of daily living among community-dwelling older adults: discrepancies between self-report and performance are mediated by cognitive reserve.</a> J. Clin. Exp. Neuropsychol. 33 (1), 92-100 (2011).</li><li>Desai, A. K., Grossberg, G. T., Sheth, D. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Activities+of+Daily+Living+in+patients+with+Dementia.">Activities of Daily Living in patients with Dementia.</a> CNS drugs. 18 (13), 853-875 (2004).</li><li>Ma, M., Jain, L. C., Anderson, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Virtual, augmented reality and serious games for healthcare 1. 68, (2014).</li><li>Allain, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detecting+everyday+action+deficits+in+Alzheimer's+disease+using+a+nonimmersive+virtual+reality+kitchen.">Detecting everyday action deficits in Alzheimer's disease using a nonimmersive virtual reality kitchen.</a> J. Int. Neuropsychol. Soc. 20 (5), 468-477 (2014).</li><li>Klinger, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=AGATHE:+A+tool+for+personalized+rehabilitation+of+cognitive+functions+based+on+simulated+activities+of+daily+living.">AGATHE: A tool for personalized rehabilitation of cognitive functions based on simulated activities of daily living.</a> IRBM. 34 (2), 113-118 (2013).</li><li>White, D., Burdick, K., Fulk, G., Searleman, J., Carroll, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+virtual+reality+application+for+stroke+patient+rehabilitation.">A virtual reality application for stroke patient rehabilitation.</a> ICMA. 2, 1081-1086 (2005).</li><li>Dimbwadyo-Terrer, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Activities+of+daily+living+assessment+in+spinal+cord+injury+using+the+virtual+reality+system+Toyra:+functional+and+kinematic+correlations.">Activities of daily living assessment in spinal cord injury using the virtual reality system Toyra: functional and kinematic correlations.</a> Virtual Real. 20 (1), 17-26 (2016).</li><li>Preische, O., Heymann, P., Elbing, U., Laske, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+value+of+a+tablet-based+drawing+task+for+discrimination+of+patients+in+the+early+course+of+Alzheimer's+disease+from+healthy+individuals.">Diagnostic value of a tablet-based drawing task for discrimination of patients in the early course of Alzheimer's disease from healthy individuals.</a> J. Alzheimers. Dis. 55 (4), 1463-1469 (2017).</li><li>Seo, K., Kim, J. K., Oh, D. H., Ryu, H., Choi, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Virtual+daily+living+test+to+screen+for+mild+cognitive+impairment+using+kinematic+movement+analysis.">Virtual daily living test to screen for mild cognitive impairment using kinematic movement analysis.</a> PLOS ONE. 12 (7), e0181883 (2017).</li><li>Albert, M. 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We detailed a kinematic measuring protocol of daily living movements with motion capture systems in an immersive VR environment. First, the experimental setting guided to how to set up, prepare, and familiarize participants with the immersive VR environment. Second, we developed two standardized IADL tasks in VR. Third, Step 3 and Step 5 in the Protocol section are the most critical steps to minimize VR sickness. When setting up the motion capture systems in the virtual environment (Step 3), it is important to mount the ...

