JP3235438B2 - Misprediction / Agnosia evaluation device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

The present invention relates to cerebral hemorrhage, cerebral infarction,
The present invention relates to a system for evaluating apraxia and agnosia in patients who remain paralyzed in a part of their body due to diseases such as subarachnoid hemorrhage, head trauma, and brain tumor.

[0002] In general, patients who require rehabilitation have paralysis remaining in a part of their body due to cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage, head trauma, brain tumor, and the like. Immediately after the onset of illness, hospitalized immediately, and after recovery, trained in functional rehabilitation at rehabilitation facilities (hereinafter abbreviated as rehabilitation)
To start.

At present, in order to confirm the state of function recovery,
During the early, middle and late stages of rehabilitation, tests are conducted by therapists. The contents are visual, physical, tactile,
It is an agnosia test of hearing, and an apraxia test such as a composing ability, an idea movement, and a clothing movement.

[0004]

2. Description of the Related Art Conventional rehabilitation evaluation tests are classified into the following three types, Format 1 to Format 3, when classified according to the work contents of the inspector.

[0005] Type 1 is a format in which the subject (ie, the patient) himself / herself writes a predetermined matter using a dedicated sheet. Type 2 is a format in which the inspector asks the subject a question and judges from the response of the subject. The form 3 is a form in which the examiner performs the operation and work by himself / herself, and the inspector makes a judgment based on the result and fills out the form.

[0006] In Format 1 for the subject to write, visual agnosia can be evaluated. As a first example, using a test sheet in which a line segment of about 4 cm is randomly drawn over the entire A3 sheet, the subject is instructed to "draw a line segment that can be seen". As a result, it is possible to know to what extent the subject has recognized. As a second example, a test sheet in which line segments of the test sheet are replaced with three or four types of numbers or figures is used. Here, the type of the number or figure is designated so that it can be checked, and the recognition ability of the number or figure can be evaluated in addition to the recognition range of the subject.

[0007] In the form 2 in which the examiner makes a question and makes a judgment based on the reaction of the subject and fills out the form, visual agnosia, tactile agnosia, and auditory agnosia can be evaluated. For example, the facial recognition test, which is one of the visual agnosia evaluations, is a test that shows subjects a laughing face, a crying face, and an angry face, and tells them what kind of facial expression they have, as well as the immediate family, the doctor in charge, and the therapy. There is a test that shows a picture of a known person, such as a technician, and tells who it is.

Form 3 in which a subject performs an operation / work and an inspector makes a judgment based on the result and fills out a form includes a test in which a physical agnosia evaluation, a component ability / motor apraxia evaluation, and the like are performed. . For example, there are a method in which the examiner performs an operation in accordance with an instruction such as “the right hand and the left eye” of the inspector, a method in which the figure is shown to assemble the building block three-dimensionally, and a method in which the gesture is performed.

As described above, in the past, a method relying on recording on a test sheet was mainly used, but recently a method that does not use a test sheet and only evaluates the recognition of a half-side visual space is disclosed in Japanese Unexamined Patent Application Publication No. Hei. -300908. The equipment used in this method includes a training board in which a plurality of optotypes each having a light-emitting device and an index switch are arranged, a controller for controlling the optotypes, a printer for printing data output from the controller, and an output from the controller. And a data recording device for storing data to be recorded.

[0010]

Among the conventional methods, the method using test paper has the following problems since it relies on recording on paper.

First, it takes time to evaluate and organize data. For example, in the format 1 in which the subject writes on the dedicated paper, there is an item to be tested while measuring time.
After the completion of the test sheets, the inspector wrote the evaluation results on a predetermined sheet. There is a problem in that there are several copies of the test, and the inspector has a lot of time to write the evaluation on a predetermined form throughout the test. Further, when the inspector later organizes data such as compiling data for each case, more complicated work is required.

Second, there are many evaluation items, and the inspector cannot concentrate on the evaluation. As described above, since the test is performed while measuring the time, the inspector cannot concentrate on the subjective evaluation.

