USF recently acquired the CAREN virtual reality system, a powerful tool that helps people with disabilities increase their independence and reintegrate into the community

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When you see the Computer Assisted Rehabilitation Environment system (CAREN) in action, the room-sized simulator resembles a giant video game, complete with avatars. Scenes projected on its 180-degree screen range from walking through a forest to driving past cityscapes to riding on a wave-tossed boat.

The three-dimensional virtual reality system engages and entertains – but its purpose is serious.

The system’s immersive environment and interactive gaming elements safely challenge people to learn new strategies for coping with changes in their balance, coordination or mobility caused by disability, traumatic injury or aging.  The advanced technology also gives researchers the scientific tools they need to advance the diagnosis and treatment of musculoskeletal and neurological disorders.

Watch time-lapse video of CAREN’s installation:

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Supported by a $450,000 National Science Foundation (NSF) grant, the University of South Florida recently became the first non-Department of Defense institution in the United States to obtain the CAREN extended model for research and rehabilitation, said William S. Quillen, DPT, PhD, associate dean of the USF Health Morsani College of Medicine and director of the School of Physical Therapy & Rehabilitation Sciences. Additional matching funds from colleges and schools across USF also helped purchase the approximately $1 million simulator

“The CAREN system will be a critical part of the university’s neuromusculoskeletal, traumatic brain injury and post-traumatic stress disorder research initiatives involving wounded warriors, warfighters and student veterans,” Dr. Quillen said. “The system will greatly facilitate our ongoing interdisciplinary research to analyze human mobility and function and to improve the quality of life for people with disabilities by increasing their independence and community reintegration.”

USF purchased the CAREN system with the support of grant from the National Science Foundation.

Integrated technologies add research and rehabilitation value

“This system integrates a lot of technologies typically used individually — like a split belt treadmill with force-sensing plates, a moveable base and motion capture analysis — to really help us better understand how an individual walks and moves in different terrains and environments,” said Kyle Reed, PhD, assistant professor of mechanical engineering in the College of Engineering.

The CAREN project will bring together more than 20 investigators with expertise in rehabilitation engineering and science from the colleges of Engineering, Medicine’s School Physical Therapy & Rehabilitation Sciences, Arts and Sciences, Behavioral and Community Sciences, Nursing, and Virtual and Performing Arts.  They will collaborate with researchers from James A. Haley Veterans’ Hospital and Draper Laboratories.

L to R: Seok Hun Kim, PT, PhD, of the USF School of Physical Therapay & Rehabilitation Sciences, with Kyle Reed, PhD, and Stephanie Carey, PhD, of the College of Engineering, look at the incoming information instantaneously displayed on CAREN’s control panel.

The system bridges the gap between the controlled environment of a laboratory or clinical rehabilitation setting and the uncontrolled community environments experienced in daily life.

“CAREN gives us a lot of opportunities to create variable scenarios that are closest to real-life environments,” said Seok Hun Kim, PT, PhD, assistant professor in the School of Physical Therapy & Rehabilitation Sciences.

Dr. Kim works with patients living with stroke, ataxia and other neurological disorders that significantly increase the risk for falls. “We can gradually increase the level of difficulty of the exercises based on patients’ performance using the CAREN system.  This allows patients to safely push their limits while working to regain balance control,” he said.

Dr. Carey secures the safety harness attached to Gordon Beadle before he begins a simulation exercise to try out his new prosthetic leg.

Gait analysis demo:  Strolling down a virtual path

During a recent demonstration in the USF Center for Assistive, Rehabilitation & Robotics Technology, Gordon “Skip” Beadle stood on CAREN’s platform safely secured in a harness suspended from a rigid frame attached to the platform.

The 71-year-old Vietnam veteran was there to try out a simulation exercise wearing his new prosthetic leg with a microprocessor-controlled knee and ankle, designed to more closely mimic natural gait.  Beadle lost his right leg in 1965 while his Marine infantry was clearing landmines as the unit advanced toward Chu Lai airbase north of South Vietnam.

Stephanie Carey, PhD, assistant research professor of mechanical engineering, leaned toward the simulator’s control panel, preparing to adjust settings and monitor the incoming data as Beadle began walking.  Jason Highsmith, DPT, PhD, CPO, associate professor in the USF School of Physical Therapy & Rehabilitation Sciences, watched from the side as the treadmill began.

The simulator’s integrated techologies, including the split-belt treadmill and motion capture system, provide real-time information to analyze gait.

