JP2018191964A - Neuropathy-related pain treatment support system and pain treatment support method - Google Patents

Abstract

To provide a pain treatment support system and a pain support method in which a shape or movement of the diseased limb imaged in a brain of a patient complaining of neuropathy-related pain is accurately reproduced in virtual spaces, and the diseased limb can be modified into the matter having a desired shape or a motion space.SOLUTION: A pain treatment support system is characterized as follows: a stereoscopically viewable virtual space by a patient complaining of neuropathy-related pain is generated; the limb in the patient's real space is detected, and a position and a size are calculated in order to be reproduced in the virtual space; the virtual diseased limb being asymmetric to the healthy limb and being felt in the patient's brain is set in the virtual space, based on the calculated position and size, and thereby the image of the limb is generated; the generated image is displayed in the virtual space so as to be visible by the patient; and the diseased limb is displayed as an animation corresponding to an action of the healthy limb in the real space, and the operating range can be adjusted.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a pain treatment support system and a pain treatment support method for providing visual feedback to a patient complaining of neuropathic pain by using images of limbs generated in a virtual space.

  In general, pain includes nociceptive pain such as burns and bruises, and neuropathic pain caused by nerve cutting and compression such as so-called phantom limb pain and thalamic pain. Regarding the latter, although the mechanism of pain generation has not been completely elucidated, it is considered that the information exchange between the sensory system and the motor system in the brain is abnormal.

  As a treatment method for the neuropathic pain alleviation, there are a therapeutic method by surgical operation in addition to a drug therapy by administration of a pain relieving drug. However, the former is a coping therapy, and there are concerns about side effects, and the latter is a highly invasive treatment, so that the physical burden on the patient is large. Therefore, rehabilitation treatment is attracting attention as a non-invasive treatment method without concern about side effects.

  In the past, rehabilitation therapy using a mirror called “mirror therapy” has been proposed as this type of treatment. This is because when a patient observes the movement of a reverse image of a healthy limb reflected in a mirror, visual feedback information is transmitted as if the affected limb is moving in the same way as the healthy limb in the patient's brain. It is to correct the abnormality of exchange.

  Conventionally, a treatment support apparatus or a treatment support method for generating a healthy limb and an affected limb in a virtual space by applying the principle of “mirror therapy” has been proposed.

  For example, a patient's posture or the like is detected by a position sensor, and a hallucination image corresponding to the movement of the patient who performs a predetermined operation based on the position sensor is presented in a virtual space, and the patient visually sees the hallucination image with a high sense of presence. A pain treatment support device that can induce the patient's brain to conclude that there is no phantom limb by learning the gap between sight and touch, etc. (For example, refer to Patent Document 1). According to this configuration, like the mirror therapy, the healthy limb and the affected limb are not limited to a simple and arbitrary movement in which the mirror image is symmetric, and there is a sense of reality, and a more natural and diverse rehabilitation environment is set. However, a high therapeutic effect can be expected.

  In addition, a camera that shoots a mark placed on a paralyzed hand and outputs a captured image, a position recognition unit that inputs a captured image and recognizes the position of the paralyzed hand, and the paralyzed hand moves There has been proposed a rehabilitation device including an image forming unit that outputs a moving image and a head-mounted display that displays the moving image on a paralyzed hand (see, for example, Patent Document 2). This configuration does not directly use the image equivalent to the mirror, but basically applies the principle of mirror therapy in that the image of the paralyzed hand is superimposed on the image of the hand in the limb state. it is conceivable that.

  By applying the principle of the so-called mirror therapy, the central and peripheral neural circuits involved in motor execution are reactivated by augmented reality and virtual reality technology, and the map of the cerebral cortex rewritten after upper limb amputation is modified. According to an experiment that tried to reduce phantom limb pain, an evaluation using the Neural Rating Scale (NSR, score 0-10) as an evaluation index was performed, and at the end of a given session, it was improved by 32%. Has been reported. (For example, refer nonpatent literature 1.)

Japanese Patent No. 4025230 JP2015-39522A

Max Ortiz-Catalan et al. “The LANCET Vol.388 / Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial in patients with chronic intractable phantom limb pain” December 10,2016 , 2885-2894

  In the patient's brain, the mirror therapy principle that conveys visual feedback information that the affected limb is moving like a healthy limb and corrects the information exchange abnormality is effective in improving neuropathic pain If so, rehabilitation in a virtual space with a sense of realism, reality, and immersion, as in the prior art, is considered to be a very effective means.

  By the way, the image of the shape of the affected limb captured in the brain by the patient having the neuropathic pain differs depending on the patient. Therefore, this shape image is not necessarily the state of the healthy limb before the loss or the state where the limbs are simply coupled to the lost stump. Further, not only the shape but also the movement of the affected limb may be different in the patient's brain even if the movement of the affected limb is intended to be the same as that of the healthy limb. Furthermore, since the image changes according to the progress of rehabilitation, it is not always the same state. Even during rehabilitation, if the image of the affected limb remains in a preset shape, the rehabilitation proceeds with the image of the affected limb that changes in real time or the affected limb that does not match the purpose of rehabilitation.