[0013] Third, there is a difference in evaluation among inspectors, and there is a possibility of oversight. On the other hand, in the method using no test paper, for example, in the invention of JP-A-5-300908, the test method (using a training board) is different from the general test method of visual space recognition (using a test paper). There is a question whether it is acceptable to evaluate.

Further, in a test using a conventional test sheet,
It is possible to evaluate all aspects of visuospatial perception, such as visual space perception impairment and fixation space impairment. For example, a unique symptom can be recorded, for example, by checking a plurality of the same marks or writing in a blank portion. On the other hand, in the training board method, the evaluation target is limited to recognition of the unilateral visual space, and since the only means for the subject to input is the optotype switch, it is not possible to record unique symptoms. There was a problem.

[0015]

FIG. 1 is a diagram illustrating the principle of the present invention. The present invention provides a coordinate input unit 1 for inputting the coordinates of a handwritten locus, a deleted line segment coordinate storage unit 3 for storing coordinate value information of a plurality of deleted lines, and a handwriting obtained from the coordinate input unit 1. By comparing the coordinate value of the trajectory obtained and the coordinate value of the deleted line segment obtained from the deleted line segment coordinate storage unit 3, an erasure determining unit for determining whether or not there is an erasing operation of the deleted line segment. 2, an operation evaluator 4 for obtaining the degree of visual space recognition based on information on the line segment to be deleted determined by the deletion determiner 2 to be deleted, and a result / time data obtained by the operation evaluator 4 or the like. And a display unit (not shown) for displaying.

For example, the coordinate input unit 1 is a combination of a tablet digitizer and an electronic pen, the erasure determination unit 2 and the operation evaluation unit 4 are a personal computer (hereinafter abbreviated as a personal computer), and the deleted line segment coordinate storage unit 3 is In the hard disk device, the display unit is constituted by a CRT display device.

FIG. 10 is a flowchart for explaining the function of the erasure determination unit 2 in the principle diagram of FIG. 1. The overall function of the apraxia / approval evaluation apparatus of the present invention will be described with reference to both figures. Appointment
The functions of the disapproval evaluator can be broadly divided into test and replay.

First, in the case of a test, a test sheet is input in the first test, and in the second and subsequent tests, the input result of the test sheet that has already been input is used.

Subsequently, a test (for example, an erasure line segment test) is performed. That is, the subject inputs to the tablet digitizer (for example, one using the electromagnetic induction method) using the electronic pen. When the input is completed, input information and the like are read. That is, input information (input handwritten input coordinates) is read from the tablet digitizer, and time information is read from a timer inside the personal computer.

Next, the process proceeds to statistical processing. That is, based on all input coordinate information and time information, the degree of visual space recognition is obtained by statistical processing, and is displayed to the inspector. Further, information such as the contents of the handwriting input, the input time, the deletion order, and the like are additionally displayed on the display unit.

Finally, after the above-described series of tests and processes are completed, the coordinates and time information of the locus of the handwritten input are stored in a deleted line segment coordinate storage unit such as a hard disk. In the case of playback, play back the data saved in the case of the test,
Thereafter, as in the case of the test, reading of input information, statistical processing and display display are performed.

As described above, in the series of processes in the test, the inspector does not need to assist the work performed by the subject. Furthermore, since the evaluation and data arrangement can be easily performed, it is possible to automate a test in which a test subject is handwritten even with a large number of evaluation items. Thus, the inspector can concentrate on the subjective evaluation of the subject.

Further, according to the present invention, real-time reproduction from stored data is possible, and it is possible to reproduce information that could not be reproduced conventionally, such as the response of the subject and the order of deletion.

[0024]

FIG. 2 shows an embodiment of the present invention. This is an embodiment using a commercially available electromagnetic induction type tablet digitizer and electronic pen as the coordinate input unit 1. Since the conventional test paper has a maximum of approximately A3 size, a tablet digitizer that can store the entire test paper is used. In order to prevent the movement of the sheet during the test, it is desirable to use electrostatic attraction or the like for fixing the sheet. Further, as for the electronic pen, since it is necessary to input coordinates while writing on the paper, it is preferable to use a type in which the pen tip can be changed to a ballpoint pen. Alternatively, coordinates may be input using a pen input personal computer instead of a tablet digitizer.