As birds chirped through the surround-sound system, Beadle began his simulated stroll along a winding cobblestone path through the forest at a slow, steady pace.  Some bumps in the terrain were introduced by CAREN’s motion platform, and the treadmill’s speed gradually increased as Beadle picked up his pace when a cottage, the finish line, came into view ahead on the screen.

Dozens of reflective sensors on Beadle’s lower body detected by high-speed, infrared cameras tracked his every step and instantaneously relayed the information to the computer software overseen by Dr. Carey.

The CAREN project investigators eventually hope to work with virtual designers to recreate the terrain of the USF Tampa campus or downtown Tampa.

Engineering and scientific methods improve functional recovery

The immersive system precisely measures and integrates a variety of data valuable to researchers and therapists — including which muscles are working at any given time, length of stride, weight bearing distribution, and how an individual’s joints move and the amount of force placed on them.

The information can be used, for instance, to analyze and correct the asymmetric gait of patients recovering from stroke, to test and improve prosthetics for lower-limb amputees, and to design assistive devices such as orthotic shoes, crutches or canes that help users walk more efficiently without tiring easily.

The system, working in concert with a therapist, could also help desensitize those suffering from post-traumatic stress disorder by having them virtually re-experience situations that provoke anxiety in carefully controlled stages.

Beadle said the system’s safety harness significantly reduced his fear of falling.

The CAREN project investigators eventually hope to work with virtual designers to recreate the terrain of the USF campus or downtown Tampa for study participants or patients, Dr. Reed said.

“We’re just beginning to use the system for studies,” he said. “We expect in the next year or two we will have lots of results that can both help researchers at other universities and make life better for people with strokes, amputations, spinal cord injuries and other physical limitations.”

Pushing limits helps increase confidence, physical abilities

One of CAREN’s advantages is that patients feel protected by the safety harness that will quickly catch them if they begin to fall, so they become more comfortable stepping up their performance when challenged with new or more complex tasks – like negotiating a steeper incline, walking on an increasingly uneven surface, or maintaining balance while the ground beneath tilts to the right and left.

L to R: Jason Highsmith, DPT, PhD, School of Physical Therapy & Rehabilitation Sciences; Kyle Reed, PhD, College of Engineering; Dimitrios Menychtas, biomedical engineering doctoral student; Seok Hun Kim, PT, PhD; Physical Therapy & Rehabilitation Sciences; and Stephanie Carey, PhD, College of Engineering.

The safety feature definitely lessened his fear of falling, Beadle said when he finished the forest path exercise. “I can see where this type of therapy for someone just beginning to use a prosthesis would be beneficial in teaching balance and building confidence at the same time.”

CAREN allows therapists working with the system operators to gradually introduce obstacles that may be even more difficult than what patients would encounter in everyday life, Dr. Reed said.  “So, when they do face some small stairs or a street curb in a real-life situation, they can potentially say ‘I can handle that.  I’ve seen much bigger ones in the simulator system.’”

The NSF-funded project for USF’s CAREN virtual reality system is directed by principal investigators Rajiv Dubey, PhD, Sudeep Sakar, PhD, and Dr. Reed, College of Engineering; Dr. Quillen, School of Physical Therapy & Rehabilitation Sciences; and  David Diamond, PhD, College of Arts and Sciences and James A. Haley Veterans’ Hospital.

The simulation system mimics real-life environments. So, for instance, if the boat on video screen tilts left the ground beneath the person tilts left.

Video and photos by Eric Younghans, USF Health Communications

]]> https://hscweb3.hsc.usf.edu/blog/2013/07/01/usf-prosthetic-research-with-wounded-warriors-may-also-benefit-civilian-amputees/ Mon, 01 Jul 2013 13:45:19 +0000 https://hscweb3.hsc.usf.edu/?p=8113 The Department of Defense study is testing how well multifunctional prosthetic feet work for rigorous, agile maneuvers soldiers must perform on the battlefield

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The Department of Defense study is testing how well multifunctional prosthetic feet work for rigorous, agile maneuvers soldiers must perform on the battlefield

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Whenever he leaves for the airport on vacation, Joshua Sparling carries along a bag full of legs and feet.  There are different prosthetic components for running, others for swimming, bicycling or golfing, and yet another for everyday walking.

Sparling, 31, who lost his right leg to an improvised explosive device (IED) while serving as an Army sergeant in Iraq in 2005, has experienced the discomfort of prostheses not particularly well suited for his high-intensity athletic endeavors. So he was enthusiastic about enrolling in a U.S. Department of Defense-funded study at the University of South Florida School of Physical Therapy and Rehabilitation Sciences – traveling from Michigan to Florida to participate in the research.

