Virtualis PDF

Virtualis Equipment 1. Motion Platform – where the patient stands for most of the therapies 2. Base Stations – make sure the headset is always in view of the base stations to ensure smooth video for the pt 3. Headset – used for all modules that aren’t on the TV 4. Vive Controllers – ne...

Virtualis Equipment 1. Motion Platform – where the patient stands for most of the therapies 2. Base Stations – make sure the headset is always in view of the base stations to ensure smooth video for the pt 3. Headset – used for all modules that aren’t on the TV 4. Vive Controllers – needed for certain modules 5. Trackers – if pt can’t hold controller, or for feet 6. Xbox Controller – needed for Ocular Tilt module General Instructions 1. Turn on motion platform (it will go up then down), then turn on computer 2. Let Vive Console start first, steamVR will load automatically. If it does not start open Vive Console 3. Do a room calibration with goggles on the platform, “Standing Only” set Calibrate Floor to 8 inches 4. Turn on Virtualis software, PW: Norcalbraincenter1. 5. To shutdown, exit the Vive console, shut down the platform and computer Using the Program 1. Once logged in create a new patient or choose an existing patient 2. When creating a new patient put their Last Name, First Name, Height, Birthdate, and Sex 3. Click “Start a Session” to select a module to use 4. Quick Hotkeys ◦ C: Center the patient’s vision ◦ Start/pause session: Spacebar ◦ Finish: Enter ◦ Quit: ESC Patient Setup Headset 1. Have the patient seated comfortably in the middle of the room – make sure base stations can see the headset 2. Put the front of the headset on the patient’s eyes and ask them to hold them comfortably. If the patient is touching the front of the headset at any time the goggles will go black 3. Tighten the back knob until it is comfortable and snug Motion Platform 1. Have the patient stand on the motion platform and close the door 2. Position the feet shoulder distance apart with the lateral malleolus on the horizontal line 3. Have the patient crouch down or stand up tall to put the headset on them Bell’s Test Purpose: Testing hemi-spatial awareness/unilateral neglect Patient: Seated initially, standing for more difficulty w/ aVive controller Settings: ◦ Distance – Closer is harder and targets are closer, further is easier and targets are further ◦ Environment – increases difficulty and challenges visual processing Instructions: We will be testing your ability to scan the environment. First you will see a practice screen. You will see a lot of objects. Squeeze the triggers to hit all the bells. Tips: Use as assessment, or a full field environment scanning stimulus. Can tell pt to keep head still and only use eyes to hit the bells on the weaker side. Use in conjunction with sidedness on NSI Electrical Track Purpose: UE movement and motor control Patient: Seated w/ headset, leap motion and 1-2 controllers Settings: ◦ Trackers – If using trackers, select on ◦ Position – Change depending on pt position ◦ Activate the Mirror – most important setting. Turning on will visually show the left hand moving when the right hand is moving, and vice versa ◦ Route – Line is suited for one hand to move and visualize, waves can use both hands ◦ Radius – Increase/decrease depending on pt difficulty ◦ Hide motor controller – Makes the mirror more effective, always select Instructions: Take the controller (or hand) and move your hand through the pipe without touching the pipe. (once they are used to it do Mirror). Now look at the opposite hand, and really believe that this is the opposite hand. Look at the opposite hand while you move your normal hand through the pipe. Tips: Adjust difficulty up/down as needed. You want to make it challenging for the patient but not too challenging or they will get frustrated. If it’s too easy they will get bored. Head-Eye Coordination Purpose: HEVM, cervical proprioception, x0 Patient: Seated initially, can progress to standing Settings: ◦ Shapes – Start off with simple line, then as they warm up progress to whatever shape you want. I typically only do lines and lemniscates ◦ ROM – This increases the shape distance. Increase/decrease as needed depending on what the patient can do, and their difficulty level ◦ Speed – Start slow, you want good smooth movements instead of choppiness. As they improve increase speed if they are maintaining smoothness ◦ Reticle Size – Changes the size of the circle. Increase/decrease as needed to patient tolerance, try to keep as challenging as possible Instructions: The circle in the middle of vision moves with your head. Try to keep the circle on top of the planet as much as you can, keeping your head moving as smoothly as possible Mirror Purpose: Mirror-box therapy, chronic pain, neglects Patient: Seated w/ headset, leap motion Settings: ◦ Motor Hand – Choose the good hand ◦ Patient Position – Seated to make easier ◦ Hand Color – Choose color closest to patient to make more realistic. ◦ Hand Size – Set to as close to the patient’s hand size as possible. ◦ Activate Mirror – Turn on to make both hands move like the dominant hand ◦ Freeze Motor Hand – Makes it more realistic by having only the non motor hand move ◦ Hide Motor Hand – Hides the moving hand, progression from Freeze Instructions: Hold the hands in front of you. Do simple movements such as figure 8, finger tapping, or any other movement while looking at the non motor hand. Pretend that you are moving the non motor hand and that the problem hand is actually doing all of these movements. Motion Program Purpose: Postural reflexes, balance Patient: Standing on platform, with or without headset Settings: ◦ Screen mode – Turn on if not using headset. I prefer this on ◦ Mode – Tilt is a slow movement of the platform, impulsions is a fast jerking movement. Always start with tilts as a warmup then as patient improves and gets bored go to impulsions ◦ Max Tilt angle – Will make the platform tilt more or less. Increase/decrease to make it more challenging ◦ Tilt duration – How long the platform takes to reach the tilt. Increasing will make easier, decreasing will be more challenging ◦ Sustain duration – How long the platform holds the tilt. Increasing will make easier, decreasing will be more challenging ◦ Pause duration – How long in between tilts. Increasing is easier, decreasing is difficult ◦ Movements – You can change these directions based on pt findings. You can make them move more in a direction that is more difficult for them or to bias a weak canal. ◦ Platform Difficulty – Can increase up to 100% to make the platform move more. Instructions: Stand on the balance platform and don’t move your feet. You are the ball and you want to keep the ball in the circle at all times. Do not bend at your waist, hips, or knees – keep your entire body straight at all times and move through your ankles. The platform will move but keep the ball inside of the circle. Optical Flow Purpose: Visual flow, divergence, downregulating visual system, habituation Patient: Seated for gentle stimulation, standing on motion platform for advanced movements Settings: ◦ Speed – A negative number will lead to posterior translation, positive will lead to anterior translation ◦ Rotation – Positive will turn the environment clockwise, negative is counterclockwise ◦ Fixed Spot – Gives a point of fixation, can be bigger or smaller. Used for sensitive patients or if you just want background flow ◦ Advanced settings – Click on direction of movement and the platform will move and make you feel like you are falling in that direction. When using this warn the patients and you may want them to hold onto the bars ◦ Platform Difficulty – Can increase up to 100% to make the platform move more. Instructions: Look straight ahead at the tunnel/at the target. You will feel the environment moving around you and/or the platform moving. If you feel dizzy/nauseous let me know and we can stop. Optokinetic Purpose: OPK/visual flow training, downregulating visual system Patient: Seated or standing on motion platform Settings: ◦ Environment – Grey wall for close obvious stimulation, stars for long distance gentle stimulation. I prefer stars ◦ Speed – Negative number goes backwards, positive number is forwards ◦ Orientation – The default is left (-) and right (+). Move the horizontal orientation to a degree to match your angle. If you want up (-) and down (+) you would change to 90 degrees. Instructions: Look ahead, the environment will be moving. Let your eyes relax and let me know if you feel dizzy or sick. Subjective Visual Vertical (SVV) Purpose: Tests and trains perceptual orientation and otolithic function Patient: Sitting initially, progressing to standing Settings: ◦ Measure count – How many trials they will do, I will typically leave at default ◦ Pseudo-random values – Randomizes the degree settings. Click once before beginning Instructions: ◦ You will see a red line in your screen. Use the controller to turn the line in each direction. The back triggers will move it more, the forward triggers will move it less. When you think you are completely up/down click the bottom “A” button to finish. KIDS Bird VR Purpose: Weight shifting training Patient: Standing on platform w/ goggles, controller w/ butterflies Settings: ◦ Screen Mode – To put on screen. Can’t use this if you want to use butterflies ◦ Circles Speed – Changes how fast the circles come up. Increase to make difficult, decrease to make easier ◦ Circles Size – Changes