  However, the prior art follows the principle of mirror therapy, and when displaying an affected limb in a virtual space, basically, an inverted image of a healthy limb is assumed. In the prior art according to Patent Document 1, it is suggested that the shape is determined by hearing the image of the affected limb (phantom limb) from the patient in advance. However, the shape is specifically determined by any configuration or method. There is no disclosure about what to do. As described above, since the pain treatment using the virtual space has been confirmed to have effective effects of realism and reality, when the affected limb in the virtual space is different from the image of the patient, sufficient improvement is achieved. There was a possibility that the effect could not be expected.

  The present invention is for solving the above-mentioned problems, and accurately reproduces the shape and movement of the affected limb imaged in the patient's brain in the virtual space, and in real time during rehabilitation, the desired shape, An object of the present invention is to provide a pain treatment support system and a pain support method capable of adjusting an affected limb to movement.

  In order to achieve the above object, a pain treatment support system according to the present invention generates a virtual space that can be stereoscopically viewed by a patient who complains of neuropathic pain, detects a limb body in the real space of the patient, and detects the virtual body. A position and size are calculated for reproduction in the space, and based on the calculated position and size, the virtual space is asymmetric with the healthy limb and perceived in the patient's brain. By setting the affected limb, an image of the limb body is generated, and the generated image is displayed so that the patient can see in the virtual space, and the affected limb corresponds to the motion of the healthy limb in the real space. The main feature is that it is displayed as a moving image and its operating range can be adjusted.

That is, a pain treatment support system for providing visual feedback to a patient complaining of phantom limb pain, thalamic pain, and other neuropathic pain by an image of a limb body generated in a virtual space,
Virtual space generating means for generating a virtual space in which the patient can stereoscopically view; and
Detecting means for detecting a limb body composed of an affected limb in the real space of the patient and a healthy limb facing the affected limb;
A calculation means for calculating the position and size of the detected limb so as to be recognizable in the virtual space;
Based on the calculated position and size, an image of the limb body is generated in the virtual space, and at least an affected limb that is asymmetric with the healthy limb and is perceived in the patient's brain. Image generation means to be set based on the main complaint or complaint;
Display means for displaying the movement of the affected limb corresponding to the movement of the healthy limb in the real space of the patient in the virtual space as a moving image based on the set image;
An adjustment unit that can adjust the image environment in the virtual space displayed by the display unit, the position and size of the limb, and the operation of the affected limb;
It is characterized by having.

  According to this configuration, the inverted image of the healthy limb is not used as it is, and the affected limb in the virtual space can be set and the motion of the affected limb can be adjusted by the patient's main complaint / complaint.

  The calculation means includes at least a first detection means for detecting the position and size of the arm leg portion and a second detection means for detecting the position and size of the limb portion of the limbs in the real space. A detection result is received, a position and a size for reproducible reproduction in the virtual space are calculated from the detected position and size, and the image generation means is configured to calculate the position and size calculated respectively. What is necessary is just to synthesize | combine the image of the arm leg part and limb part, and to produce | generate the image of the said limb.

  According to this configuration, the affected limb in the virtual space can be reproduced with high definition.

  The image data of the limbs generated by the image generation means has storage means for storing corresponding to ID data unique to each patient, and the image generation means stores image data stored in the storage means If there is an image, the corresponding image data is read by the ID data, and when there is a change in the main complaint or complaint of the patient, the image is reset and the image data to be stored in the storage means is stored. It may be updated as data.

  Usually, since this type of rehabilitation is performed a plurality of times, according to this configuration, rehabilitation can always be performed with an affected limb that matches the latest image of the affected limb in the patient's brain.

  The setting of the image generation means is at least the setting of the joint angle of the affected limb in the virtual space, the length setting by the longitudinal extension / contraction of the arm leg or limb of the affected limb, and the width setting by the lateral extension / contraction of the affected limb. It is possible to set the joint angle, length, and width as needed after the display of the set affected limb by the display means.

  For example, when a healthy limb is generated as a model case, the shape of the affected limb imaged by the patient in the brain can be generated by modifying and processing the healthy limb by any of angle, expansion / contraction, and expansion / contraction. Therefore, this configuration makes it possible to reproduce an accurate affected limb in the virtual space.

  In the virtual space, the adjusting means relatively regulates the range of motion or momentum of the affected limb that operates in synchronization with the motion of the healthy limb in the real space in relation to the range of motion or the amount of exercise of the healthy limb. It may be.

  Even if the patient moves the affected limb in imitation of the movement of the healthy limb in the virtual space, the movement of the healthy limb does not completely match in the patient's brain. According to this configuration, since the movement of the affected limb is regulated and adjusted, an accurate reproduction of the affected limb imaged in the patient's brain can be realized.

