EMBEDDED ARTS FOR MOVEMENT RETRAININGLise Worthen-Chaudhari

DescriptionEmbedded Arts is an interactive computer program

designed as a rehabilitation biofeedback tool. The purpose of the system is to tap into artistic and creative neural pathways during performance of standard rehabilitation exercises. Using real-time data from biophysical sensors, the program integrates creative process within rehabilitation protocols by translating movement into art.

Purpose• “I wanted to enable patients to create fun,

individualized images that would be aesthetically and kinesthetically satisfying, but that would also represent a patient's personal movement and healing."

Hypothesis• Embedding interactive arts processes within

rehabilitation exercises may improve outcomes– Increasing gains in skill acquisition – Improving patient attention and compliance– Enhancing clinician tracking

http://www.youtube.com/watch?v=MABD7sYplkk

Therapy and Neurorehab

“This ability of our neural wiring to reroute when given the right stimuli can be a powerful agent for recovery and has, since the 1980s, emerged as the most promising phenomenon for facilitating neurorehabilitation.”

Nudo & Dancause (2007) in Brain Injury Medicine: Principles and Practices

Implicit Learning• Skill acquisition that occurs without awareness

or directed by no one on a conscious level (e.g. riding a bike, cooking by taste, playing chess, making medical diagnoses) Cleermans (2003)

• Once learned, implicit knowledge is hard to verbally articulate

• Critical for force regulation and memory

Implicit Learning• Implementations in rehabilitation– Amnesia Meulemans et al. (2003), Foerde (2010)

– Stroke Patton et al. (2004, 2005); Pohl et al. (2006); Boyd et al. (2010)

– Parkinson’s Witt et al. (2006)

• Examples– Robotics & video gaming Patton et al. (2004, 2005)

– Improvisational arts generation– Analog learning

Design Research• Asked the experts– Patients, artists, and clinicians – Feedback was iterative process of using the

program, getting feedback, implementing improvements (exploration within the exploration)

Design constraints• Action painting aesthetic

“…shifted the emphasis from the object [of art] to the struggle itself, with the finished painting being only the physical manifestation, a kind of residue, of the actual work of art, which was in the act or process of the painting’s creation.”

http://en.wikipedia.org/wiki/Action_painting

• Random aesthetic elements

Design phase results• Practical setup, operation, maintenance required (fast, easy,

inexpensive for telerehabilitation)

• Output appropriate for large format in gallery showing

• Dancers suggested explicit use instructions; patients tended to figure out for themselves.

• Artists more logical/pragmatic; clinicians more artistic.

Summary• Interactive arts technologies enhance standard

rehabilitation• Embedding creative process within rehabilitation may

improve outcomes • Outputting artistic work from rehabilitation exercises adds

economic element to rehabilitation endeavors• Motion capture data transformed for feedback and recorded

for quantitative outcomes analysis in the clinic and home health settings

• Artistic nature of personal movement in a rehabilitation setting is explored

ConclusionIn the rehabilitation paradigm, movement is

medicine. In the dance paradigm, movement is art. Often, a single movement can be both. Perhaps, through the phenomemon of movement, the arts and medicine are more interdependent than we previously imagined.

Worthen-Chaudhari (in press) New Partnerships Between Dance and Neuroscience: Embedding the Arts for Neurorecovery, Dance Research Journal

Future developments

• Study the effectiveness of Embedded Arts programs

• Implement programs found to be feasible and effective (Dodd Hospital - all floors)

http://www.youtube.com/watch?v=MABD7sYplkk

Acknowledgements

• This project has been partially funded by The OSU College of the Arts, Department of Dance and Department of Physical Medicine and Rehabilitation

• Special thanks to: Helen Alkire, Brad Burns, Chuck Crosby, John Griffith, Ashley Hahn, Joseph F. Kuspan, Jill Sarina, Aaron Wolfe (artists), Professors Michael Kelly Bruce, David Covey, Susan Petry (Dance), D. Michele Basso (Allied Health), Sharon K. McDowell, Jerry Mysiw (PM&R), the staff of the OSUMC NeuroRecovery Network and Stroke Inpatient clinics, my extended family, my children and my husband, Ajit Chaudhari.

Rehabilitation Improvisations

ReferencesBoyd LA, Quaney BM, Pohl PS, Winstein CJ. Learning implicitly: effects of task and severity after stroke.

Neurorehabil Neural Repair 21: pp.444–454, 2007.Brewer B, McDowell SK, Worthen-Chaudhari LC. Post-stroke upper extremity rehabilitation: a review of

robotic systems and clinical results. Topics in Stroke Rehab 14(6): pp. 22-44, 2007. Cleeremans A. Implicit learning. In: Nadel L, ed. Encyclopedia of Cognitive Science. London: Nature

Publishing Group, 2003.Foerde K. Implicit Learning and Memory: Psychological and Neural Aspects. Encyclopedia of Behavioral

Neuroscience, pp. 84-93, 2010.Job Accommodation Network by the Office of Disability Employment Policy, “Network Fact Sheet

Series: Self employment for artists with disabilities”, viewed February 11, 2010 <www.jan.wvu.edu/entre/pubs/Entre_Artists.doc>.

Meulemans T, Van der Linden M. Implicit learning of complex information in amnesia. Brain and Cognition 52(2), pp. 250-257, 2003.

Patton JL, Mussa-Ivaldi FA. Robot-assisted adaptive training: custom force fields for teaching movement patterns. IEEE Trans Biomed Eng. 51: pp. 636–646, 2004.

Patton JL, Stoykov ME, Kovic M, Mussa-Ivaldi FA. Evaluation of robotic training forces that either enhance or reduce error in chronic hemiparetic stroke survivors. Exp Br Res 168 (3): pp.363-383, 2005.

ReferencesPohl PS, McDowd JM, Filion D, Richards LG, Stiers W. Implicit learning of a motor skill after mild and

moderate stroke. Clin Rehabil.20: pp.246–253, 2006.Thaut MH, McIntosh GC, Rice RR, Miller RA. Rhythmic auditory stimulation in gait training for

parkinson’s disease patients. Movement Disorders 11(2): pp.193-200, 2004.The New York Times, “Learning his body; learning to dance”, viewed February 11, 2010

<http://www.nytimes.com/2009/11/25/arts/dance/25palsy.html>.Whitall J, Waller SM, Silver KHC, Macko RF. Repetitive bilateral arm training with rhythmic auditory

cueing improves motor function in chronic hemiparetic stroke. Stroke 31: pp. 2390-2395, 2000.Witt K, Daniels C, Daniel V, Schmitt-Eliassen J, Volkmann J, Deuschle G. Patients with Prkinson’s

disease learn to control complex systems – an indication for intact implicit cognitive skill learning. Neuropsychologia 44(12), pp. 2445-2451, 2006.

Yadev V, Schmiedeler J, McDowell SK, Worthen-Chaudhari LC. Quantifying age-related differences in human reaching while interacting with a rehabilitation robotic device, Journal of Applied Biomechanics and Bionics accepted 2010.