Instrumental activities of daily living (IADL), such as handling financial transactions, using public transportation, and cooking, are medical markers since they require multiple neuropsychological functions1. Impaired IADL capabilities are thus considered precursors to neurological diseases, such as mild cognitive impairment (MCI) and dementia2. Gold&#39;s comprehensive review of IADL tasks3 indicated that more cognitively demanding tasks, such as managing finances and using public transportation, were the earliest predictor of MCI and dementia.
To date, the most commonly used assessments of IADL are self-reported questionnaires, informant-based questionnaires, and performance-based assessments4. Questionnaire-based assessments of IADL are cost-effective and easy to use, but are prone to subjective bias. For instance, when self-reporting, patients tend to over- or under-estimate their IADL capabilities5. Similarly, informants misjudge IADL capabilities due to the observer&#39;s misperceptions or knowledge gaps4. Thus, performance-based assessments that ask patients to carry out specific IADL tasks have been preferred, although many of the tasks are inappropriate for a general clinical setting6.
Recently, virtual reality (VR) studies have shown that this technology could have significant applications in medicine and healthcare, which includes everything from training to rehabilitation to medical assessment7. All participants can be tested under the same VR conditions, which mimic the real world. For instance, Allain et al.8 developed a virtual coffee-making task and showed that patients with cognitive impairment performed the task poorly. Klinger et al.9 developed another VR environment for mailing and shopping tasks and found a meaningful relationship between task completion time in VR and neuropsychological test results. Previous VR studies of IADL assessment have mostly focused on simple performance measures such as reaction time or accuracy when using conventional input devices such as a mouse and keyboard8,9. More detailed performance data about IADL is thus needed to efficiently screen for patients with MCI4.
Kinematic analysis of real-time motion capture data is a powerful approach to quantitatively document detailed performance data associated with IADL tasks. For example, White et al.10 developed a virtual kitchen that captures the participant&#39;s joint angle data during daily living tasks and used captured data to quantitatively assess the effectiveness of physical therapy. Dimbwadyo-Terrer et al.11 developed an immersive VR environment to assess upper limb performance when conducting basic daily living tasks and showed that kinematic data recorded in a VR environment highly correlated with functional scales of the upper limb. These kinematic analyses with motion capture systems could provide further opportunity to quickly assess a patient&#39;s cognitive impairment12. Inclusion of the detailed kinematic data in screening for patients with MCI significantly improved the classification of patients compared to healthy controls13.
Here, we describe a protocol to assess the kinematics of daily living movements with motion capture systems in an immersive VR environment. The protocol comprised two complex IADL tasks: &#34;Task 1: Withdraw money&#34; (handling financial transactions) and &#34;Task 2: Take a bus&#34; (using public transportation). While the tasks were performed, a motion capture system traced the position and orientation of the dominant hand and head. After completing Task 1, dominant hand trajectory, moving distance, and time to completion were collected. In Task 2, head trajectory, moving distance, and time to completion were collected. The Representative Results section in this article details the preliminary test of patients with MCI (i.e., IADL capabilities are impaired) compared to healthy controls (i.e., IADL capabilities are intact).

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			<td height="357" style="height:357px;width:216px;">Computer</td>
			<td style="width:161px;">N/A</td>
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			<td style="width:457px;">Computer requirements:&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; - Single socket H3 (LGA 1150) supports 
			- Intel&#174; Xeon&#174; E3-1200 v3, 4th gen. Core i7/i5/i3 processors 
			- Intel&#174; C226 Express PCH 
			- Up to 32GB DDR3 ECC/non-ECC 1600MHz UDIMM in 4 sockets 
			- Dual Gigabit Ethernet LAN ports 
			- 8x SATA3 (6Gbps) 
			- 2x PCI-E 3.0 x16, 3x PCI-E 2.0 x1, and 2x PCI 5V 32-bit slots 
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			- 10x USB 2.0 (4 rear + 6 via headers) 
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			- 1x DOM power connector and 1x SPDIF Out Header 
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			- WD 1TB BLUE WD 10EZEX&#160; 3.5&#34; 
			- NVIDIA QUADRO K5000 &#38; SYNC</td>
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			<td height="84" style="height:84px;width:216px;">Stereoscopic 3D Projector</td>
			<td style="width:161px;">Barco</td>
			<td style="width:127px;">F35 AS3D WUXGA&#160;</td>
			<td style="width:457px;">Resolution:&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; - WQXGA (2,560 x 1,600)&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; - Panorama (2,560 x 1,080)&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; - WUXGA (1,920 x 1,200), 1080p (1,920 x 1,080)&#160;</td>
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			<td height="21" style="height:21px;width:216px;">Stereoscopic Glasses</td>
			<td style="width:161px;">Volfoni&#160;</td>
			<td style="width:127px;">Edge 1.2</td>
			<td>For further information, visit http://volfoni.com/en/edge-1-2/</td>
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			<td height="42" style="height:42px;width:216px;">Motion Capture Systems</td>
			<td style="width:161px;">NaturalPoint OptiTrack</td>
			<td style="width:127px;">17W</td>
			<td style="width:457px;">For further information, visit http://optitrack.com/products/prime-17w/</td>
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			<td height="42" style="height:42px;width:216px;">OptiTrack (Motion capture software)</td>
			<td style="width:161px;">NaturalPoint OptiTrack</td>
			<td style="width:127px;">Motive 2.0</td>
			<td style="width:457px;">For further information, visit https://optitrack.com/downloads/motive.html</td>
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			<td height="42" style="height:42px;width:216px;">MiddleVR (Middleware software)</td>
			<td style="width:161px;">MiddleVR</td>
			<td style="width:127px;">MiddleVR For Unity</td>
			<td style="width:457px;">For further information, visit http://www.middlevr.com/middlevr-for-unity/</td>
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			<td height="42" style="height:42px;width:216px;">VRDaemon (Middleware software)</td>
			<td style="width:161px;">MiddleVR</td>
			<td style="width:127px;">MiddleVR For Unity</td>
			<td style="width:457px;">For further information, visit http://www.middlevr.com/middlevr-for-unity/</td>
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			<td height="21" style="height:21px;width:216px;">Unity3D (Game engine)</td>
			<td style="width:161px;">Unity Technologies</td>
			<td style="width:127px;">Personal</td>
			<td>For further information, visit https://unity3d.com/unity</td>
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measuring the kinematics of daily living movements with motion capture systems in virtual reality