In order to achieve the above object, a pain treatment support method according to the present invention includes:
A pain treatment support method for providing visual feedback to a patient complaining of phantom limb pain, thalamic pain, and other neuropathic pain by using an image of a limb body generated in a virtual space,
Generating a virtual space in which the patient can stereoscopically view;
Among the limbs composed of the affected limb in the real space of the patient and the healthy limb opposite to the affected limb, the position and size of the arm leg are set as the first detection, and the position and size of the limb are set to the second. Detecting as detection;
Receiving the results of the first detection and the second detection, and calculating the position and size in order to reproduce each detected position and size in the virtual space so as to be visible;
The images of the arms and legs and the limbs of the calculated position and size are combined to generate an image of the limb in the virtual space, and at least asymmetric with the healthy limb, and the patient's brain Generating an image in which the affected limb perceived within is set based on the main complaint / complaint of the patient;
The movement of the affected limb corresponding to the movement of the healthy limb in the real space of the patient is displayed as a moving image in the virtual space based on the set image, and is set and displayed in the virtual space. Adjusting the position, size and movement of the affected limb;
It has the most important feature.

  The setting is at least one of a joint angle setting of the affected limb in the virtual space, a length setting by extending or contracting the arm leg or limb of the affected limb in the longitudinal direction, and a width setting by expanding or contracting the affected limb in the short direction. The joint angle setting, length setting, and width setting are changed while the patient is viewing the set affected limb after the set affected limb is displayed by the display means. You may make it perform.

According to this configuration, for example, when the patient's affected limb is being watched during the rehabilitation of the patient, the affected limb can be brought close to the shape of the healthy limb in real time.

  The pain treatment support system and method according to the present invention can accurately reproduce in the virtual space the shape and movement of the affected limb that is asymmetrical with the healthy limb imaged in the brain of the patient. A certain image can be displayed, and the effect of drastically improving pain can be expected.

  Furthermore, since the affected limb can be corrected to a desired shape and movement in real time during rehabilitation, the reaching of the ideal shape and movement is promoted and the rehabilitation period is shortened.

FIG. 1 is a block diagram of a pain treatment support system according to the present invention. FIG. 2 is a diagram showing a configuration example of a virtual space generated by the pain treatment support system according to the present invention. FIG. 3 is a diagram showing a setting work screen for the affected limb in the virtual space. FIG. 4 is a diagram showing an example of a three-dimensional model image of a limb. FIG. 5 is a diagram showing an example in which a slider for adjusting the position and motion of the affected limb is provided on the image in the virtual space. 6A and 6B are diagrams showing adjustment of motion of the affected limb, where FIG. 6A shows an example of adjusting the range of motion of the affected limb, and FIG. 6B shows an example of adjusting the momentum of the affected limb. It is. FIG. 7 is a diagram in which the target image for rehabilitation and the image in the brain are superimposedly displayed on the affected limb. FIG. 8 is a flowchart of the pain treatment support method according to the present invention.

  Referring to FIG. 1, reference numeral 1 denotes a pain treatment support system according to the present invention. The pain treatment support system 1 can visually recognize a patient complaining of neuropathic pain such as phantom limb pain and thalamic pain as if the patient is moving the affected limb by his / her own intention in the virtual space. The moving image is reproduced and visual feedback is provided to the brain of the patient who has visually recognized the moving image.

The pain treatment support system 1 uses motion capture technology that captures the movement of the patient P who complains of the neuropathic pain. Motion capture technology digitizes the movement of moving objects such as people and reproduces real-world motion in a virtual space in real time. Although there are various types of motion capture techniques, the pain treatment system according to the present invention is not limited to a specific type. However, for the purpose of treating neuropathic pain, it is necessary to capture the movement of the patient P, reproduce it in real time and in high definition in a virtual space, and immediately provide visual feedback so that the patient P can visually recognize the movement. Therefore, an optical type is preferable. As an optical motion capture technology, it is common to attach a marker to a feature point of motion of a moving object (in the case of a person, for example, a joint part), and detect and measure this optically. Irradiate an infrared laser to a certain range without attaching a marker to the moving object, generate an environment in which fine points are distributed, and the moving object moves to change the distribution of the points in the irradiation area. There is a motion capture technology that uses a depth sensor to capture motion. Hereinafter, as an example, the present embodiment will be described on the assumption of such a markerless motion capture technique.

  In addition, for convenience of explanation, the case where there is an affected limb in one of the upper limbs will be described unless explicitly specified. However, even if any of the four limbs is an affected limb, A pain treatment support method can be applied, and treatment (rehabilitation) can be performed in the same manner.

