Rehabilitation Gaming System: Healing the Brain with Interactive Virtual Reality Systems

by Paul Verschure (@PaulVerschure )

Researchers discover a new approach and tested approach towards neurorehabilitation through the combination of art and science, stubbornness, perseverance, teamwork and FET.

In May 2002 the exhibition projectAda: Intelligent Space opened its doors at the Swiss national exhibition Expo.02. As project leader of this initiative I had managed a team of about 25 scientists and technicians over a period of about 3 years to turn an idea on an interactive neurally controlled sentient space into a turnkey application. The basic idea was derived from the, so called, RoBoser project where a robot controlled by a system level model of the brain, called Distributed Adaptive Control (DAC), composed music in interaction with its environment. RoBoser was developed in 1998 together with the Brazilian composer and mathematician Jonatas Manzolli.


ADA: the Intelligent Space 2002

Upon the invitation of the Expo organization to submit a proposal the notion seemed obvious: if an interacting robot could compose music, why not have a whole space compose a complex audio-visual composition in interaction with its visitors telling a story on the future confluence of biology, technology and humanity? The idea was a hard sell to the institution where I was working, for a number of reasons some petty and political others more fundamental such as the tendency of scientists to look at phenomena in terms of a fragmented set of atomic elements rather than a connected system further compounded with a deep distrust of presenting results to a general audience which, so the cliché goes, would not understand anyway. Indeed, most colleagues saw me ruin what was to be a scientific career by pursuing a flaky dream. We can see these negative attitudes as an expression of what Ortega y Gasset  has dubbed the barbarism of specialization. Anyway, despite an extremely tortuous organizational trajectory and tribal skirmishes, almost magically and based on a prolonged and dedicated effort of the research team and support from its sponsors, Ada saw the light of day on May 15, 2002 and over a period of 5 months over 500K people visited this unique and unprecedented synthetic organism. The impact of this autonomous sentient space on its visitors gave rise to what now has become the Rehabilitation Gaming System.

Among the many visitors to Ada were also people with different kinds of physical and mental handicaps. Their engagement with Ada was astonishing because it showed that Ada was highly intuitive and inclusive through its strongly implicit audio-visual modes of interaction. It was clear to me that this could be turned into a quality of life enhancing technology but we had our hands full on running Ada’s phenotype, the machinery of the neuronal control system and conducting experiments so this idea had to wait. After the successful termination of the Expo.02 exhibition, where Ada had provided the most bang for the buck (or SFr) as compared to most other exhibits, my goal was to develop a new research activity based on the Ada experience towards quality of life technologies with a focus on stroke and Alzheimer’s disease. A new idea and research line brings with it the usual scramble for resources, expertise, (clinical) partners and subjects. Above all the challenge is to pose the right questions and to follow them wherever they lead you, in order to turn an intuition into an application. Here the DAC theory of mind and brain played a key role. DAC, was first proposed in 1992 and has evolved in a mature theory with many applications. Its synthetic validation methodology goes back to Giambattista Vico whose epistemological principle was that we only understand what we can build. Hence, DAC advanced as a function of the artefacts we have created with it and studied such as Ada, the mobile robots Khepera, ePuck or the humanoid robot iCub.



This illustrates the notion that a scientific theory should not only explain and predict but also provide the ability to control. Hence, by moving to the domain of neurorehabilitation we could test this third criterion even further: can we have an impact on brain repair in the clinic on the basis of the hypotheses on fundamental principles of brain organization as captured in DAC? One would expect that with widely publicized boisterous claims of building a brain by 2020 as long as the money is provided, we should be in a good position to assist people in recovering function after stroke or other neuropathologies. Unfortunately, nothing is further from the truth: we have made very little progress over the last 50 years. In addition, with the ageing population we are pressed for generating effective solutions as opposed to hiding behind big claims. Hence, there is a critical role to be played by new technologies in building a dignified society. However, once one has decided on the technology, decisions on content must be made and here technology and methods are silent. Rather one needs ideas and/or a theory. RGS developed from combining the idea of interactive media, in particular virtual reality, for neurorehabilitation with the DAC theory of mind and brain. This decision was a key step because it made choices on the content of treatment protocols non-arbitrary and every intervention became a well defined interaction with a user from which lessons could be immediately drawn. By now RGS incorporates about 20 specific DAC derived principles that range from the key role of sensori-motor contingencies in organizing cognition and action to the importance of goal-oriented and error-driven intervention.

