2nd International Conference on Mathematical and Computational Biomedical Engineering – CMBE2011

March 30 – April 1, 2011, Washington D.C., USA

P. Nithiarasu and R. Löhner (eds)

AUGMENTED REALITY GAME FOR LOW BACK PAIN REHABILITATION

Eduardo F. Damasceno1,2, Luis Fernando B. Lopes1,2,

Edgard A. Lamounier Jr.2, Alexandre Cardoso2
1
Federal University of Uberlandia-Minas Gerais – Brazil
2
Federal Institute of Education, Science and Technology Goiano, Rio Verde –Goiás- Brazil
edamasceno.rv@ifgoiano.edu.br, edgard@ufu.br, alexandre@ufu.br

SUMMARY

This article shows the use of Augmented Reality technology applied to creating serious games for
a proposed non-conventional treatment of low back pain based on computer (lumbalgo)
mechanics. In this work, a description of the proposed tool and discussed the issues relevant to
their design and development.

Key Words: Augmented Reality, Serious Game, Low Back pain.

1. INTRODUCTION
In recent years, postural dysfunctions are increasing much in the general population; this is due to
a summation of causes such as bad posture habits or professional, congenital or acquired,
sedentary lifestyle and emotional factors that often interfere in the activities daily and
professional.
The most dysfunction in this people is a Low Back Pain (LBP). That is a common
musculoskeletal disorder affecting 80% of people at some point in their lives. It accounts for
more sick leave and disability than any other medical condition.
Most cases of lower back pain are due to benign musculoskeletal problems and are referred to as
non specific LBP. They are generally believed to be due to a sprain or strain in the muscles of the
back and the soft tissues, especially if the pain arose suddenly during physical load to the back,
and the pain is lateral to the spine.
It can be either acute, subacute or chronic in duration. Most often, the symptoms of low back pain
show significant improvement within a few weeks from onset with conservative measures.
Low back pain can have a mechanical origin, inflammatory, neoplastic, metabolic,
psychosomatic, or genetic malformation.
The management of mechanical low back pain include the following processes: (i) Activities of
Muscle Relaxation, (ii) Stimulation of muscle, (iii) conditioning the muscle. Since this treatment
process is applied only when the patient has no pain, And when exercising an activity generates
pain exercises are stopped and a relaxation process is performed again.
Moreover, since the rehabilitation exercise is a one-to-one process, for each patient there needs to
be at least one therapist who should be working with it.
Among the advances in computing applied to healthcare, is the increasingly common use of
virtual environments associated with both cognitive rehabilitation as engine, gradually replacing
conventional procedures [1].
These systems are considered as assistive tools that allow therapists quantitatively measure
patient’s treatment progress. In addition, since classic rehabilitation exercises are composed of
repetitive movements of simple tasks, they are usually boring and patients lose their interest
easily [2]. In computer-based rehabilitation, patients motivation is stimulated by constructing an
interesting Virtual Reality (VR) world and mapping the simple movements to input to the VR
world that responds to the input [3].
The rehabilitation therapies play an important role in patient recovery, since the motor
impairments that arise after a trauma and may be corrected or reduced depending on the quantity,
practice type and intensity of rehabilitation treatment.
The Augmented Reality (AR) and techniques are increasingly being applied to treatments of
either motor or cognitive rehabilitation [1]. It has improved techniques from an application and
information visualization by computer vision to the regular use of digital games that strongly
increases patients’ interest [4].
In this paper, our focus is to present an Augmented Reality Game for the LBP treatment’s, which
was developed to elicit the process of perception and involvement within Augmented Reality
Environment and its application as a motivational factor in rehabilitation.

2. The FisioGame-AR
The FisioGameAR is an Augmented Reality prototype that provides set of exercises for LBP
patient rehabilitation. These exercises are derived from Willians and McKenzie Protocols [5], and
described in section 2.1 and how the patient pass to level by level is described in bellow section.
The main advantage of the FisioGameAR is to let patients exercise with a cognitive
interpretation of the movement, e.g. use an virtual soccer ball to play, and the involvement
produced by the associated sound leave the patient in game atmosphere, see Figure 1.

Patients
Information’s

Figure 1- Patient during AR Game session.

Basically patients can see real world scene mixed with a virtual reality game, and he manipulate
the virtual ball in their exercises.
After all, the therapist follows the completion of the therapeutic evaluation form that assesses the
intensity of the disease and how the patient's mobility is impaired. It is through this Health
Information System (HIS) that provides data for the augmented reality environment.

2.1 The Willians & McKenzie Protocol for LBP Rehabilitation

 In many respects, the goals for treatment for both Williams and McKenzie were similar. They both
attempted to teach their patients their versions of the reasons why back pain developed in the first place,
and they both taught patients self-control techniques.
The Williams’ protocol of the exercises emphasizes the patient's posture and a change in behavior
through repetition of tasks to reduce the lumbar curve. Since the McKenzie’s protocol, leaned more
towards the use of extension and flexion of the lower limbs as a viable instrument for treatment.

2.2 Level of the Game and Exercises of the Protocol in FisioGame AR

AR applications augment a user’s view of a real environment with virtual objects in order to create
novel and immersive experiences. An important emerging aspect of AR research is creating seemingly
physical interactions between real and virtual objects.
Different interactions types into AR systems offers the potential to greatly improve the sense of
immersion created for users, and will be necessary for creating the next generation of motion-rich AR
games.
To the patient go to the next stage of the game he should do a number of exercises, there is an indicator
symbol, an image that shows the user what stage of this exercise is.
Associate the rule of passage, as well as fulfilling the objective of the exercise, the system computes the
kinetic energy stored in the exercise, which is done with the measurement of stress and fatigue. In theory it
is possible to find the formula described in Figure 2.

Where M = Body Mass

V = Speed of Movement

Figure 2- Kinetic Energy Equation.

And based on user perception of the patient and through a questionnaire evaluating the qualifications of
pain, pain, fatigue and motivation of the patient with each new therapy.
These data are included in the system through the therapist and is expressed after compiling a record of
monitoring showing the regression of the condition and progress of therapy, and stores them as a Patient
Performance information.
Periodically, the Decision Support Engine (DSE) checks the patient’s performance and sends
recommendation messages to assistant therapists through the HIS user Interface, which in turn allows
therapists to change and/or view patients/profiles and performance results. In addition, the therapists can
instruct the Exercise adapter to modify the patient’s treatment plan based on information presented to him
by the performance metrics.

3. CONCLUSIONS
The analysis of initial data show that the rehabilitation projects using digital technologies
promote a greater demand from patients needing longer treatments because these treatments help
increase the motivation of rehabilitation exercises.
Initial studies show that this is a very interesting project from an academic standpoint and even
trade, considering its potential for innovative and intuitive way to interact with the user.
Use of this system is so far restricted to a group of patients who have mechanical low back pain,
but may in future applications to be used also for low back pain during pregnancy, where the
energy function should be replaced for better measurement.
This tool can serve as support for users who want to improve the performance of physical
activities in order to reduce the risk of injury or for people injured in the recovery process.
It is important to clarify that the system is not intended to replace the professional rehabilitation,
on the contrary, it must be supervised by professionals and orthopedic physical therapy who wish
to have a computational tool capable of assisting their clients or students to perform exercises
better, getting results more expressive in a more interactive and motivating.
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