The trajectory input information recording section 22 includes a clock section 21, a deleted line segment coordinate storage section 3 for storing coordinate value information of a plurality of deleted lines, and coordinates of a trajectory handwritten from the coordinate input section 1. , The coordinate value of the trajectory and the input time obtained by referring to the clock unit 21 are stored in association with each other.

The deletion determination unit 2 compares the coordinate value of the handwritten locus obtained from the coordinate input unit 1 with the coordinate value of the line to be deleted obtained from the coordinate storage unit 3 for the line to be deleted. By this, it is determined whether or not there is an act of deleting the line to be deleted.

The operation evaluation unit 4 obtains the degree of visual space recognition based on information on the line segment to be deleted determined by the deletion determination unit 2 to have been deleted. The trajectory input information storage unit 22, the clock unit 21, the erasure determination unit 2, and the calculation evaluation unit 4 can be realized by using the functions built in the personal computer.

FIG. 3 shows an example of a line segment deletion test sheet. The test is instructed to the subject by saying, "Draw a line like a visible line diagram and delete." FIG. 4 is an example of a display on a display unit (such as a display of a personal computer) when an input is made as in FIG. Although only the information on the line segment written by the subject is displayed on the sheet, the display also shows the deletion order, the deletion time, and the elapsed time on the display. Further, on the display, the erasure path is easily understood by connecting the erasure locations with lines.

Specifically, the area indicated by 9 in FIG. 4 indicates that the erasure order is the first and the erasure time is 0 minutes and 4 seconds.
A display of "1, 00:04" is displayed, and the erasure is connected by a dotted line 8 and an area indicated by 10 indicates that the elapsed time is 0 minutes 25 seconds with the display of "elapsed time 00:25". Show.

FIG. 5 is a display example of the evaluation result of the line segment deletion test. In this example, the test paper is divided into four quadrants, and the line segment erasure rate, the average of the reaction time, the recognition area, the total area, and the area recognition rate are obtained for each quadrant. The result is displayed on the display unit. The circle defining the recognition part has a line segment interval W of 4 cm
Due to the degree, the recognition radius R is set to 3 cm in the range of W / 2 <R <W.

The reason why the recognition radius R is set to W / 2 <R is to ensure that almost all the test papers fall within the recognition circle when all of them are deleted. Also, the reason why R is set to R <W is that if the deleted line segment and the unerased line segment are adjacent to each other, if the range of R> W is selected, more than half of the unerased line segment will be recognized. This is because inconsistency arises due to lack of recognition. Further, in this embodiment, a scale is displayed at the time of screen display or printing, and the correspondence between the actual test paper size and the size is shown.

FIG. 6 shows an example in which the recognition area is quantized. FIG. 7 shows an embodiment in which the area is integrated in the horizontal direction (X direction) and the vertical direction (Y direction) using this. In the present embodiment, the recognized portion is indicated by a hatched bar graph, and the case where all the portions are deleted is indicated by a white bar graph. In this embodiment,
It is possible to grasp the distribution state of the area of the recognition part shown in the entire area.

FIG. 8 shows an embodiment in which the value of the erasure area with respect to the entire area is obtained and displayed for each quantization unit in the area integration display in FIG. In this embodiment, the distribution of the recognition rate can be understood.

FIG. 9 shows an embodiment in which the movement amount of the erased portion in FIGS. 5 to 8 is displayed with the passage of time (the passage from the start of the test). Regarding the movement amount, the pen down (Xd (n), Yd (n), Td (n)) and the pen up (Xu (n), Yu (n), Tu
(n)), and at time (Td (n) + Tu (n)) / 2, the center coordinates of the pen-down and pen-up erased at the (n-1) th position ((Xd (n-1) + Xu
(n-1)) / 2, (Yd (n-1) + Yu (n-1)) / 2), the center coordinates of the pen-down and pen-up erased at the n-th position ((Xd (n) + Xu (n )) / 2,
The distance of (Yd (n) + Yu (n)) / 2) is defined as the movement amount. Here, n = 1 to N (N is the number of pen down-ups).

