Scientist under the microscope: Evi Wezenbeek & Joke Schuermans on VR

In this new blog series, we give the floor to scientists engaged in technology related research and valorization activities within the sports technology and innovation field at Ghent University. In this way we want to provide insight into what is brewing behind the scenes. In short, we put the researcher under the microscope.

In this blog we have a double interview with Dr. Evi Wezenbeek & Dr. Joke Schuermans.

Evi and Joke are both postdoctoral researchers at the Department of Rehabilitation Sciences. Together they are working on a project on the use of Virtual Reality in return to sport screening after ACL reconstruction.

A new approach to return-to-sport screening & rehab

The project started from a literature review on the added value of virtual reality in sports physiotherapy. More specifically, the added value in return-to-sport screening in ACL reconstruction compared to traditional screening methods was assessed in detail.

The ACL injury usually occurs due to a certain mechanical movement pattern involving knee flexion, abduction and external rotation (i.e. knee valgus). In order to promote safe return to play (RTP) conditions when allowing an athlete to reparticipate in training and match play after a rehabilitation period following ACL repair surgery; the athlete is screened on a series of functional features, amongst which quality / control of movement. During rather traditional screening processes, patients must run in certain directions indicated by LED lights. During more advanced screening methods using VR, a more sport-specific context can be created. A comparison can then be made whether the valgus of the knee is more prevalent with the traditional or the VR method.

Evi and Joke are collaborating with Professor Glenn Van Wallendael (Ghent University – imec – IDLAB) for the project. He investigates immersive visualization and interaction. In the context of this project, he designs the virtual reality environments and interactions using  simulations in the Unity game engine. Additionally, he takes care of the synchronization between the virtual environment and the motion capture system and the EEG measurements.

We think VR can effectively add value. Not just in screening, but in rehabilitation as well. And that this will help them get back on the field much more safely in the long run

Getting back on the field safely with VR

Pilot testing on healthy athletes has now been completed, so testing on ACL injury patients can start during the upcoming Summer. This will be done by Robbe Capelleman, a PhD student. Testing will include screenings and thereby taking a closer look at what happens in the brain as well.

The injury and subsequent reconstruction can cause impaired coordination due to missing tissue and receptors. As a result, patients are very focused on their vision during rehabilitation; in retraining that coordination or proprioception, they rely heavily on a visual dominant movement strategy.

Evi: “With virtual reality headsets, you can make them rely less on their vision, as opposed to visual-driven rehabilitation. With the help of VR, the idea is that a patient’s proprioception could improve. That’s the next phase so to speak: using EEG measurements to investigate what happens at the brain level during rehabilitation.”

Joke: “There’s a lot of muscle training in classical rehabilitation. But when the players return to the field after rehab, they’re completely lost. They don’t know how to listen to their body anymore and how to get their mind on the field. We think VR can effectively add value in that population. Not just in screening, but in rehabilitation as well. And that this will help them get back on the field much more safely in the long run.”

Evi: “That’s the internal versus external focus. During rehab they’re working very often with an internal focus, towards performing the right movements. But when the patient finds themselves in a competition situation where all sorts of things are going on, they’re not busy with their knee at all. This makes us interested in what happens in the brain when it has to process information during rehabilitation and whether adding VR to the rehab (and shifting the focus) could allow us to better automate the movement strategy of ACL patients.

If the research does show that VR has an impact, the technology can be integrated into the rehabilitation process with the objective to optimize it. Currently, the project is still in the fundamental research phase, but Evi and Joke are already thinking about a follow-up trajectory.

Evi: “We’re talking about one very specific injury now. But we’re actually thinking about expanding to other musculoskeletal injuries as well – all injuries where that internal versus external focus has an impact. Also in terms of performance, we definitely think there’s more value in it. Once we have more basic research data on that, that’s definitely something to put on a valorization track.“

We want to start from fundamentally sound research, with good results, before we move on to valorization. And I think right now the technical aspects of getting that done, that is our biggest challenge

Beyond the gaming industry

VR is currently primarily used in the gaming industry. However, Joke and Evi assume that the technology will eventually also be used and standardized by physical therapists, hospital services or sport clubs.

Joke: “I think the intermediate step will be that, from EEG, from biomechanics itself, they’ll offer screening modules to athletes or to specialized clinical centers. To see what happens to the brain and the motor apparatus when they offer that VR option. So they can eventually offer workable and user-friendly VR modules in rehabilitation, training and the home environment.”

Evi: “I went on a foreign research trip to Emory University ‘Sports Performance and Research Center’ in the USA. They’re doing a large-scale study there, in Georgia. They’re going to equip all high schools with virtual reality as part of injury prevention and document the impact on injury rates. VR is already widely used in the USA, and I think other countries will follow soon.”

Huge amounts of data and uncontrollable factors

Just like all research projects, this one comes with its own challenges.

Joke: “We’re currently working with 64 EEG channels, each emitting a signal and synchronizing with a 3D whole-body kinematic model. We also give participants different sport-specific game situations and a number of control and balance tasks. So we’re left with huge amounts of data.”

Evi: “We want to start from fundamentally sound research, with good results, before we move on to valorization. And I think right now the technical aspects of getting that done, that is our biggest challenge.”

Joke: “Another challenge is the fact that we want to test all ACL patients after rehabilitation, but the project takes 3 years and not everyone is injured at the same time. We hope we can test them at the scheduled time, but that’s out of our control. There are many uncertainties and we depend on many external factors. But you do need them, all the participants, to solidify your story.”

Evi: “Yes, that’s true. So those are the biggest challenges we are struggling with right now, knowing that the road is actually quite long still. But we still believe in it (laughs). We’re taking it one step at a time.”

Valorizations to keep an eye on

The team is still figuring out what are the best next steps in translating the findings into actual solutions. One potential strategy is to start collaborating with one of the existing VR rehab companies out there in the market. Another option is to make the existing modules available to a larger audience through the set-up of a new venture.

Evi: “Something that I think is very widespread and still proves its added value is the SportKompas. The SportKompas is accepted by the broader society while at the same time it’s based on a solid foundation of scientific research. And the research is still ongoing. I find great inspiration in that particular example.”

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