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based assessments of IADL are easy to use but prone to subjective bias. Here, we describe a novel virtual reality (VR) test to assess two complex IADL tasks: handling financial transactions and using public transportation. While a participant performs the tasks in a VR setting, a motion capture system traces the position and orientation of the dominant hand and head in a three-dimensional Cartesian coordinate system. Kinematic raw data are collected and converted into &#39;kinematic performance measures,&#39; i.e., motion trajectory, moving distance, and time to completion. Motion trajectory is the path of a particular body part (e.g., dominant hand or head) in space. Moving distance refers to the total distance of the trajectory, and time to completion is how long it took to complete an IADL task. These kinematic measures could discriminate patients with cognitive impairment from healthy controls. The development of this kinematic measuring protocol allows detection of early IADL-related cognitive impairments.

CSV files from &#34;Task 1: Withdraw money&#34; were analyzed using the statistical software R to calculate the dominant hand trajectory, moving distance, and time to completion. The trajectory of the dominant hand movement is visualized (Figure 6). The moving distance of the dominant hand is calculated by summing the total distances between sequential hand positions while performing Task 1. The distance between positions is the Euclidian distance. Time to co...

We designed a virtual reality test to assess instrumental activities of daily living (IADL) with a motion capture system. We propose a detailed kinematic analysis to interpret the participant&#39;s various movements, including trajectory, moving distance, and time to completion to evaluate IADL capabilities.

Measuring the Kinematics of Daily Living Movements with Motion Capture Systems in Virtual Reality

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based ...

