RU2781674C1 - Method for motor rehabilitation of neurological patients in virtual reality through multi-user training taking into account the psychological profile of the patient - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to neurology, and can be used for motor rehabilitation of neurological patients. Motor rehabilitation of neurological patients is carried out in virtual reality through the use of wireless portable virtual reality helmets. At the same time, patients are immersed in a common immersive virtual environment in which several patients are present in one virtual training room, see virtual images of each other, perform team exercises through game scenarios simulating adapted sports and household games in the form of a multi-user mode with cooperative interaction or a multi-user mode with competitive interaction. Moreover, in order to select the volume of training in the exercises of game scenarios, patients undergo a calibration training session before they start. At the same time, the amounts of movements in their hands by performing them in different directions: right, left, up and down are estimated, as well as the possibility of performing a capture by pressing the buttons on the controller. Each game scenario is adjusted to the type of interaction characteristic of the patient, which is determined by testing on the interpersonal relations questionnaire. For the Ie type of interaction, a competitive training mode is used, and for the Iw type of interaction, a cooperative training mode is used. The success of completing the volume of the training mode of the game scenario and the need for its complication is assessed by the time of its performance. Moreover, with a reduction in the performance time of the initial training volume relative to the initial one, as well as relative to the training volume of other patients, its performance is estimated as successful with the possibility of further complicating the training volume of the game scenario.

EFFECT: method provides an expansion of the arsenal of technical means designed for motor rehabilitation of neurological patients in virtual reality through multi-user training, taking into account the psychological profile of the patient with high efficiency.

1 cl, 2 ex

Description

FIELD OF TECHNOLOGY TO WHICH THE INVENTION RELATES

[0001] The invention relates to medicine, in particular to neurology, and can be used to improve the technology of motor rehabilitation of neurological patients using an interactive multi-user virtual space.

BACKGROUND OF THE INVENTION

[0002] As is known, it takes a long time to achieve a pronounced and lasting effect from rehabilitation measures. So, for patients who have had a stroke and have a motor deficit, rehabilitation can last for years and over time, patients lose interest in doing exercises. And if at the inpatient stage, patients are forced to follow the training regimen and perform all the necessary exercises, since they are constantly monitored by specialists, then at the outpatient stage, the lack of specialist control negatively affects the patient's adherence to treatment [Chen, Y., Abel, K. T., Janecek, J. T., et al. Home-based Technologies for Stroke Rehabilitation: A Systematic Review. International Journal of Medical Informatics, 2018,. doi:10.1016/j.ijmedinf. 2018.12.001].

[0003] In modern devices used for home rehabilitation, two main types of motivation are used: internal and external. External motivation is designed to encourage or force something to be done by external circumstances or incentives for a person. This type of motivation is most often used in modern virtual reality systems in the form of game exercises necessary for motor recovery [Klochkov A.S., Khizhnikova A.E., Kotov-Smolensky A.M., Chernikova L.A., Suponeva N.A. Correction of static and dynamic balance using a virtual reality system in patients with cerebrovascular diseases, Journal of Nervous Diseases, 2018, No. 3, p. 28-32].

[0004] This method allows you to diversify and make the daily complex of rehabilitation exercises exciting. However, it has one disadvantage: in the absence of any variety, the motivational effect may gradually decrease. Intrinsic motivation is not associated with external circumstances, but with the very content of the activity. To maintain this type of motivation, objective monitoring of performance is important. Thus, it has been shown that the patient's adherence to treatment is higher if he sees his progress [Kirk P, Grierson M, Bodak R, et al. Motivating Stroke Rehabilitation Through Music: A Feasibility Study Using Digital Musical Instruments in the Home. Proc 2016 CHI Conf Hum Factors Comput Syst 2016:1781-1785. doi:10.1145/2858036.2858376].

[0005] One of the first solutions for socialization and the problem of low motivation was interpersonal rehabilitation games integrated into various rehabilitation devices that allowed the patient to perform a task in cooperation or competition with another person. At the same time, the first proposed interpersonal rehabilitation games were aimed at cooperative interaction between the patient and the rehabilitator, and soon after that, games aimed at competition between two people began to be developed [Johnson, Μ. J., Xin Feng, Johnson, L. M., Ramachandran, B., Winters, J. M., & Kosasih, J. B. (n.d.). Robotic Systems that Rehabilitate as well as Motivate: Three Strategies for Motivating Impaired Arm Use. The First IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics, 2006. BioRob 2006. doi:10.1109/biorob.2006.1639095]. The disadvantages of these methods of rehabilitation was that the individual personal characteristics of the patient were not taken into account in this rehabilitation process.