The project is evaluating how well different multi-functional prosthetic feet work for rigorous and agile maneuvers soldiers must perform on the battlefield – from running and jumping to dodging, crawling and climbing.

The advanced prosthetic research involving military amputees may ultimately benefit civilian amputees with physically challenging occupations or recreational pursuits, such as firefighters, police officers, construction workers, triathletes, marathon runners or rock climbers.

“Our findings will have implications not only for the rehabilitation of soldiers who seek to stay on active duty, but also for civilians with amputations who want to participate in activities at a more intense level,” said Jason Highsmith, PhD, DPT, the USF Health assistant professor of physical therapy leading the study.  The knowledge researchers gain from evaluating high-end prostheses that can help soldiers move more efficiently across war zone terrain can also be applied to developing prosthetics “for common movements like walking or jogging at a comfortable pace,” he added.  

Army Staff Sgt. Brian Beem, a partcipant in the DOD-supported prosthetic research study, hoists himself over one of the many obstacles at the Walter C. Heinreich training site.

Beem races agains the clock to finish a course that pushed participants to complete the same physically-demanding maneuvers soldiers must perform on the battlefield.

The USF researchers enrolled 28 physically fit people in the DOD double-blind randomized trial. Half are soldiers and veterans who wear prostheses for below-the-knee amputations, the most common kind of lower limb loss. The other half are non-amputees from the local law enforcement SWAT team.

This spring, the military amputees were evaluated wearing each of three different commercially-available high-tech prostheses. The study participants were tested in USF’s Human Functional Performance Laboratory, where they walked and ran on treadmills while researchers measured performance parameters, including range of joint motion, prosthetic foot power, oxygen consumed and energy expended. At the Hillsborough County Sheriff’s Office training facility, the researchers evaluated obstacle course completion times, heart rates and perceived difficulty of performing such tactical maneuvers as charging up inclines, climbing ropes and slalom running requiring a combination of speed, agility and balance. Each participant was asked to rate the preferred prosthetic foot – both in the lab and in the field.

Non-amputees are presently completing the same testing. Researchers will compare the physical performance of the amputee group to the non-amputee control group, with the aim of identifying which prosthetic foot may be best suited for military applications.  They expect to have results by the end of this year.

Jason Highsmith (left), PhD, DPT, assistant professor of physical therapy leading the DOD study, adjusts the oxygen mask of Joshua Sparling.

In the USF School of Physical Therapy and Rehabilitation Sciences Human Functional Performance Laboratory, study participant Sparling, wearing one of the hi-tech prosthetic feet being tested, runs on a split-belt treadmill as researchers monitor his gait and various performance indicators.

Scientifically determining which prosthesis comes closest to an anatomic foot when performing battlefield maneuvers is important, Highsmith said, because a person with an amputation uses more energy than someone with a natural foot for comparable movements at the same speed.

USF’s prosthetic research has the potential to transform the lives of a growing number of young wounded warriors, like Army Staff Sgt. Brian Beem, by giving them the option of returning to active service – possibly even the war zone – if they desire and can perform the functions required by the job.

While deployed in Iraq in 2006, Beem, 35, lost his right leg below the knee following a roadside blast that claimed the life of a fellow soldier and friend.  Despite the injury, he re-enlisted for the third time November 2011 at Forward Operating Base in Frontenac Afghanistan and continued to serve his country with other Calvary scouts.  Beem, who calls himself a “career soldier,” now tests night-vision goggles, scopes and other devices at the Army’s Research and Development Center in Fort Belvoir, VA.

“I take it as a badge of pride that at one place I worked it took three months for my boss to figure out I was an amputee,” Beem said.  “It’s easy to forget you’re ‘disabled’ when the technology we have now can make the prosthesis comparable to a fully functioning foot.”

Sparling is impressed with the latest-generation prosthetics he’s been asked to help evaluate – all integrating varying degrees of rotational, shock-absorbing and energy-returning characteristics. “The advances made to this point have been pretty amazing,” he said.  “Nothing leads me to think it won’t get even better.”

Dr. Highsmith specializes in research to improve prosthetic options for those who lose limbs from traumatic injury or diseases – including soldiers and veterans reintegrating into society. He works with USF physical therapy and engineering colleagues.

USF’s Highsmith is equally impressed with the wounded warriors and veterans like Beem and Sparling who volunteered for the DOD study and push themselves to perform at levels comparable to SWAT team members without amputations.