The pain treatment support system 1 includes detection means for detecting the limbs of the patient P, but includes a first detection unit 11 and a second detection unit 12 in the present embodiment. The 1st detection part 11 and the 2nd detection part 12 detect presence of the said limb in real space from the motion of the limb used as a detection target. Here, the first detection unit moves the arm part of the upper limbs, that is, shoulder flexion / extension / abduction / inversion / external rotation / internal rotation, elbow flexion / extension, forearm pronation / rotation. It detects relatively large movements such as outside. On the other hand, the second detection unit performs relatively fine movements (individual finger movements) such as hand movements, that is, bending / extension / bending / bending of palm, bending / extension / bending of each finger, etc. It is to detect. In the case of the lower limb, the first detection unit 11 detects the movement of the leg and the second detection unit 12 detects the movement of the foot. As described above, both the first detection unit 11 and the second detection unit 12 use motion capture technology, and preferably the movement of the arm and hand of the patient P is performed by the infrared irradiation unit and the infrared light reception unit. Anything can be used. However, for example, the first detection unit 11 has an effective distance of 0.8 to 4 m level and recognition accuracy of 1 mm unit level, and the second detection unit 12 has an effective distance of 2.5 to 60 cm level and recognition accuracy of 1 level. The recognition range of the sensor differs depending on the detection target so as to be at the / 100 mm level.

  The detected limb is reproduced in the virtual space generated by the virtual space generation unit 13. FIG. 2 shows a configuration example of the virtual space V. The virtual space V is formed so that the patient P can view stereoscopically, and the generated virtual upper limb Vh is reflected as a moving image, as will be described later. A virtual guidance box Vb that guides the line of sight of the patient P facing the virtual space V to the virtual upper limb Vh, a virtual partition Vp that partitions the healthy limb from the affected limb, and a virtual mirror that objectively visually recognizes the movement of the virtual upper limb Vh. Vm, a virtual tool Vs for supporting movement such as grasping and rolling with the virtual upper limb Vh, and a virtual clock Vw for confirming the rehabilitation time. Since the virtual space V varies depending on the rehabilitation training menu or the like, a plurality of different virtual spaces may be generated and registered in the storage unit 16 to be described later. Furthermore, sound effects that increase concentration can be generated as an auditory stimulation function as well as vision. By producing a sound effect, the effect of making the parasympathetic nerve dominant and promoting concentration on rehabilitation can be expected. Specifically, in addition to rain sounds and hustle sounds, sounds generated when the virtual tool Vs is rolled or dropped may be generated.

  Returning to FIG. 1, based on the movement of the upper limb detected by the first detection unit 11 and the second detection unit 12, the calculation unit 14 is configured to reproduce the upper limb of the patient P as the virtual upper limb Vh in the virtual space V. The position and size of the limb in the P real space are calculated. The calculation method is not particularly limited as long as the virtual upper limb Vh can be reproduced as a stereoscopic image in the virtual space V without a sense of incongruity, but information on the upper limb on the plane detected by the depth sensor is a three-dimensional image. It is sufficient to calculate according to the perspective projection transformation reproduced as That is, the depth (depth) of the point on the detected image may be calculated by triangulation using a parameter set in advance by the viewing angle of the depth sensor.

  Based on the position and size calculated by the calculation unit 14, the virtual upper limb Vh is set by the image generation unit 15 in order to display the virtual upper limb Vh in the virtual space V generated by the virtual space generation unit 13.

  In general, the external shape of the affected limb imaged in the brain of the patient P who complains of neuropathic pain is not the same as the opposite healthy limb but is asymmetric. (Here, the “relatively healthy limbs” refers to, for example, the right limb of the left upper limb when the right limb is the affected limb. Therefore, even if the affected limb is displayed as an inverted image of the healthy limb, such as mirror therapy which has been conventionally proposed as a pain relieving technique, the disease in the brain of the patient P As a result of a gap between the limb image, there is a problem that effective visual feedback cannot be obtained even if the inverted image is viewed. Therefore, the setting of the virtual upper limb Vh of the image generation unit 15 sets the affected limb perceived in the brain of the patient P asymmetrically with the opposing healthy limb based on the main complaint and complaint of the patient P. In addition, it was decided that the patient P would not be able to accurately represent the affected limb imaged in the brain because the patient P's main complaint or complaint is based on the complaint or complaint. This is because the setting contents may be supplemented while referring to past setting examples.

  FIG. 3 is an example of a screen for setting the affected limb. The detected limb of the patient P is calculated by the calculation unit 14, reproduced by the graphic image generated by the image generation unit 15, and superimposed on the graphic image of the limb to clearly define the operation point of the limb. In order to achieve this, the joint portion is a sphere (joint), the humerus and the femur that connect the joints are rod-like bodies (joint chains), and the whole is converted into a simplified skeleton image. While the joint color set as the affected limb is red, hearing the patient's main complaint / complaint, for example, the joint chain is stretched in the longitudinal direction, and the patient P is imaged in the brain as viewed from the balance of the entire limb. Set the length of the affected limb. In FIG. 3, C1 is a front perspective view, C2 is a rear view, and C3 is a side view of the affected limb (upper right limb). However, any desired pointing device such as a mouse can be used on the screen. It can be operated freely so that it can be seen from the direction.