[0006] One of the most motivating rehabilitation technologies is considered to be virtual reality. The virtual environment has the most important property - variability, this allows you to adapt training to the patient's motor and cognitive capabilities, which helps to increase involvement in rehabilitation [Iosa Μ, Morone G, Fusco A, et al. Seven capital devices for the future of stroke rehabilitation. Stroke Res Treat. 2012;2012:1-9]. Currently, the number of publications on the topic of virtual reality in rehabilitation is growing steadily, however, the heterogeneity of technologies implied by this term significantly affects the effectiveness data. Thus, most large meta-analyses have not yet revealed a significant advantage of rehabilitation in virtual reality over classical one [Laver K, George S, Thomas S, et al. Virtual reality for stroke rehabilitation. Stroke. 2012;43:e20-e21].

[0007] There is a known method for the rehabilitation of patients in the acute stage of stroke using biofeedback and virtual reality, which consists in installing glasses and a virtual reality helmet on the patient's head, installing motion sensors on the patient's head, torso and pelvic region, downloading software software consisting of a virtual environment and controls, while directed training of coordinated movements of the head, torso and pelvic region is carried out by means of a virtual reality environment and motion sensors, where the underwater world is used as a virtual environment. Moreover, the rehabilitation procedure is carried out in an immersion bath [RU 2432971, 11/10/2011]. In this method, the restoration of basic voluntary movements of the trunk, head and neck, and not the limbs, is carried out. This method of rehabilitation does not restore the movement of the arms and legs and does not give the patient the feeling of walking upright, and the patient cannot influence the objects of virtual reality, but can only see them. Accordingly, the patient cannot use biofeedback in the first person, using multisensor analyzers, i.e. visual, auditory, skin-kinesthetic. This method also does not take into account the individual personal characteristics of the patient in the process of conducting rehabilitation sessions.

[0008] A known method for the rehabilitation of patients with motor dysfunctions of the limbs using virtual reality, including the use of a virtual environment with controls and sensory interaction with a virtual object, while taking into account the information received from the recording electroencephalographic and electromyographic sensors installed on the head and the affected limb respectively, as well as the patient's ability to move, regulate the volume of control virtual movements in such a way that gives a feeling of completeness of the movement performed when demonstrating virtual reality tasks, moreover, sensory interaction with virtual objects through the use of visual, auditory channels, as well as tactile and proprioceptive stimulation of limb receptors carried out in such a way as to ensure the association of the patient with a virtual avatar, with the feeling of tactile and proprioceptive contact with virtual objects and a sense of completion of the movement. In the process of training, the patient is fitted with virtual reality glasses on his head [RU 2655200, 05/24/2018]. This method of rehabilitation does not use group mechanotherapeutic training aimed at restoring the function of the limbs and individual personal characteristics of the patient during rehabilitation sessions, which accordingly reduces the effectiveness of the rehabilitation process.

[0009] The closest technical solution to the invention is a method for the rehabilitation of motor disorders, including conducting physiotherapy exercises with feedback, while the feedback in the process of conducting physiotherapy exercises is carried out by completely immersing the subject in a virtual environment using virtual reality glasses or a virtual reality helmet or rooms with panoramic screens, while in front of the subject they create the effect of immersion from the first person, namely, the appearance of repeating the movements of the subject's eyes made by the subject in reality, and the lesson is divided into 3 parts: the first - exercises aimed at restoring the motor function of the hand, the second - movements aimed at restoring the motor function of the leg and static balance, the third - exercises aimed at restoring the coordination of the upper and lower extremities in space, and during the exercise of physical therapy, the level of the initial motor activity is assessed. o activity of the patient by moving the arm to the side with the maximum possible amplitude, raising the arm in front of him with the maximum possible amplitude, abducting and adducting the raised arm to the sides to determine the right and left boundaries, the maximum possible flexion and extension of the arm in the elbow joint, flexion of the hip and knee in front of you with the maximum possible amplitude, moving the leg to the side with the maximum possible amplitude, tilting the body to the right and left, forward and backward, taking it as 100%, and when it is reached during the exercise, automatically increase the required level of activity by 10% and more relative to the initial level, thereby carrying out virtual sensory stimulation, and the duration of one exercise therapy session is no more than 45 minutes [RU 2645604, 26.02.2018]. However, this method of rehabilitation, as described above, does not use group mechanotherapeutic training aimed at restoring the function of the limbs and individual personal characteristics of the patient during rehabilitation sessions, which accordingly reduces the effectiveness of the rehabilitation process.