In the case of a healthy person, the movement amount is substantially constant at substantially constant time intervals. The amount of movement is large,
If the user concentrates on a certain period of time, it can also be used to evaluate attention.

The algorithm for the line segment deletion test according to the present invention will be described below. The algorithm is roughly divided,
It is divided into paper input, test, playback, and statistical processing. Before performing the test, it is necessary to input paper. If the paper is standardized, it is only necessary to input the paper once, and it is not necessary to input it again for each test. Paper input is performed according to the flowchart shown in FIG. That is, after performing positioning (mechanical positioning) on a certain place (for example, the edge of the digitizer) on the tablet digitizer on which the paper is to be set, an electronic pen is used to instruct on a certain point on the paper (pen down). T) Input the reference point (electronic alignment). Subsequently, the line to be deleted on the paper is traced with the electronic pen, and the coordinates of pen-up and pen-down are input.

As a result, the reference point and the line segment to be deleted are stored in the personal computer. That is, the line segment coordinates are stored as relative coordinates based on the reference point on the sheet. Therefore, in subsequent tests using the same paper, there is no need to input the line segment to be deleted.

In each of the second and subsequent tests, the paper is aligned with the edge of the digitizer to secure the level of the paper, and the coordinates of the reference point are input to perform alignment. That is, mechanical alignment and electronic alignment are performed, and the process immediately proceeds to the test process.

FIG. 11 is a flowchart of the line segment deletion test. By inputting the paper reference point, the contents of the paper already input can be used for the test. In the line segment deletion test, information on the pen status is constantly sent from the tablet digitizer to the PC via RS232C, and when information such as pen up or pen down occurs, the time information from the start of the test by the internal timer of the PC Get.

It is determined whether or not there is any erasing operation based on this information and the information on the line segment to be erased of the paper which has already been stored. That is, erasure is determined by judging whether or not a line segment connecting the line to be erased and the pen-up coordinate and the pen-down coordinate intersects. For example, as shown in FIG. 3, it is assumed that the erasure is performed by an operation of drawing a line segment 7 intersecting the line segment 6 to be erased with the tip of the electromagnetic pen 5. If the object to be erased is a character or graphic other than a line segment, a circular recognition range may be determined from its center, and a case where the object falls within the circle may be regarded as an erase.

When it is determined that the line segment or the like has been deleted, the counter of the number of deletions is advanced by one, and the number of deletions and the time of deletion are set as display data. Next, a screen display is performed by matching the deletion order and the deletion time with the subject handwritten data. For example, as shown in FIG. 4, "1,00: 04" (first, meaning 0 minutes and 4 seconds) is displayed in the fixed area 9 near the deleted line segment.

If it is determined that the line segment or the like has not been deleted, the line data to be deleted on the next sheet is called to determine the deletion. If a line segment deletion operation is performed even though there is no line segment data to be deleted, for example, "out of line segment"
Or image display.

The end of the test is determined by the inspector by clicking the mouse or the like, and after the end, the trajectory (coordinates) and time information are stored in a storage device such as a hard disk. FIG.
Is a flowchart of a reproducing process. First, tested storage data such as pen-down / pen-up coordinates, time, and the like are obtained from a storage device (such as a hard disk).

In the case of real-time reproduction, the line erasure process is reproduced on the display device in the order of line erasure from the previously obtained stored data. For example, if the handwritten input data is
Pen-up and pen-down information in the form of coordinates (Y-coordinate, Y-coordinate, time)
d (n)) and pen-up (Xu (n), Yu (n), Tu (n)). Time (Td (n) + Tu (n)) / 2− (Td (n-1) + Tu (n
-1)) / 2, the coordinates (Xd (n), Yd (n)) and the coordinates (Xu (n), Yu
(n)), a real-time reproduction becomes possible by displaying the straight line connecting to the CRT. Here, the time means an elapsed time from the start of the test, and n = 1 to N (N is the number of pen down-ups).