As is clear from the rear view of C2, in this embodiment, the right upper limb is set to be longer than the left upper limb, which is a healthy limb, but of course, both the left and right upper limbs and lower limbs are affected limbs. Can be set. In the present embodiment, the example of expansion and contraction of the joint chain in the longitudinal direction is shown, but in addition, the joint angle of the affected limb can be set, and the width can be set by expanding and contracting the affected limb in the short direction. A combination of a plurality of settings (for example, a setting in which joint angles and expansion / contraction / expansion / contraction of the joint chain are combined) is also possible. Furthermore, in the present embodiment, the setting is based on the detection of the arm by the first detection unit 11, but the above-described various settings are also possible in the setting based on the detection of the limbs by the second detection unit 12 (not shown). ).

In the above embodiment, the patient P's chief complaint / complaint is heard and the setting operation of the affected limb is performed. However, a setting screen as shown in FIG. The patient P himself / herself may set the affected limb using the virtual upper limb Vh on the setting screen. Further, after the setting, the joint angle setting, the length setting, and the width setting may be performed at any time while being displayed on the display unit 17 described later.

  The image generation unit 15 generates an image of the limb of the patient P by synthesizing the images of the arm legs and limbs of the position and size calculated by the calculation unit 14.

  The image of the limb including the affected limb set by the image generation unit 15 is displayed in the virtual space V by the display unit 17. In the display unit 17, when the patient P moves the healthy limb in the real space, the healthy limb moves in the virtual space V as well, and the patient P who is looking at the display unit 17 moves the movement of the healthy limb in the real space. I'm watching. At this time, in the virtual space V, the set affected limb moves corresponding to the movement of the healthy limb.

  As shown in FIG. 4, in the upper limb of the patient P displayed on the display unit 17, the left upper limb Vhl is the affected limb and the right upper limb Vhr is the healthy limb. The left upper limb Vhl and the right upper limb Vhr are bilaterally asymmetric and reproduce the affected limb imaged by the patient P in the brain. In the present embodiment, the one with the hand attached immediately from the vicinity of the shoulder of the left upper limb Vhl is displayed, but depending on the patient, for example, the hand is buried in the chest or abdomen. The affected limb may be an image in the brain. In some cases, the affected limb in a state where the arm is bent in a direction different from that of the healthy limb is an image in the brain (not shown).

  The device constituting the display unit 17 is not particularly limited as long as it can display a moving image of a stereoscopic video, but effective visual feedback can be expected, so that the patient P who sees the moving image has an immersive feeling. A head mounted display capable of displaying a stereoscopic image to be applied is preferable. In particular, those having a head tracking function in which the display follows the movement of the head worn in a wide-angle visual field are preferable. The mechanism of the stereoscopic image may be any one in which the liquid crystal panel is divided into left and right parts and auditioned with the left and right eyes. However, the present invention is not limited to this. For example, a large screen may be used.

  The affected limb imaged in the brain of the patient P with the above settings is reproduced on the display unit 17, but fine adjustment of the image environment in the virtual space V, the position and size of the limb may be required. For example, before displaying on the display unit 17, in order to set the height of the first detection unit 11 and the line of sight of the patient P when the display unit 17 (head mounted display) is mounted in a horizontal position, a tripod or the like is used. 1 When the height of the detection unit 11 is adjusted, and when it is actually displayed on the display unit 17, further fine adjustment is necessary in order to improve the visibility of the upper limb Vh from the eye of the patient P There is. In addition, in a state where the virtual upper limb Vh is displayed in the virtual space V, it may be necessary to finely adjust the position of the desk on which the virtual upper limb Vh is placed in the front, rear, left, and right directions.

Therefore, the image environment in the virtual space V, the position and size of the limbs can be adjusted by the adjustment unit 18. For example, as illustrated in FIG. 5, the adjustment unit 18 may be provided with a slider on a screen displaying the limbs of the patient P in the virtual space V, and may be adjusted by operating the slider. In the present embodiment, an example is shown in which a pair of sliders A1 and A2 that are slidable in the vertical and horizontal directions with respect to the screen are provided on the left and right sides below the screen. For example, one of the slider A1 and the slider A2 may adjust the image environment such as the height and depth of the desk, and the other adjusts the position and size of the limbs such as the head and the shoulder.

  By the way, as described above, in general, the affected limb imaged in the brain of the patient P is asymmetric with the opposing healthy limb, but its movable range and momentum are also different from the healthy limb. Usually, both the range of motion and the amount of exercise of the affected limb receiving damage are smaller than those of the opposing healthy limb. Therefore, the image (moving image) displayed on the display unit 17 simply imitates the movement of a healthy limb when the movement of the affected limb is synchronized with the movement of the healthy limb in the real space in the virtual space V. If it is a movement, it does not accurately represent the movement of the affected limb imaged in the brain of the patient P, and may not provide effective visual feedback.

Therefore, the adjustment unit 18 can also adjust the motion of the affected limb. In the present embodiment, as shown in FIG. 5, a pair of sliders A3 are provided so that the motion of the affected limb can be adjusted. A more specific example will be described with reference to FIG.