SUMMARY OF THE INVENTION

[0010] The technical result consists in expanding the arsenal of technical means intended for motor rehabilitation of neurological patients in virtual reality through multi-user training, taking into account the psychological profile of the patient with high efficiency.

[0011] The technical result is achieved by the fact that the motor rehabilitation of neurological patients in virtual reality is carried out by completely immersing patients in a virtual environment through the use of wireless portable virtual reality helmets, while patients are immersed in a common immersion virtual environment in which several patients are present in one virtual in the training hall, see virtual images of each other, perform team exercises through game scenarios that simulate adapted sports and everyday games in the form of a multi-user mode with cooperative interaction, or a multi-user mode with competitive interaction, and in advance to select the amount of training in the exercises of the game scenarios before they start patients undergo a calibration training session, while assessing their range of motion in their arms, by performing them in different directions to the right, left, up and down, and also the ability to perform a capture by pressing the buttons on the controller, then, depending on the individual motor capabilities of the patient, the instructor in the scenario for gross motor disorders in the hand uses auto-capture, and in their absence, the patient performs squeezing and releasing the buttons on the controller independently, the instructor also adjusts the flight path ball in such a way that to hit it, the patient pulls his hand to the area necessary for training and the required number of hit balls, where 0-3 is the minimum value, 4-8 is the average value, 9 or more is the maximum value of hit balls, depending on cognitive capabilities of the patient, the instructor in the script adjusts the level of complexity of the recipe, in accordance with the patient's own choice of a set of ingredients and their quantity, where 1-4 is the minimum value, 5-7 is the average value, 8 or more is the maximum value of the ingredients and the list of their purchases, and in dependence on cognitive and motor x the patient’s capabilities, the instructor adjusts the level of difficulty of performing the assembled figure in accordance with the patient’s own choice of the size of the figures and their number, where 1-3 is the minimum value, 4-6 is the average value, 7 or more is the maximum value of the figures that need to be assembled in the scenario, each game scenario is adjusted to the type of interaction characteristic of the patient, which is determined by testing on a questionnaire of interpersonal relations, namely, with the type of interaction Ie - the desire to accept others so that they have an interest in him and take part in his activities; actively seeks to belong to different social groups and to be as many and often as possible among people use a competitive mode of training, and with the type of interaction Iw - tries to have others invite him to take part in their activities and strive to be in his society, even when he does not apply no effort is made to this, a cooperative training mode is used, while patients are immersed in a virtual space with a three-dimensional avatar display and tracking the volume of training performed in exercises of game scenarios in a competitive or cooperative mode by assessing the movements of the hands, head, squeezing and unclenching fingers, the number of hit balls and feeding them to problem areas, the level of complexity of choosing recipes in accordance with the number of ingredients and the list of their purchases, the level of complexity of choosing the size of the figures and their number, and the success of the volume of the training mode of the game scenario and the need for its complication are assessed by the time it is completed. Moreover, with a reduction in the execution time of the initial training volume relative to the initial one, as well as in relation to the training volume of other patients, its implementation is evaluated as successful and as a possibility of further complication of the training volume of the game scenario.

[0012] In the preferred embodiment, game exercises are aimed at developing coordination of movements, functional training of the proximal and distal parts of the hands, the development of fine motor skills and proprioceptive sensitivity.

DETAILED DESCRIPTION OF CARRYING OUT THE INVENTION

[0013] Wireless portable virtual reality helmets (for example, Oculus, Samsung Odyssey, etc.) are used as a hardware basis, with the help of which several patients (who are at the outpatient stage of rehabilitation at home, in different cities or countries) are immersed in a common an immersive virtual environment where they are present in the same virtual training room, see virtual images (avatars) of each other, communicate with each other, perform team exercises or compete with each other under the remote control of an instructor. Immersion in an immersive virtual environment with interactive tracking of the movements of the body, head and fingers creates a feeling of owning a virtual body, which helps to increase external and internal motivation. The software contains team exercises that simulate adapted sports and everyday games. The virtual environment copies the environment familiar to patients (shop, kitchen, gym), and the training technique recreates the conditions of everyday (cooking, grocery shopping, cleaning the table) and sports (tennis, camps) skills. Several game scenarios have been created that simulate adapted household scenarios, such as a kitchen, a store, and sports game scenarios, such as towns, table tennis. Each of the game scenarios is adjusted to the capabilities of the patients, namely, in order to select the volume of training in the exercises of the game scenarios, before they begin, patients undergo a calibration training session. At the same time, they evaluate the volume of movements in their hands, by performing them in different directions to the right, left, up and down, as well as the possibility of performing a capture by pressing the buttons on the controller. Further, depending on the individual motor capabilities of the patient, the instructor in the scenario for gross motor disorders in the hand uses auto-capture, and in their absence, the patient performs squeezing and releasing the buttons on the controller independently.