In the case of the result display, only the final result is displayed on the display device. FIG. 14 shows the statistical processing (area). This is a method of calculating the recognition area or the ratio of the recognition area in the entire screen to evaluate the degree of visual space recognition. Here, a circle having a predetermined radius centered on the center of the deleted line segment is used as a recognition portion, the area of the deleted location (that is, the recognition portion) is integrated, and the integrated area is defined as the recognition area. In the integration method, the whole is quantized with a resolution d, it is determined whether or not one quantization unit is included in the recognition circle, the number of included units is integrated, and the area is obtained by multiplying the quantization area.

In this example, the sheet is divided into four quadrants in the front, rear, left and right directions, and the erased area, the total area, and the ratio (= deleted area / total area) are obtained for each quadrant. X next to the test paper
With the axis and the vertical as the Y axis, the area quantized in the X-axis direction is integrated and the coordinates of half the area of the erasure area, and similarly, the area quantized in the Y-axis direction is integrated and the area of the half of the erasure area is calculated. Is obtained, the center of gravity of the recognition area can be obtained.

FIG. 15 shows the statistical processing (reaction time). This method evaluates the degree of visual space recognition based on which part of the subject's visual field responds quickly and which part responds slowly. The reaction time here is defined as the n-th reaction time dT as (Td (n) + Tu (n)) / 2- (Td (n-1) + Tu (n-1)) / 2, The average is calculated by integrating each quadrant and dividing by the number of erasures. Also, since the number of line erasures is known for each quadrant on this flowchart, the line erasure rate (= the number of erasures / the number of all lines)
May be used for evaluation of visual space recognition.

[0048]

As is apparent from the above description, according to the present invention, evaluation and data reduction can be easily performed. Even if there are many evaluation items, the test written by the subject can be automated, so that the inspector can concentrate on the inspection. In addition, the coordinates and time information of the handwriting input enable real-time reproduction, and new information such as the reaction of the subject and the deletion order can be obtained.

[Brief description of the drawings]

FIG. 1 is a principle diagram of the present invention.

FIG. 2 shows an embodiment of the present invention.

[Figure 3] Example of a line erase test paper

Fig. 4 Example of screen display during line segment deletion test

[FIG. 5] An example of a line deletion test evaluation screen

FIG. 6 shows an example of an evaluation screen for a line deletion test

FIG. 7 is an example in which areas are integrated and displayed in the X direction / Y direction.

FIG. 8 is an example in which areas are integrated and displayed in the X direction / Y direction.

FIG. 9 is an example of displaying a deletion interval (movement amount) on a time axis.

FIG. 10 is a flowchart illustrating a function of an erasure determination unit according to a principle diagram of the present invention.

[Figure 11] Flow chart of paper input

[Figure 12] Flowchart of line segment deletion test

FIG. 13 is a flowchart of a reproduction process.

FIG. 14 is a flowchart of statistical processing (area).

FIG. 15 is a flowchart of statistical processing (reaction time).

[Explanation of symbols]

1 is a coordinate input unit, 2 is a deletion determination unit, 3 is a deleted line segment coordinate storage unit, 4 is an operation evaluation unit, 5 is an electromagnetic pen, 6 is a deleted line segment, 7 is a (intersecting) line segment, 8 Is a (dot) line connecting the erased parts, 9, 10, 11, 12, 13, and 14 are fixed display areas on the screen for displaying characters and the like, 21 is a clock section, and 22 is a trajectory input information storage section.

──────────────────────────────────────────────────続 き Continuation of the front page (56) References JP-A-55-16663 (JP, A) JP-A-63-149621 (JP, A) JP-A-1-178238 (JP, A) JP-A-3-3 118065 (JP, A) JP-A-5-300908 (JP, A) JP-A-6-190080 (JP, A) JP-A-5-508786 (JP, A) (58) Fields investigated (Int. Cl. ⁷ , DB name) A61B 5/16 A61H 5/00 JICST file (JOIS)

Claims (14)

