# US 10,945,641 B2 · Virtual reality for movement disorder diagnosis and/or treatment > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,945,641 B2 - Document ID: US10945641B2 - Status: Granted - Kind: B2 - Application number: 14/350,567 - Filed: 2012-10-09 - Published: 2014-09-18 - Granted: 2021-03-16 - Earliest claimed: 2011-10-09 - Assignees: The Medical Research, Infrastructure and Health Services Fund of the Tel Aviv Medical Center - Applicants: The Medical Research, Infrastructure and Health Services Fund of the Tel Aviv Medical Center - Inventors: Anat Mirelman; Jeffrey M. Hausdorff; Nir Giladi - Web page: https://patentgrep.com/patent/US10945641B2 ## CPC - A61B 5/1104: {induced by stimuli or drugs (A61B5/1102 takes precedence)} - A61B 5/1117: {Fall detection} - A61B 5/112: {Gait analysis} - A61B 5/162: {Testing reaction times} - A61B 5/744: {Displaying an avatar, e.g. an animated cartoon character} - A61B 5/0205: Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition - A61B 5/026: Measuring blood flow {(A61B3/1233, A61B3/1241 take precedence)} - A61B 5/1118: {Determining activity level} - A61B 5/369: Electroencephalography [EEG] - A61B 5/378: Visual stimuli - A61B 5/7203: {for noise prevention, reduction or removal} - A61B 5/7257: {using Fourier transforms} - A61B 2505/09: Rehabilitation or training - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract Methods and/or systems for diagnosing, monitoring and/or treating persons at risk for falling and/or other pathological conditions. In an exemplary embodiment of the invention, people are diagnosed before they actually start falling. Optionally, the diagnosis includes trying out and identifying one or more fall triggers using virtual reality tools. Optionally or alternatively, treatment includes training the persons using situations and/or triggers which are determined to be relevant for that person. ## Claims ### Claim 1 A method of assessment of impairment, comprising: presenting a subject with a plurality of motor and cognitive dual tasking provocations delivered by virtual reality (VR) on a display during locomotion selected to provoke at least one gait pathology associated with dual tasking, at least one of said provocations including a vertical component, wherein at least a partial virtual representation of movement of the feet of said subject viewed from the back is presented on said display at a distance from the eyes of said subject as part of a task designed to allow negotiation of said provocations by said partial virtual representation of the feet movement of said subject viewed from the back on said display, wherein said at least a partial virtual representation indicating movement of the feet of the subject gives the subject feedback as to negotiating vertical and horizontal obstacles, wherein said feedback includes presenting by said VR a vertical distance of a forefoot of the subject from the obstacle, wherein said presenting in said VR includes presenting an avatar in said VR, said avatar including at least the foot of the subject passing over the obstacle while the subject is walking; and wherein said display is fixed relative to a surface on which said subject walks; measuring one or more physiological parameters of the subject during said locomotion; and assessing a plurality of impairments based on said measuring, each of said impairments comprise one or more of cognitive and motor dual tasking associated impairments, wherein said cognitive impairments comprise one or more of executive function, attention, planning, and visual spatial processing. ### Claim 2 (depends on 1) A method according to claim 1, further comprising generating a training program based on said assessing wherein said training program comprises provocations. ### Claim 3 (depends on 2) A method according to claim 2, wherein said training program comprises reaction to obstacles presented on said display. ### Claim 4 (depends on 3) A method according to claim 3, wherein said obstacles comprise at least one vertical obstacle or at least one horizontal obstacle. ### Claim 5 (depends on 1) A method according to claim 1, wherein presenting comprises presenting situations of varying complexity. ### Claim 6 (depends on 1) A method according to claim 1, wherein presenting comprises presenting provocations both expected to induce falls or near falls and those expected not to induce falls or near falls. ### Claim 7 (depends on 1) A method according to claim 1, wherein presenting comprises presenting dual motor and cognitive tasks. ### Claim 8 (depends on 1) A method according to claim 1, wherein presenting comprises personalizing the presentation to a subject performance and/or a subject clinical history. ### Claim 9 (depends on 1) A method according to claim 1, comprising identifying one or more parameters of a situation and/or a trigger which induce falls or near falls in the subject. ### Claim 10 (depends on 9) A method according to claim 9, comprising setting up a training program responsive to the identifying. ### Claim 11 (depends on 1) A method according to claim 1, comprising detecting a near fall based on a change in a pattern of data from one or more movement sensors, with the support of one or more additional physiological sensors. ### Claim 12 (depends on 