[0014] Also, the instructor adjusts the trajectory of the ball in such a way that, to beat it, the patient pulls his hand to the area necessary for training and the required number of beaten balls, where 0-3 is the minimum value, 4-8 is the average value, 9 or more is the maximum the value of the hit balls.

[0015] Depending on the cognitive capabilities of the patient, the instructor in the scenario adjusts the level of complexity of the recipe, in accordance with the patient's own choice of a set of ingredients and their number, where 1-4 is the minimum value, 5-7 is the average value, 8 or more is the maximum value of the ingredients and their shopping list. Depending on the cognitive and motor abilities of the patient, the instructor adjusts the level of difficulty of performing the assembled figure in accordance with the patient's independent choice of the size of the figures and their number, where 1-3 is the minimum value, 4-6 is the average value, 7 or more is the maximum value of the figures that must be assembled into a script.

[0016] In each of the games, competition with each other or a team game (including against an instructor) is possible. Exercises for practicing everyday activities, for example, going to the store for shopping, collecting products from the shelves according to the list, cooking according to the recipe (the instructor remotely selects the complexity and specifics of each task). The instructor is present with patients in the same virtual room or observes from the side through the image on the tablet, changing the training conditions in real time in the form of a multi-user mode with cooperative interaction, or a multi-user mode with competitive interaction. Moreover, each game scenario is adjusted to the type of interaction characteristic of the patient, by testing according to a questionnaire of interpersonal relations, namely, with the type of interaction Ie - the desire to accept others so that they have an interest in him and take part in his activities; actively seeks to belong to different social groups and to be as many and often as possible among people use a competitive mode of training, and with the type of interaction Iw - tries to have others invite him to take part in their activities and strive to be in his society, even when he does not apply to this no effort, apply the cooperative mode of training.

[0017] At the same time, patients are immersed in a virtual space displaying a three-dimensional avatar and tracking the volume of training performed in the exercises of game scenarios in a competitive or cooperative mode by assessing the movements of the hands, head, squeezing and unclenching fingers, the number of balls hit and feeding them to problem areas, the level of complexity of choosing recipes in accordance with the number of ingredients and the list of their purchases, the level of complexity of choosing the size of the figures and their number.

[0018] The success of the volume of the training mode of the game scenario and the need for its complication is evaluated by the time of its execution, and if the time for the initial volume of training is reduced relative to the initial one, as well as relative to the volume of training of other patients, its execution is evaluated as successful and as a possibility of further complication of the volume of training game scenario.

[0019] Each game scenario implies a separate virtual room, which may contain several patients and instructors.

[0020] The system contains training scenarios, including coordination of movements, functional training of the proximal and distal parts of the hands, everyday scenarios, development of fine motor skills, proprioceptive sensitivity. To maintain the intensity of training in the format of distance rehabilitation, each scenario includes motivating components in the form of: competitive or cooperative activities, an objective assessment of the effectiveness of the training, followed by comparison with previous results, both own and other patients.

[0021] The main disadvantage of most currently existing virtual reality systems is the lack of a multi-user mode and real-time communication with a specialist (usually communication after a workout). At the same time, the single-user mode is necessary as a method of choice for a patient with severe motor disorders, this is due to the fact that when training in a group with a patient with a less pronounced deficit, a decrease in motivation is observed in both subjects (a more severe patient is not satisfied with his results, a less severe patient worries about his teammate, which reduces the effectiveness of his training). Data from studies of group training made it possible to determine that different types of interaction are characteristic of different types of patient personality, so patients with an introverted type prefer cooperative training, and competitive training with an extravertive type. Thus, undoubtedly important for the successful implementation of a multi-user rehabilitation virtual environment is the ability to provide several types of interaction: cooperation and competition.

EXAMPLES OF PERFORMING THE METHOD

[0022] Prior to the selection of the volume of training in the exercises of the game scenarios, before they begin, patients undergo a calibration training session. The instructor evaluates the range of movements in each patient's hands by performing them in different directions to the right, left, up and down, as well as the possibility of performing a grip by pressing the buttons on the controller. Depending on the individual motor abilities of the patient, the instructor in the scenario for gross motor disorders in the hand uses either auto-capture, and if there are no gross violations, the patient performs squeezing and releasing the buttons on the controller independently.