  In FIG. 6, the motion of the affected limb is limited by two parameters, the range of motion and the momentum. As the upper limb Vh in the virtual space V, a right upper limb (healthy limb) Vhr and a left upper limb (affected limb) Vhl are shown, and the affected limb Vhl is displayed asymmetrically with a shorter length in the longitudinal direction of the arm than the healthy limb Vhr. ing.

  In FIG. 6A, the range of motion of the affected limb Vhl is set by the slider A31. Assuming that the range of motion of the forearm that moves with the elbow joint Vjr as the fulcrum in the healthy limb Vhr is θ1, adjust the slider A31 while observing the movement of the forearm with the elbow joint Vjl of the affected limb Vhl as the fulcrum. The range of motion of the affected limb Vhl is limited so that the range of motion is smaller than θ1 (θ1> θ2). In the present embodiment, the pointer of the slider A31 indicates that the angle formed by the movable range θ2 is 100 °. (The range of motion θ1 of the healthy limb Vhr is, for example, about 145 °.)

  In FIG. 6B, the amount of exercise of the affected limb Vhl is set by the slider 32. When the movement of the healthy limb in the real space is reproduced as a momentum from the healthy limb Vhr in the virtual space V to the position of the healthy limb Vhr ′ with the elbow joint Vjr as a fulcrum, the affected limb Vhl is also synchronized with this. The forearm moves with the elbow joint Vjl as a fulcrum. In order to set this momentum to the momentum of the affected limb imaged in the brain of the patient P, the slider A32 is adjusted. In the present embodiment, when the momentum setting is set to 50%, the affected limb Vhl is moved only to the position of the affected limb Vhl ′ with the momentum of 50% while synchronizing with the movement of the healthy limb VHr ′. It has become.

  The sliders A31 and A32 are stepless, but may be stepped. However, the stepless setting can be finely adjusted, which is preferable for reproducing the realistic movement of the affected limb.

  As described above, the adjustment unit 18 adjusts the image environment in the virtual space V, the position and size of the limb, and the range of motion of the affected limb in the virtual space V that operates in synchronization with the motion of the healthy limb in the real space. Alternatively, the amount of exercise can be relatively restricted in relation to the range of motion or the amount of exercise of the healthy limb in the virtual space V that reproduces the movement of the healthy limb in the real space. Therefore, since both the external shape and motion of the affected limb imaged in the brain of the patient P are accurately reproduced, it is possible to provide good visual feedback.

  Returning to FIG. 1, the image data of the limbs generated by the image generation unit 15 is stored in the storage unit 16 in association with the ID data unique to each patient P. When there is image data stored in the storage unit 16, the image generation unit 15 reads the image data corresponding to the ID data, and performs resetting when there is a change in the main complaint or complaint of the patient P. The reset image data is updated as image data to be stored in the storage unit 16.

  The storage unit 16 stores the current position of the affected limb set in the virtual space V in association with the data indicating the ideal position as a healthy limb, and the image generation unit 15 stores the current state from the storage unit 16. It is also possible to read out the data at the position and the ideal position and to superimpose them together so that they can be identified, and to display the synthesized data visually on the display unit 17. Specifically, as shown in FIG. 7, for example, when the affected limb is a short image in the longitudinal direction of the upper limb, the upper limb Vh1 as the affected limb is shown and the upper limb Vh2 of the length of the healthy limb is superimposed. What is necessary is just to make it display with the synthesized image. In this case, if the upper limb Vh1 is displayed in a colored or translucent manner, the upper limb Vh2 is displayed in a transparent manner and only the contour is displayed as a solid line or a broken line, the display can be identified. By displaying such an image, it is possible to image the affected limb closer to the position of the upper limb Vh2, that is, the position of the healthy limb as a rehabilitation target. And the pain is improved by making the image of the affected limb in the brain of the patient P close to the healthy limb before the onset of pain, and bringing the image in the brain close to the image to be viewed.

  In this embodiment, one of the upper limbs and the lower limbs is an affected limb, and the opposite other is an example of a healthy limb. However, neuropathic pain is caused by both upper limbs or both lower limbs, or all four limbs. It also develops. Therefore, among the limbs in the virtual space V, for the healthy limbs, instead of the healthy limbs in the real space, a virtual healthy limb generated based on the predetermined data of the patient P, and the movement of the virtual healthy limb is A myoelectric potential signal may be acquired at the affected limb stump in the real space, and a motion corresponding to the acquired myoelectric potential signal may be reproduced in the virtual space as a motion of a healthy limb (not shown). Specifically, the predetermined data of the patient P may be, for example, data obtained by converting the size of the healthy limb from data or a video of the healthy limb before the neuropathic pain of the patient P.