1) A method according to claim 1, comprising detecting a fall or near fall in a person having fewer than 1 fall or near fall in 10,000 steps in daily life. ### Claim 13 (depends on 1) A method according to claim 1, comprising increasing a rate of falls or near falls over average daily activities by a factor of at least 10. ### Claim 14 (depends on 1) A method according to claim 1, wherein said assessing is based on change of activity in frontal lobes of the subject. ### Claim 15 (depends on 14) A method according to claim 14, wherein said change in activity is detected using EEG. ### Claim 16 (depends on 14) A method according to claim 14, wherein an increase in blood flow to a frontal lobe is taken to indicate a gait disorder due to lack of or over activity in the frontal lobes. ### Claim 17 (depends on 14) A method according to claim 14, wherein a decrease in blood flow to a frontal lobe is taken to indicate a gait disorder due to frontal lobe dysfunction. ### Claim 18 (depends on 1) A method according to claim 1, wherein said one or more physiological parameters includes an anticipatory postural adjustment. ### Claim 19 (depends on 1) A method according to claim 1, wherein said provocations comprise one or more obstacles. ### Claim 20 (depends on 19) A method according to claim 19, wherein said one or more obstacles comprise at least one vertical obstacle or at least one horizontal obstacle. ### Claim 21 (depends on 19) A method according to claim 19, wherein said negotiation of said obstacles comprises stepping over said one or more obstacles presented on said display, by said partial virtual representation of the feet movement of said subject viewed from the back on said display. ### Claim 22 (depends on 19) A method according to claim 19, wherein said one or more obstacles comprise obstacles with varying height. ### Claim 23 (depends on 1) A method according to claim 1, wherein said presenting comprises presenting said plurality of provocations to said at least partial virtual representation of said subject on said display. ### Claim 24 (depends on 1) A method according to claim 1, comprising: selecting by a controller said plurality of motor and cognitive dual tasking provocations personalized for a particular subject, wherein said plurality of motor and cognitive dual tasking provocations are selected to provoke at least one gait pathology in said particular subject. ### Claim 25 (depends on 1) A method according to claim 1, wherein said assessing comprises assessing cognitive and/or motor success in response to said motor and cognitive dual tasking provocations based on said measured physiological parameters. ### Claim 26 (depends on 1) A method according to claim 1, wherein said virtual representation of movement of the feet viewed from the back comprises an indication of a shoe. ### Claim 27 (depends on 1) A method according to claim 1, wherein said measuring the subject's activity in response to the provocations includes measuring at least one of clearance of an obstacle during obstacle negotiation, changes in strides between obstacles, and reaction time in regards to the provocations. ### Claim 28 (depends on 27) The method according to claim 27, wherein said changes in stride between obstacles includes changes in at least one of step length, foot clearance, gait asymmetry, gait variability, and base of support. ### Claim 29 (depends on 1) The method according to claim 1, further including measuring changes in performance across a plurality of sessions. ### Claim 30 (depends on 1) The method according to claim 1, wherein said presenting a plurality of provocations includes selecting a plurality of provocations personalized for the subject to improve performance of the subject. ### Claim 31 (depends on 1) The method according to claim 1, further including measuring the subject's activity in response to said provocations during said locomotion, wherein said measuring of the subject's activity is performed by at least one camera, and wherein assessing includes assessing a plurality of impairments based on said measuring said physiological parameters and based on said measuring the subject's activity in response to the provocations. ### Claim 32 (depends on 31) The method according to claim 31, wherein at least one camera readable marker is attached to the subject, and wherein said measuring the subject's activity is performed by said at least one camera by reading the at least one readable marker. ### Claim 33 (depends on 1) The method according to claim 1, further including measuring clearance over a virtual obstacle. ### Claim 34 (depends on 1) The method according to claim 1, wherein said feedback indicates clearance of the obstacle by at least the foot in both a vertical direction and a horizontal direction. ### Claim 35 (depends on 1) The method according to claim 1, said method for providing treatment of the subject's impairment, said treatment being personalized to the subject's needs using the VR system. ### Claim 36 Apparatus for gait based assessment of a subject, comprising: (a) a display; (b) a controller configured to: present at least a partial virtual representation of movement of the feet of said subject viewed from the back, at a distance from the eyes of said subject on the display and