“They’re extremely inspirational,” he said. “They’ve left parts of their bodies overseas defending our freedom… It’s personally rewarding to spend time with these heroes, hear their stories, contribute in some way to their ongoing rehabilitation, and, hopefully, we’ll find out which prosthesis works best so they can continue to stretch their limits.”

Brian Beem

Joshua Sparling

Video by Allyn DiVito, USF Health Information Systems, and photos by Eric Younghans, USF Health Communications

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Army Sgt. Danny Swank’s lower right leg was amputated following dozens of surgeries to try to save the limb severely damaged when a grenade exploded inside his Humvee in Kandahar, Afghanistan. Joe Hutchinson’s lower leg was blown off by a roadside bomb when he served as a soldier in the Iraq War.

Both veterans participate in USF studies seeking to improve the quality of lives of combat wounded warriors through better prosthetics. The USF School of Physical Therapy & Rehabilitation Sciences specializes in research to improve prosthetic options for those who lose limbs from traumatic injury or diseases – including soldiers and veterans reintegrating into society.

Combat veteran Joseph Hutchinson, wearing an advanced knee prosthetic designed to more smoothly mimic a natural gait, walks up and down stairs.

With the help of Swank and Hutchinson, the school recently offered a behind-the-scenes look at its programs and research to help amputees resume leading active lives, including engaging in rigorous athletics or returning to the workforce, school or active duty.  The Walk With a Warrior event was hosted by William S. Quillen, PT, DPT, PhD, FACSM, associate dean and director of the USF School of Physical Therapy & Rehabilitation Sciences.  Attendees included former enlisted members of Air Force, Marine Corps and Navy as well as representatives from foundations supporting veterans and the Greater Tampa Chamber of Commerce Military Affairs Council.

“Our goal is to do our best to maximize the function of prostheses, whether they are used for athletic pursuits like running, cycling and aquatics or activities of daily living,” said Jason Highsmith, PT, DPT, CP assistant professor of physical therapy.

Jason Highsmith (center), assistant professor at the USF School of Physical Therapy & Rehabilitation Sciences, explains some of the school’s advanced prosthetics research.

Hutchinson participated in USF’s study comparing the effectiveness of two microprocessor-controlled prosthetic knees — the gold standard C-Leg® and the new Genium knee joint, designed to more closely mimic natural gait. The study was funded by the Florida High-Tech Corridor and manufacturer Otto Bock. The study was funded by the Florida High-Tech Corridor and manufacturer Otto Bock.

During the event, Hutchinson demonstrated the climbing and descending stairs with the Genium knee he wears, while Highsmith explained how the prosthetic knee’s biotechnology responds to environmental inputs to make motion more intuitive.

“The microprocessor knee is figuring out what Joe wants to do next,” Highsmith said. “Based on analysis of the speed and angles of his movements, the technology senses he’s about to go down the stairs, so the motion of the prosthetic slows accordingly.”  .

An upcoming Department of Defense-funded randomized trial led by Highsmith will evaluate which of three different types of high-tech multifunctional prosthetic feet are best for highly mobile soldiers and veterans with below-the-knee amputations.

William S. Quillen, DPT, director of the USF School of Physical Therapy & Rehabilitation Sciences, presented an overview of the school’s applied research projects to representatives of military and veterans organizations.

Swank, training to scale Africa’s Mt. Kilimanjaro with several other combat-wounded veterans in January, plans to enroll in the study.

“This study could benefit guys who want to return to active duty by fitting them with prostheses that help them do their job as well as before” they lost limbs,” Swank said.

That includes young amputee soldiers who want the option of returning to the battlefield.

As they work on determining which prosthesis comes closest to a real foot in performing high-intensity tactical maneuvers like running, jumping, climbing and crawling, Highsmith emphasizes that the research has applications for civilians as well.

The same knowledge used to develop a prosthetic that can help soldiers more efficiently maneuver across war zone terrain can be applied to people who want to move better in their own homes and work environments, or remain competitive in sports they enjoy, he said.

Faculty members at the USF School of Physical Therapy & Rehabilitation Sciences have attracted more than $3 million in funding from federal agencies, the state, and industry partners  The state of Florida recently provided $500,000 of recurring funding to support a comprehensive range of interdisciplinary research in prosthetics and orthotics optimization, musculoskeletal disorders, traumatic brain injury, and balance and movement disorders.

Story by Anne DeLotto Baier, and photos by Eric Younghans, USF Health Communications