the size of the rings. Increase to make easier, decrease to make difficult ◦ Platform Difficulty – Can increase up to 100% to make the platform move more. ◦ Butterflies – Adds a dual task, pt has to catch butterflies as well as navigate through rings ◦ Butterflies speed – Increase to make butterflies come faster, Decrease to slow down Instructions: Without moving your feet and keeping your body straight, sway to control the bird and move the bird through the rings. Use the controller to catch butterflies at the same time. Bow VR Purpose: ATNR reflex, UE mm tone, head turns, visual tracking, timing, accuracy Patient: Standing on platform, with both controllers Settings: ◦ Bow – Pick the non dominant hand ◦ Difficulty – Start at very easy for warmup and progress as needed ◦ Very Easy – Target is in front and doesn’t change ◦ Easy – Target appears slightly L/R around target ◦ Medium – Target is further away and more around the environment ◦ Hard – Target no longer has a preview of pathing, targets are further and may move ◦ Very Hard – Target is constantly moving around the clouds and is more difficult to hit Instructions: Hold your non dominant hand in front of you as if you were holding a bow. Bring the other hand up to the bow, and when the arrow nocks pull the dominant hand trigger and hold. Bring your hand back to your face and release the trigger when you want to let the arrow go. Feel free to move your feet around as needed Limits of Stability Rehabilitation (LOS Rehab) Purpose: Weight shifting training Patient: Standing on platform, w/ or w/o headset Settings: ◦ Screen mode – Puts the target on the screen. I prefer on ◦ Ensure the patient height is in here ◦ Hold duration – How long the pt has to hold their position on the flower. Decrease to make easier ◦ Time before disappearance – How long the flower lasts for before it disappears. Increase to make easier ◦ Objective size – How large the flower is. Increase to make easier ◦ Efforts – Change the global size if too easy or hard. Decrease to make easier, increase to make more difficult. If they are struggling in one particular plane you can change that by itself. Instructions: You are the bee, when you see a flower you want to sway in that direction with your whole entire body through your ankles. Hold it there until the flower disappears, and then go back to the beehive. Ski Purpose: Weight shifting training Patient: Standing on platform Settings: ◦ Screen mode – Puts the target on the screen. I prefer on ◦ Forward speed – How fast you are moving forward. Increase to make difficult ◦ Forward tilt – How steep it looks. Increase for more difficulty ◦ Lateral tilt – To make them sway to one side. Change to weight one side more ◦ Bumps – Creates an up/down movement. Turn on for more difficulty/stimulation ◦ Bump height/length – Increase to make more unstable ◦ Gate width – How wide the gates are. Increase for easier, decrease for more difficult ◦ Gate amplitude – Distance between gates. Increase for further apart, decrease for more often ◦ Platform Difficulty – Can increase up to 100% to make the platform move more. Instructions: You will be skiing. Lean left and right to move yourself and try to go through the gates every time. Target Tracking Purpose: Visual scanning, VOR Patient: Standing on platform Settings: ◦ Spawning areas – Pick what quadrants you want the targets to appear at ◦ Size – How big the target is. Increase for easier, decrease for harder ◦ Apparition frequency – How often the target comes. Increase to make easier, decrease to maker harder ◦ Once targeted – How long you have to hold the target. Increase to make harder, decrease to make easier ◦ Viewfinder – How big the circle is. Increase to make easier, decrease to make harder Instructions: You are going to see little bugs around the area, with arrows pointing towards it. Move your head and hold the target in the circle until it disappears  Troubleshooting 1. Computer doesn’t turn on ◦ Hold power button until computer turns off. Wait 30 seconds and turn it back on. You may have to do this multiple times. 2. Vive shuts down with error ◦ Restart the Vive program and calibrate the room again 3. Can’t calibrate the room ◦ Ensure the base stations can see the goggles then place them slowly on the platform 4. Patient vision is blurry ◦ Goggles aren’t on properly – usually have to raise them up slightly 5. Patient vision is black ◦ Make sure the front of the headset is not being held, and that the base stations can see the headset 6. Patient sees the steam viewer through goggles ◦ This is due to Virtualis opening before Steam – make sure Vive/steam is open before Virtualis ◦ On the Steam tab, click Open Media Player and close it. You may need to do this multiple times