[0023] Before starting training, patients are also tested for the type of interaction on the Interpersonal Relationship Questionnaire (OMO). According to this questionnaire, patients were divided into 2 groups of behavior according to inclusion parameters:

Inclusion:

Ie - the desire to accept others so that they have an interest in me and take part in my activities; I actively strive to belong to different social groups and to be among people as much and as often as possible.

Iw - I try to get others to invite me to take part in their activities and strive to be in my company, even when I don't put any effort into it.

Group Ie is used competitive training, group Iw - cooperative.

[0024] The applicable game scenarios will be described below.

[0025] Game scenario "Kitchen".

The task of the patient is to prepare a dish according to one of the recipes chosen by him. The instructor in the script adjusts the difficulty level of the recipe, in accordance with the patient's own choice of a set of ingredients and their quantity, where 1-4 is the minimum value, 5-7 is the average value, 8 or more is the maximum value of the ingredients and their purchase list.

[0026] In the game scenario, training is carried out for range of motion in the joints of the arm and hand, coordination of movements, various types of reach (from English reaching), grips and manipulations with familiar household objects. The script is intended for the patient's adaptation to the everyday household environment and training of household skills.

Multiplayer scenarios.

1. Cooperation: Several patients are combined into a group according to the same level of complexity of the volume of the prescription, in accordance with the independent choice of each patient of the same set of ingredients and their quantity.

2. Competition: Patients perform several parallel tasks without seeing each other, but only the status with the percentage of other patients completing their tasks. Variants of tasks: set the table, prepare a dish according to the recipe.

3. Cooperation: Patients need to prepare meals on a pop-up order, simulating the work of a restaurant.

4. Competition: Imitation of a restaurant in which 2 chefs need to cook, the competitive process is how many orders each chef will have time to complete according to the cooking time.

5. Competition: Culinary duel combining shop scenario with cooking. First, food is collected, after food is collected, patients enter a single space (kitchen tables are arranged in a circle), after which patients cook, competing in speed with each other (in this scenario, patients will be able to observe each other and communicate).

[0027] Game scenario "Shop".

The scenario is a simulation of a trip to the store with training in finding objects from the shopping list, coordination of movements, movements in the large joints of the hands when taking products from the shelves and placing them in the basket, as well as various types of grip depending on the shape of the object, manipulating objects when scanning purchases on checkout. When approaching the checkout, the purchased products are placed on the tape by the patient. The patient needs to scan the products and put them into packages. Each product has a clearly visible large barcode. The scenario is part of the household and social adaptation program and is a precursor to the "Kitchen" scenario.

[0028] Game scenario "Tennis".

The scenario simulates a table tennis game with an opponent in the competition mode. For patients prone to cooperative mode, the training tasks will include hitting automatically generated balls, with the task of hitting the highlighted sector in the opposite half of the table. Automatic feeds are beaten off by patients one by one, with a single account management for two.

Multiplayer Scenarios

1. Cooperation: Joint search for products for a certain period of time, a basket and a shopping list can be shared by different patients to stimulate social interaction and joint actions.

2. Cooperation: One patient collects the purchases, the other patient scans them and sorts them into packages, depending on the type of products (for example, 3 different packages also with product pictures (paper boxes, iron cans, glass). The time allotted for sorting each product is limited (for example, 3, 5 and 7 seconds).

3. Competition: Patients collect the goods according to the list and scan the products for speed.

[0029] Game scenario "Towns".

The scenario imitates a game of gorodki. The motor tasks are both breaking figures by throwing a bat or ball, and preliminary drawing up figures. From the point of view of motor rehabilitation, the benefit of such a scenario is aimed at training the complex characteristics of motor actions and higher mental functions, which include: fine intermuscular coordination; performance of motor actions taking into account the spatial characteristics, shape and features of the objects to which the action is directed; programming and execution of a complex motor act; working memory training; concentration of attention.

Multiplayer Scenarios

1. Cooperation:

Patients play together, taking turns compiling with an independent choice of the size of the figures and their number, where 1-3 is the minimum value, 4-6 is the average value, 7 or more is the maximum value of the figures and breaking the figures. Before the start of the scenario, a goal is set that must be achieved together, while the goal can change daily (daily quest format):

• Score a certain number of points

• Knock out fully defined figures (actualizes the bonus roll, that is, the quality of the compiler's work)

• Complete the scenario in a limited time (arrangement + splitting).