The overall goal of this experimental procedure is to assess kinematic performance measures of daily living movements with motion capture systems in an immersive virtual environment. This method can help answer key questions in the medical field, such as how to diagnose dementia and mild cognitive impairment early through the ability to complete daily tasks. The main advantage of this technique is that it can quantitatively document detailed kinematic data, such as trajectory, moving distance, and timed completion while performing daily tasks in real time.The implication of this technique extends towards early diagnosis of dementia in EMSCI because the ability to complete daily tasks such as using public transportation are closely intertwined with neuropsychological functions. We first had the idea for this method when we realized the potential of virtual reality as an assessment environment, where the participants can be tested under the same conditions which mimic the real world experiences. Generally, individuals new to this method will struggle, because conducting experiments in virtual reality and analyzing kinematic data are hard to perform.Begin by setting up the hardware, including four computers, four stereoscopic three-dimensional projectors, and eight motion tracking cameras to track the position and orientation of the dominant hand and head during the two instrumental activities of daily living, IADL tasks. Ensure that all computers are equipped with the required software. For middleVR, check the website to obtain the latest versions of the libraries for the input devices, stereoscopy, clustering and interactions.Next, create a Windows 10 HomeGroup to connect the four computers to a home network. On the primary computer, create a folder and share it with other HomeGroup computers. Next, mount eight motion tracking cameras, in a virtual environment to fully cover the capture volume.Fix cameras securely so that they remain stationary during capture. Ensure objects in a virtual environment will be visible by at least two cameras at all times. Install motion capture software on the primary computer using the installation manual.Connect the primary computer with the motion capture systems with category six Ethernet cables. Next, prepare the virtual environment by moving all reflective objects. Ensure that all computers, stereoscopic 3D projectors, and motion capture systems are turned on.Once four computers are running, launch the VR software by double clicking on VRDaemon.exe. Finally, on the primary computer, initiate the motion capture software. Click the button near the top menu labeled open existing project, load the camera calibration file.Begin by providing the participant with stereoscopic glasses, weighing around 50 grams, and ensure that they are placed comfortably over the eyes and ears. Next, attach reflective markers, weighing less than one gram, to the participant's dominant hand and head. Be careful to attach reflective markers tightly.Inform the participant that they can freely move or rotate in the virtual environment using head movement, and can click virtual objects with the dominant hand. Let them know that a virtual hand will appear in the virtual environment to mimic the position of their index finger. Next, ask the participant to freely move in the virtual environment for five minutes to familiarize themselves with the VR environment.Then, ask them to click virtual buttons for five minutes in order to become familiar with how to interact with virtual objects with the dominant hand. Lastly, check whether the participant is immune to VR sickness with a simulator sickness questionnaire. First, explain to the participant the details of the task, and provide the eight action steps to complete the task in the virtual environment.Inform them the steps are one, insert the card into the ATM two, select the withdraw menu, three, select the amount to withdraw, four, select the bill type, five, enter the PIN or personal identification number, six, select the receipt option, seven, remove the card, and eight, take the money from the ATM. On the primary computer, initiate the middleware software. On the simulations tab, select a simulation file for task one, and a configuration file.Then, press the run button. Observe the participant completing task one. Once the first task is finished, check the saved cinematic data and csv files for further analysis from a shared folder.Provide the participant with a five minute break. Then start the second task, take a bus, by explaining the details. On the primary computer, initiate the middleware software.On the simulations tab, select a simulation file for task two and a configuration file. Press the run button to start task two. Instruct the participant to wait in the bus stop.Click the space bar key on the keyboard to make buses arrive at the bus stop. Finally, once the task is finished, check the saved kinematic data and csv files for further analysis from a shared folder. Help the participant remove the stereoscopic glasses and detach the reflective markers from the dominant hand and head.Here, the trajectory of the hand is visualized from task one, withdraw money, in healthy controls, and patients with mild cognitive impairment. Further, the trajectory of the head movement is visualized from task two, take a bus, in healthy controls and patients with mild cognitive impairment. Once mastered, this technique can be done in ten minutes, if it is performed properly, while attempting this procedure, it's important to remember to fix motion tracking camera securely to fully cover the capture volume, and to familiarize the participant sufficiently with the virtual environment to prevent VR sickness.Following this procedure, other non-invasive neuroimaging methods like electroencephalogram and functional near-infrared spectroscopy can be performed in order to answer additional questions like the relationship between kinematic performance measures and its underlying neurophysiological manifestation. After its development, this technique paved the way for researchers in the field of medicine to explore the kinematics of daily living movements in patients with neuropsychological disease. After watching this video, you should have a good understanding of how to set up a virtual environment, familiarize the participant, conduct tasks in VR, and measure the kinematics of daily tasks with motion capture system in the virtual environment.Don't forget that performing tasks in virtual reality can cause VR sickness and precautions such as sufficient familiarization with the virtual environment, and check whether the participant is immune to VR sickness should always be taken while performing this procedure.

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