(57) [Claims] 1. A coordinate input unit for inputting coordinates of a handwritten locus, a deleted line segment coordinate storage unit for storing coordinate value information of a plurality of deleted lines, and a handwritten locus obtained from the coordinate input unit By comparing the coordinate value of the deleted line segment and the coordinate value of the deleted line segment obtained from the deleted line segment coordinate storage unit, An apraxia / agnosia evaluation apparatus, comprising: a calculation evaluation unit that obtains a degree of visual space recognition based on information on a line segment to be deleted that is determined to be deleted by a deletion determination unit. 2. A coordinate input unit for inputting coordinates of a handwritten locus; a clock unit; a deleted line segment coordinate storage unit for storing coordinate value information of a plurality of deleted lines; A trajectory input information recording unit that stores a coordinate value of the trajectory and an input time obtained by referring to the clock unit in association with the notification of the coordinates of the trajectory, and a handwriting obtained from the coordinate input unit By comparing the coordinate value of the trajectory thus obtained with the coordinate value of the deleted line segment obtained from the deleted line segment coordinate storage unit, A calculation / evaluation unit that obtains a degree of visual space recognition based on information on a line segment to be deleted that the deletion determination unit determines to have been deleted. 3. The operation evaluation unit according to claim 1, wherein the operation evaluation unit obtains a recognition rate based on a ratio of the number of lines to be deleted determined to be deleted to the total number of lines to be deleted. Misprediction / approval evaluation device. 4. The arithmetic evaluation unit calculates an average value for all coordinates for which a time difference from a time when a specific coordinate is input from the coordinate input unit to a time when the specific coordinate is input next time is input. The apraxia and agnosia evaluation device according to claim 1 or 2. 5. The operation evaluation unit expands a plane having a predetermined shape corresponding to the line segment to be deleted determined to be deleted on input two-dimensional coordinates, and expands the plane on the input two-dimensional coordinates. 3. The recognition rate is obtained by integrating the area of a plane and calculating the ratio of the integrated area and the area integrated when all the deleted line segments are determined to be deleted. The apraxia and agnosia evaluation device described in 1. 6. The operation evaluation unit quantizes an area of a plane developed on the two-dimensional coordinates, and projects a recognition area on a horizontal axis and a vertical axis in units of quantization and displays the area on a display device. The apraxia and agnosia evaluation apparatus according to claim 5, wherein 7. The arithmetic evaluation unit calculates a ratio of an area determined to be deleted to an area integrated when all the deleted line segments are determined to be deleted, and displays the calculation result on the display device. 7. The apraxia and agnosia evaluation apparatus according to claim 6, wherein the apraxia and agnosia are evaluated. 8. The apraxia and agnosia evaluation apparatus according to claim 5, wherein the arithmetic evaluation unit obtains a center of gravity of the recognized portion and displays the center of gravity on the display device. . 9. The arithmetic evaluation unit obtains a movement amount which is an interval between the coordinates of the checked mark and the coordinates of the mark checked immediately before, and displays the movement amount on the vertical axis and time on the horizontal axis. 6. The apraxia and agnosia evaluation apparatus according to claim 5, wherein the apparatus is displayed on an apparatus. 10. The apraxia / agnostic evaluation apparatus according to claim 5, wherein the arithmetic evaluation unit divides a test sheet or a test screen into a plurality of areas and evaluates each area. 11. The deleted line segment coordinate storage unit stores coordinates and time data of a trajectory input from a coordinate input unit, and the calculation evaluation unit stores the trajectory from the deleted line segment storage unit. The coordinates and the time data are taken out, and the coordinates of the trajectory are displayed on the display device with a time difference of each data in the order of the time data on the basis of a certain point in time, thereby reproducing and displaying the trajectory handwritten by the subject. The apraxia and agnosia evaluation apparatus according to claim 5, wherein the apraxia / approval evaluation apparatus has a function to perform the evaluation. 12. The abortion / recognition according to claim 5, wherein the operation evaluation unit displays a check order near a checked mark on the display unit at the time of a check and at the time of reproduction. Evaluation device. 13. The operation evaluation unit according to claim 1, wherein at the time of a check and at the time of reproduction, an elapsed time from a check start to a mark check is displayed near the mark on the display unit. Item 5. The apraxia / agnosia evaluation device according to Item 5. 14. The apraxia according to claim 5, wherein the arithmetic evaluation unit connects the checked marks with a straight line according to a check order and displays the marks on the display unit at the time of checking and at the time of reproduction. Disapproval evaluation device.