2. Competition:

First, users build their figures. In the future, having received or not received bonus throws, they begin to knock out pieces in turn (2 attempts) for each. At the same time, they see the results of the opponent in real time.

[0030] Clinical example #1:

Patient A., 49 years old, had an ischemic CVD in the territory of the right middle cerebral artery (MCA). Prior to the start of rehabilitation measures, according to the OMO questionnaire, the type of interaction characteristic of the patient (Ie) was determined.

Patient K., aged 56, had a hemorrhagic type NMC in the right MCA territory. Prior to the start of rehabilitation measures, according to the OMO questionnaire, the type of interaction characteristic of the patient (Ie) was determined.

[0031] During the first calibration training session, before the start of training, to select their volume, patients were individually adjusted to the game parameters in accordance with motor capabilities. An assessment was made of the volume of movements in the hands, by performing them in different directions to the right, left, up and down, as well as the possibility of capturing by pressing the buttons on the controller. Arm range calibration: right arm - full range of motion in both patients. For patient A. left hand - 70% of the total range of motion; for patient K. left arm - 50% of the total range of motion. Both patients have no gross movement disorders; therefore, autocapture was not used.

[0032] In the "Tennis" scenario, the ball density for patients A. and K. is set to the left field, to initiate movements with the left hand. Ball speed in the Tennis scenario is set to 60% for both patients.

[0033] According to the results of the calibration training:

• The number of balls hit, which reflects the number of balls that the patient touched with the racket after serving, regardless of the subsequent trajectory of the ball, was 7 for patient A. and 6 for patient K;

• The number of successfully hit balls, representing the number of balls that the patient was able to hit and then touched the opposite side of the table, was 5 for patient A. and 4 for patient K.

[0034] The level of difficulty for training, in the form of the required number of successfully returned balls, was set at the average level (for patient A. 8 balls, for patient K. 6 balls). The initial time spent on this level of difficulty was 34 seconds for A. and K. 56 sec.

[0035] In the "Kitchen" scenario, when setting the difficulty level for the recipe, patient A. independently selected a set of 5 ingredients, and patient K. a set of 7 ingredients. According to the results of the calibration training, the difficulty level for the subsequent trainings of patients A. and K. was set to the average level (soup recipe). The initial time spent preparing the soup was 184 seconds for A. and K. 223 sec.

[0036] In the "Shop" scenario. According to the results of the calibration training, the difficulty level for subsequent training sessions for patients A. and K. was also set to the average value (shopping list of 6 products). The initial time spent on this level of difficulty was 210 seconds for A. and K. 250 sec.

[0037] In the "Towns" game scenario, when setting the difficulty level for the execution of the assembled figure, patient A. independently selected 4 figures, and patient K. 6 figures. The difficulty level for patients A. and K. was set for subsequent training at the intermediate level (5 simple figures to be assembled in the scenario).

[0038] According to the results of the calibration training, the correctness of the composition of the gorosh figure, reflecting the number of errors made as a result of drawing up the gorosh figure, was 2 out of 5 for patient A. and 1 out of 5 for patient K. The initial time spent on compiling the gorosh figure was 23 seconds for patient A. and 38 seconds for patient K.

[0039] These patients were assigned to multi-user training using virtual reality in a competitive mode, according to the type of interpersonal interactions. The training was carried out for 30 minutes once a day for 10 days. The patients were completely immersed in a common immersion virtual environment through the use of wireless portable virtual reality helmets, in which patients were present in one virtual training room and observed each other's virtual images, performing team exercises in the form of game scenarios.

[0040] The training included the following scenarios and modes: 1. Game scenario "kitchen" - Competition: Patients performed several parallel tasks without seeing each other, but only the status with the percentage of other patients completing their tasks. Task Options: Prepare a dish according to the recipe. 2. Game scenario "Tennis" - Competition: The scenario imitated a game of table tennis with an opponent. 3. Game scenario "Shop" - Competition: Patients collected goods according to the list and scanned the products for speed. 4. Game scenario "Towns" - Competition: First, users built their figures. In the future, having received or not received bonus throws, they began to knock out pieces in turn (2 attempts) for each. At the same time, we saw the results of the opponent in real time.

