The Virtual Occupational Therapy Assistant (VOTA) will enable stroke patients to practice activities of daily living (ADLs) as part of an in-patient, skilled nursing, outpatient, home health, and/or teletherapy rehabilitation program. The system leverages low-cost human motion tracking, advanced kinematic pose estimation algorithms, and state-of-the-art game engine technology to create a compelling world in which patients can perform realistic virtual ADLs that challenge both motor and cognitive function. The system's advanced human motion tracking capabilities enable automatic generation of performance metrics, supporting both user feedback and remote monitoring of user status by providers. VOTA also comprises an OT Dashboard that lets therapists track progress, plan activities, and interact with patients. Problem to be addressed: VOTA provides a tool for upper extremity (UE) rehabilitation, potentially benefiting approximately three quarters of a million individuals in the United States who are affected by stroke each year. VOTA addresses critical challenges of: (1) improving outcomes by enabling increased dosage and intensity in physical practice, and promoting cortical reorganization based on physical practice and mental imagery;(2) reducing costs by decreasing the time and expense associated with patient/therapist travel;and (3) providing services to remote and underserved areas. Long-Term Goal: Improve stroke rehabilitation outcomes through effective and efficient delivery of care. Phase I Results: Phase I produced a VOTA prototype application that includes a compelling virtual world, two virtual ADL activities, and automated generation of motor and cognitive metrics. A pilot study was conducted at the University of Virginia-HealthSouth Rehabilitation Hospital in Charlottesville, VA that involved 10 stroke patients. Analysis confirmed the primary Phase I hypothesis that VOTA-generated metrics correlate significantly with accepted measures of UE motor function. Subjective inquiry through patient interviews and questionnaires strongly supports acceptance of VOTA by stroke survivors for clinical or home health use. Phase II Summary: In the proposed Phase II SBIR effort, the team will develop a VOTA application suitable for use as a stroke intervention, demonstrate the efficacy of virtual ADL therapy for UE motor recovery, and establish the usability of the VOTA system by patients and providers. Development will include an expanded breadth and depth of virtual activities, provider tools for patient monitoring and planning, activity authoring tools, improved motion tracking, and teletherapy interfaces. The effort will culminate in randomized, controlled trials to investigate VOTA efficacy, as measured by improvement in standardized assessment scores. Commercial Opportunity: Barron Associates, Inc. is uniquely positioned to rapidly commercialize this technology. Participation by HealthSouth, the nation's largest provider of rehabilitative healthcare services, provides a springboard for the introduction of VOTA therapy in clinical, home health, and teletherapy settings.

Public Health Relevance

The Virtual Occupational Therapy Assistant (VOTA) is a virtual world-based rehabilitation system that will enable functional practice of activities of daiy living through a standard personal computer and an off-the-shelf motion tracking sensor. The proposed Phase II SBIR research addresses important public health concerns by: (1) improving stroke outcomes by enabling increased frequency and intensity of practice;(2) promoting cortical reorganization through combined physical practice and mental imagery;(3) providing reliable tracking mechanisms for patient activity and functional status;(4) increasing access to remote and underserved areas;and (5) controlling cost by reducing patient/therapist travel expenses.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Business Innovation Research Grants (SBIR) - Phase II (R44)
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Special Emphasis Panel (ZRG1)
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Quatrano, Louis A
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Barron Associates, Inc.
United States
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Adams, Richard J; Lichter, Matthew D; Ellington, Allison et al. (2018) Virtual Activities of Daily Living for Recovery of Upper Extremity Motor Function. IEEE Trans Neural Syst Rehabil Eng 26:252-260
Ellington, Allison; Adams, Richard; White, Marga et al. (2015) Behavioral intention to use a virtual instrumental activities of daily living system among people with stroke. Am J Occup Ther 69:6903290030p1-8
Adams, Richard J; Lichter, Matthew D; Krepkovich, Eileen T et al. (2015) Assessing upper extremity motor function in practice of virtual activities of daily living. IEEE Trans Neural Syst Rehabil Eng 23:287-96