present a plurality of motor and cognitive dual tasking provocations during locomotion calculated to induce a fall or near fall on the display, at least one of said provocations including a vertical component, wherein said dual tasking provocations comprise one or more obstacles presented on said display, and wherein said at least a partial virtual representation indicates movement of the feet of the subject gives the subject feedback as to negotiating vertical and horizontal obstacles, wherein said feedback includes presenting by said VR a vertical distance of a forefoot of the subject from the obstacle, wherein said presenting in said VR includes presenting an avatar in said VR, said avatar including at least the foot of the subject passing over the obstacle while the subject is walking; measure one or more physiological parameters of the subject during said locomotion; assess a plurality of impairments based on one or more measured physiological parameters, each of said impairments comprise cognitive and motor dual tasking associated conditions, and wherein said cognitive conditions comprise one or more of executive function, attention, planning and visual spatial processing. ### Claim 37 (depends on 36) Apparatus according to claim 36, wherein said controller is configured to select said one or more provocations personalized for a particular subject. ### Claim 38 (depends on 37) Apparatus according to claim 37, wherein said controller is configured to select said one or more provocations in response to measurement by a system of subject activity. ### Claim 39 (depends on 37) Apparatus according to claim 37, wherein said controller is configured to modify a parameter of a selected provocation in response to measurement by a system of subject activity. ### Claim 40 (depends on 36) Apparatus according to claim 36, wherein said display is a virtual reality (VR) display. ### Claim 41 (depends on 36) Apparatus according to claim 36, comprising a plurality of wearable modules. ### Claim 42 (depends on 41) Apparatus according to claim 41, wherein a module is wireless and includes one or both of a sensor and an actuator. ### Claim 43 (depends on 36) Apparatus according to claim 36, comprising a treadmill controlled by said controller. ### Claim 44 (depends on 36) Apparatus according to claim 36, wherein said controller is configured to detect a fall and a near fall. ### Claim 45 (depends on 44) Apparatus according to claim 44, wherein said detection is based, at least in part, on one or both of a heart rate and an indication of frontal lobe activity. ### Claim 46 (depends on 36) Apparatus according to claim 36, wherein said controller is configured to measure at least an indication of brain activity. ### Claim 47 (depends on 36) Apparatus according to claim 36, wherein said controller is configured to generate a virtual reality simulation on said screen comprising negotiation of said one or more obstacles. ### Claim 48 (depends on 47) Apparatus according to claim 47, wherein said one or more obstacles comprise at least one vertical obstacle or at least one horizontal obstacle. ### Claim 49 (depends on 36) Apparatus according to claim 36, wherein said controller presents said one or more provocations to said at least a partial representation of said subject on said display. ### Claim 50 (depends on 36) Apparatus according to claim 36, wherein said controller is configured to assess cognitive and/or motor success in response to said provocations based on said measured physiological parameters. ### Claim 51 (depends on 36) Apparatus according to claim 36, wherein said virtual representation of movement of the feet viewed from the back comprises an indication of a shoe. ### Claim 52 A method of assessment of impairment, comprising: presenting a subject with a plurality of motor and cognitive dual tasking provocations delivered by virtual reality (VR) environment during locomotion selected to provoke at least one gait pathology associated with dual tasking, at least one of said provocations including a vertical component, wherein at least a partial virtual representation of movement of the feet of said subject viewed from the back is presented in said VR environment as part of a task designed to allow negotiation of said provocations by said partial virtual representation of the feet movement of said subject viewed from the back, wherein said at least a partial virtual representation indicating movement of the feet of the subject gives the subject feedback as to negotiating vertical and horizontal obstacles, wherein said feedback includes presenting in said VR environment a vertical distance of a forefoot of the subject from the obstacle, wherein said presenting in said VR environment includes presenting an avatar in said VR environment, said avatar including at least the foot of the subject passing over the obstacle while the subject is walking; measuring one or more physiological parameters of the subject during said locomotion; and assessing a plurality of impairments based on said measuring, each of said impairments comprise one or more of cognitive and motor dual tasking associated impairments, wherein said cognitive impairments comprise one or more of executive function, attention, planning, and visual spatial processing.