[0041] Both patients were tested on the Fugl-Meyer scale and Frenchy test for the upper limb before and after rehabilitation activities. In patient A., the total score on the Fugle-Meyer scale in the arm was 39 points, after rehabilitation it was 44 points; according to the French test before the rehabilitation course, 4 points, after 5. In patient K., the total score on the Fugle-Meyer scale in the hand was 28 points, after rehabilitation 37 points; according to the French test before the rehabilitation course, 4 points, after 5. The time spent on the implementation of the game scenario "kitchen" decreased by A. by 24 seconds. for K. by 24 sec., for the execution of the game scenario "Shop" decreased for A. by 80 for K. by 70, for the performance of the game scenario "Tennis" decreased for A. by 7 for K. by 11, and for the performance of the game scenario "Tennis" scenario "Towns" was 18 seconds for patient A. and 28 seconds for patient K.

[0042] This was judged as a successful completion of the training volume of the game scenarios and it was decided to further complicate the training volume to the maximum level.

[0043] Thus, it can be concluded that this method of motor rehabilitation has a positive effect on both general motor recovery and the recovery of household and sports skills. [0044] Clinical example #2:

Patient Ch., 39 years old, had an ischemic NMC in the territory of the left MCA. Prior to the start of rehabilitation measures, according to the OMO questionnaire, the type of interaction characteristic of the patient (Iw) was determined.

Patient S., aged 52, had an ischemic CVD in the territory of the left MCA. Prior to the start of rehabilitation measures, according to the OMO questionnaire, the type of interaction characteristic of the patient (Iw) was determined.

[0045] During the first calibration training session, before the start of training, to select their volume, patients were individually adjusted to the game parameters in accordance with motor capabilities. An assessment was made of the volume of movements in the hands, by performing them in different directions to the right, left, up and down, as well as the possibility of capturing by pressing the buttons on the controller. Calibration of the range of motion of the hands: for patient Ch. - the left hand is the full range of motion, the right hand is 50% of the total range of motion; for patient S. - the left hand is the full range of motion, the right hand is 60% of the total range of motion.

[0046] In the "Tennis" scenario, the ball density for patients C. and C. is set to the right field, to initiate movements with the right hand. Ball speed in the Tennis scenario is set to 50% for both patients.

[0047] According to the results of the calibration training:

• The number of hit balls, reflecting the number of balls that the patient touched with the racket after serving, regardless of the subsequent trajectory of the ball, was 4 for patient C. and 6 for patient C;

• The number of successfully hit balls, representing the number of balls that the patient was able to hit and then touched the opposite side of the table, was 2 for patient C and 5 for patient C.

[0048] The level of difficulty for training, in the form of the required number of successfully returned balls, was set to the minimum level for patient C. (0-3 balls) and to the average for patient C. (6 balls.). The initial time spent on this level of difficulty was 65 seconds for Ch. and 50 seconds for S.

[0049] In the "Kitchen" scenario, based on the results of the calibration training, the difficulty level for the subsequent training sessions of patients C. and S. was set to easy (juice recipe) and medium difficulty (salad recipe).

[0050] In the "Shop" scenario. Based on the results of the calibration training, the difficulty level for subsequent training sessions for patients C. and C. was set to the average value (shopping list of 7 products).

[0051] In the game scenario "Towns", according to the results of the calibration training, the correctness of drawing up the gorosh figure, reflecting the number of errors made as a result of drawing up the gorosh figure, was 1 out of 5 for patient C. and 2 out of 5 for patient C. The time spent on compiling the gorosh figure figure was 50 sec. for patient C. and 39 sec for patient C.

[0052] These patients were assigned to multi-user training using virtual reality in cooperation mode, according to the type of interpersonal interactions. The training was carried out for 30 minutes once a day for 5 days. The patients were completely immersed in a common immersion virtual environment through the use of wireless portable virtual reality helmets, in which patients were present in one virtual training room and observed each other's virtual images, performing team exercises in the form of game scenarios.

[0053] The training included the following scenarios and modes: 1. Game scenario "kitchen" - Cooperation: Several patients cook a dish according to a common recipe, distributing tasks among themselves (independently or with the help of an instructor). Separation of duties: one patient cuts food, and the second directly cooks: adds to the pan, salts / peppers (moreover, salt and pepper may be in the area of action of the second user and be required more than once), stirs with a spoon. 2. The game scenario "Tennis" - Cooperation: was carried out according to the scenarios of a single-user mode with the participation of an instructor-methodologist of exercise therapy. 3. Game scenario "Shop" - Cooperation: Joint search for products for a certain period of time, a basket and a shopping list can be in different patients to stimulate social interaction and joint actions. 4. Game scenario "Towns" - Cooperation: Patients play together, taking turns composing and breaking figures.