As a specific hardware configuration example of the pain treatment support system 1, as described above, as the first detection unit 11 and the second detection unit 12, the arm part and the hand part of the patient P are used by the infrared irradiation unit and the infrared light reception unit. Any depth sensor that captures movement may be used. Further, the display unit 17 may be a head mounted display or the like that can display a 3D video. The virtual space generation unit 13, the calculation unit 14, the image generation unit 15, the storage unit 16, and the adjustment unit 18 other than those described above may be dedicated devices that exhibit their respective functions, but are preferably a central processing unit. Any personal computer including a (CPU), a main memory, a magnetic disk, a display, and other peripheral devices may be used. The CPU mainly controls the operation of each component described above. The main memory stores a control program executed by the CPU, and provides a work area when the CPU executes the program. The magnetic disk stores various applications including an operating system, a device drive of a peripheral device, and a program for performing various processes according to the present invention. The display displays the setting screen executed by the image generation unit 15 and the adjustment screen executed by the adjustment unit 18.

  However, in the present invention, since image processing that requires relatively high-precision movement is required, a graphic board (GPU) with high stereoscopic image rendering performance is required. In addition, in order to distribute the load on the CPU, a device having a CPU on the first detection unit 11, the second detection unit 12, and the display unit 17 side may be used.

  FIG. 8 is a flowchart of the pain treatment support method according to the present invention. First, when the pain treatment support system 1 is started up, it is determined whether or not the virtual upper limb of the patient P has already been registered, that is, whether or not it is a new image (S1). In the case of a new image (Y in S1), a virtual space V is generated (S2). The virtual space V may be generated individually by a rehabilitation menu performed by the patient P. When the virtual space V is generated, the limbs of the patient P are detected. In the present invention, an arm or leg with relatively large movement and a hand or foot with relatively fine movement are separately detected according to the detection accuracy. In the case of arm leg detection (Y in S3), first detection for detecting the movement of the arm leg is performed (S4), and the position / size of the arm leg is calculated (S5). On the other hand, when it is not the detection of the arm leg part (N of S3), the 2nd detection which detects the motion of a limb part is performed (S6), and the position and magnitude | size of a limb part are calculated (S7). It should be noted that both the first detection and the second detection may use motion capture technology, and preferably may capture the movement of the arm and hand of the patient P by the infrared irradiation unit and the infrared light reception unit.

  The detected images are synthesized based on the positions and sizes calculated in S5 and S7, and an image of the limb is generated so that it can be displayed in the virtual space V (S8). An affected limb image to be imaged in the brain of the patient P is set for the generated image (S11).

  If the image is not a new image (N in S1), the ID of the patient P is input (S9), the registered image is read (S10), and the brain of the patient P at that time is read from the registered image read out. What is necessary is just to reset the affected limb image imaged in (S11).

  The set affected limb is displayed as a moving image in the virtual space V (S12). That is, the set affected limb is displayed as a moving image together with the movement of the limb in the virtual space V. The motion of the affected limb is synchronized with the motion of the healthy limb relative to the affected limb.

  Next, while adjusting the positional relationship between the environment in the virtual space V and the limbs, the range of motion and momentum of the affected limb that operates in synchronization with the motion of the healthy limb are related to the range of motion and the amount of exercise of the healthy limb. Make relative regulatory adjustments. That is, it is determined whether or not the image environment in the virtual space V, the position and size of the limbs need to be adjusted, and when the adjustment is necessary (N in S13), specifically the position / size, etc. The image environment such as the depth and the depth, and the position and size of the limbs such as the head and shoulders are adjusted (S14). When adjustment is unnecessary (Y in S13), or after adjusting the position and size, it is determined whether or not adjustment of the motion of the affected limb is necessary (S15). If adjustment of the motion of the affected limb is necessary (N in S15), the motion of the affected limb, specifically, the range of motion and the amount of exercise of the affected limb are adjusted (S16).

  If adjustment of the motion of the affected limb is unnecessary (Y in S15), or after adjusting the motion of the affected limb, rehabilitation is started (S17). In this embodiment, the necessity of adjusting the motion of the affected limb is determined after the necessity of adjusting the position / size, etc., but this process may be interchanged.

  After the rehabilitation for a predetermined time, it is determined whether or not the setting of the affected limb image is changed. If the setting is changed (N in S18), the registered image is updated (S19) and stored. In S1, in the case of a new image, instead of the update in S19, the patient P is newly registered with a unique ID (not shown).

  When there is no change in setting of the affected limb image (Y in S18), or when the registration is updated and registered, the rehabilitation is terminated (S20).

  The setting of the affected limb is at least the setting of the joint angle of the affected limb in the virtual space V, the length setting by extending or contracting the arm leg or limb of the affected limb in the longitudinal direction, and the width by expanding or contracting the affected limb in the short direction. The setting is performed in any one of the settings, and after displaying the set affected limb, the patient P is viewing the set affected limb, that is, after the start of rehabilitation, the joint angle setting, length The height setting and the width setting may be changed. By performing such an operation, at the start of rehabilitation, the affected limb corresponding to the image in the brain of the patient P can be forcibly moved closer to the healthy limb while the patient P is viewing, It is thought that the image in the brain approaches the movement of a healthy limb, provides good visual feedback, and contributes to pain relief.