RGS at Vall dHebron2

RGS in use at Vall dHebron Hospital in Barcelona

RGS has advanced over the last 12 years via an extensive experimental agenda realized with dedicated partners in Barcelona. In order to support these experiments we have installed RGS therapy stations in associated hospitals, which are in continuous use. As a result, RGS has build up an unprecedented empirical track record having been tested in a wide range of conditions on over 500 patients at the acute and chronic stages of stroke including in at home settings. Building on these results we are now together with our clinical partners validating the generalization of RGS to other neuropathologies such as Parkinson’s disease, cerebral palsy, traumatic brain injury and spinal cord lesions and the initial analysis looks very encouraging.

Many of the users in our experiments have asked to be able to continue the RGS therapy. This demand combined with the clinical results that show that RGS is more effective than any other intervention available today, has lead to the creation of the spin-off company together with the University Pompeu Fabra and the Catalan Institute of Advanced Studies. Eodyne’s goal is to make RGS available to as many people as possible for a minimum cost. Starting a spin-off was a very interesting experience for the research team, because it showed that our objectives of large-scale low cost distribution to the world population of 60M stroke victims of a science based product was something only very few of the companies, managers, VCs and consultants we had to deal with could comprehend. Hence, Eodyne has entered the market under its own steam and pursues an organic growth path. This experience, however, raises questions and new challenges for the domain of impact investing and ethical entrepreneurship in the local European context where the business culture is of a very different quality than in the USA. It might be another opportunity for Europe to build its own model of business creation as opposed to following what we believe others do.

RGS has developed as a prototypical example of a FET project: visionary, disruptive, multi-disciplinary, high-risk and science based. It has received indirect support via the FET PRESENCCIA (FP6) and CEEDS (FP7) projects and direct support via the AAL instrument in the, so called, RGS project (FP7). Currently the RGS work on neglect is supported as part of the ERC advanced grant cDAC. It should be mentioned that within the health calls of the EC, RGS never fared well because it was usually reported by the reviewers to be too scientific, the idea of basing technology on basic principles appeared difficult to understand. This, however, is not a reason to change the approach we have taken. RGS is successful because of its inclusive science based and technology oriented multi-disciplinarity that sees societal impact as the objective of science. Indeed, RGS was born in the interaction between science and art that started with RoBoser and Ada and has continued with Re(per)curso, the Brain Orchestra and many more installations and exhibitions build by SPECS. In addition, RGS sets an example for the development and deployment of advanced neurorehabilitation technologies: First, ground it on solid science; second, perform the clinical studies; third, introduce it into society. I emphasize this structure because the norm is rather to spin a nice story to investors without much of a scientific and/or clinical grounding, a reprise of the bubble economy of the “new new thing” model of innovation. This might work on the very short term for those at the receiving end of the money stream but as scientists it is our duty to have specific societal impact not to fool the public and our sponsors with promises of the elixir of life. Rather given the science based approach behind RGS provided by DAC, we can envision a form of deductive medicine where scientific theories find validation in the clinic and the clinic in turn provides key insights in advancing our theories of mind and brain. DAC has through RGS closed this validation loop showing that a virtuous cycle between basic and applied research can be created and above all science can deliver on its promise to contribute to the creation of a dignified and inclusive society. RGS is only the beginning.

this blog was originally published in DAE blog on 17/02/2016

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