[0054] Both patients were tested on the Fugl-Meyer scale and Frenchy test for the upper limb before and after rehabilitation activities. In patient Ch., the total score on the Fugle-Meyer scale in the hand was 29 points, after rehabilitation 36 points; according to the French test before the rehabilitation course, 2 points, after 4. In patient S., the total score on the Fugle-Meyer scale in the hand was 33 points, after rehabilitation 38 points; according to the French test before the rehabilitation course 4 points, after 5.

[0055] The time spent on the execution of the game scenario "kitchen" was reduced by Ch. by 10 seconds. for S. by 18 sec., for the execution of the game scenario "Shop" decreased for Ch. by 15 sec. for S. by 11 sec., for the execution of the game scenario "Tennis" decreased for Ch. by 5 sec. for S. by 10 seconds, and it took 66 seconds for patient C. and 51 seconds for patient S to complete the game scenario "Gorodki".

[0056] This was judged as successful completion of the training volume of the game scenarios and it was decided to further complicate the training volume to the maximum.

[0057] Thus, it can be concluded that this technique of motor rehabilitation also favorably affects both general motor recovery and the recovery of household and sports skills.

[0058] Therefore, multi-user virtual reality systems have great potential in medical rehabilitation, especially in the third outpatient stage, when patient motivation comes to the fore for effective motor and cognitive recovery.

Claims (6)

A method for motor rehabilitation of neurological patients in virtual reality, including complete immersion of patients in a virtual environment through the use of wireless portable virtual reality helmets, characterized in that patients are immersed in a common immersion virtual environment in which several patients are present in a single virtual environment in the form of virtual avatars, perform team exercises through game scenarios that simulate adapted sports and everyday games in the form of a multi-user mode with cooperative interaction or a multi-user mode with competitive interaction, and in order to select the amount of training in the exercises of the game scenarios, before they begin, patients undergo a calibration training session, during which they perform assessment of the volume of movements in the hands by performing hand movements in different directions - to the right, left, up and down, as well as the ability to perform a grip by clamping the buttons on the controller, then, depending on the individual motor capabilities of the patient, the instructor in the scenario with gross motor disorders in the hand and the absence of the possibility of active flexion and extension of the fingers uses auto-capture, and in their absence, the patient performs squeezing and releasing the buttons on the controller independently; perform virtual reality training sessions in which patients perform one or more of the following exercises as part of a game scenario: hitting the ball, in which the instructor adjusts the trajectory of the ball in such a way that, to hit it, the patient pulls his hand to the area necessary for training, while calculating the number of hit balls, where 0-3 is the minimum value, 4-8 is the average value, 9 and more - the maximum value of batted balls; cooking a dish, in which, depending on the results of the calibration session, the instructor in the scenario adjusts the difficulty level for the execution of a recipe containing a given amount of ingredients, where 1-4 is the minimum value, 5-7 is the average value, 8 or more is the maximum value of the ingredients; assembling a figure, in which, depending on the patient's cognitive and motor abilities, the instructor adjusts the level of difficulty of performing the assembled figure in accordance with the patient's independent choice of the size of the figures and their number, where 1-3 is the minimum value, 4-6 is the average value, 7 or more - the maximum value of the figures that need to be assembled in the scenario, moreover, each game scenario is adjusted to the type of interaction characteristic of the patient, which is determined by testing on a questionnaire of interpersonal relations, namely, with the type of interaction Ie - the desire to accept others so that they have an interest in him and take part in his activities; actively strives to belong to different social groups and to be among people as much and as often as possible, they use a competitive mode of training, and with the Iw type of interaction, he tries to have others invite him to take part in their activities and strive to be in his society, even when he is not makes no effort to this, uses a cooperative training mode, while patients are immersed in a virtual space with a three-dimensional avatar display and tracking the amount of training performed in the exercises of game scenarios in a competitive or cooperative mode by assessing the movements of the hands, head, squeezing and unclenching fingers, the number of repulsed balls and throwing them in the areas most difficult to reach for the patient, determined during the calibration session, the level of difficulty in choosing recipes in accordance with the number of ingredients, the level of difficulty in choosing the size of the figures and their number, and the success of the volume of the training mode of the game scenario and the necessary the possibility of its complication is assessed by the time of its execution, and with a reduction in the execution time of the initial training volume relative to the initial one, as well as in relation to the training volume of other patients, its implementation is evaluated as successful and as a possibility of further complication of the training volume of the game scenario.