  Here, in the rehabilitation, the patient P first superimposes the affected limb imaged in the brain on the position of the affected limb in the set virtual space V. Since the pain treatment support method according to the present invention reproduces the affected limb according to the image of the patient P in the virtual space V, the patient P assumes that the affected limb imaged in the brain is actually present. Visible. For this reason, compared with the method using the conventional virtual reality, it can concentrate on rehabilitation without a sense of incongruity, and a dramatic rehabilitation effect can be expected. Next, the healthy limb is moved in the real space while concentrating on the affected limb. In the virtual space V, the affected limb moves in synchronization with the movement of the healthy limb in the real space. Therefore, the image of moving the affected limb with attention to the affected limb is obtained, and the movement of the affected limb is followed. At this time, in order not to lose sight of the movement of the affected limb, the position of the head is not moved and the eye is moved as much as possible for tracking, and when there is a virtual mirror Vm, the affected limb and the virtual mirror in the virtual space V are detected. Exercise while moving while watching both affected limbs over Vm.

  By performing the training as described above, since the patient P can proceed with smooth rehabilitation, a high pain relieving effect can be expected.

  According to the said nonpatent literature 1, it has been reported that the effect of a pain relief by rehabilitation using this kind of system has a pain reduction effect of 32% by predetermined | prescribed pain index evaluation as mentioned above. This figure is the same as the conventional technique, in which the affected limb is not generated as the image in the patient's brain, that is, the affected limb is generated as an inverted image of the healthy limb, and the movable range of the affected limb is the same as the healthy limb. It is an evaluation when it is about. This evaluation becomes an index value of the pain alleviating effect. Here, when the pain treatment support system (method) according to the present invention is used, as shown in Table 1, 46% of the subjects obtained a pain relief effect of 30% or more, and more than half of them have a pain relief rate. It was 40% or more, greatly exceeding the index value.

  Moreover, as shown in Table 2, the pain index is reliably reduced by continuously using the pain treatment support system (method) according to the present invention. In addition, although the total value of the pain index temporarily increased from the 11th to the 14th training, a typhoon came at this time. In general, when a low pressure such as a typhoon approaches, the sympathetic nerve becomes stronger and the blood vessels contract. Due to blood vessel contraction, the calcium-centered mass at the end face of the affected limb further worsens blood circulation, increases muscle tension, and worsens blood flow, causing surrounding cells to become deficient in oxygen and accumulate bradykinin. The pain is said to increase. Therefore, the increase in the total value of the temporary pain index is considered an abnormal value in view of the overall tendency.

DESCRIPTION OF SYMBOLS 1 Pain treatment support system 11 1st detection part 12 2nd detection part 13 Virtual space generation part 14 Calculation part 15 Image generation part 16 Memory | storage part 17 Display part 18 Adjustment part V Virtual space Vh Virtual upper limb

Claims (11)

A pain treatment support system for providing visual feedback to a patient complaining of phantom limb pain, thalamic pain, or other neuropathic pain by using images of limbs generated in a virtual space,
Virtual space generating means for generating a virtual space in which the patient can stereoscopically view; and
Detecting means for detecting a limb body composed of an affected limb in the real space of the patient and a healthy limb facing the affected limb;
A calculation means for calculating the position and size of the detected limb so as to be recognizable in the virtual space;
Based on the calculated position and size, an image of the limb body is generated in the virtual space, and at least an affected limb that is asymmetric with the healthy limb and is perceived in the patient's brain. Image generation means to be set based on the main complaint or complaint;
Display means for displaying the movement of the affected limb corresponding to the movement of the healthy limb in the real space of the patient in the virtual space as a moving image based on the set image;
An adjustment unit that can adjust the image environment in the virtual space displayed by the display unit, the position and size of the limb, and the operation of the affected limb;
A pain treatment support system characterized by comprising:   The detection means includes, from among the limbs in the real space, at least a first detection means for detecting the position and size of the arm leg portion, and a second detection means for detecting the position and size of the limb portion. The calculation means calculates a position and size for reproducible reproduction in the virtual space from each detection result, and the image generation means calculates the calculated position and size. The pain treatment support system according to claim 1, wherein the images of the limbs are generated by synthesizing images of the arm legs and limbs.   The image data of the limbs generated by the image generation means has storage means for storing corresponding to ID data unique to each patient, and the image generation means stores image data stored in the storage means If there is an image, the corresponding image data is read by the ID data, and when there is a change in the main complaint or complaint of the patient, the image is reset and the image data to be stored in the storage means is stored. The pain treatment support system according to claim 1 or 2, wherein the pain treatment support system is updated as data.   The setting of the image generation means is at least the setting of the joint angle of the affected limb in the virtual space, the length setting by the longitudinal extension / contraction of the arm leg or limb of the affected limb, and the width setting by the lateral extension / contraction of the affected limb. The joint angle setting, length setting, and width setting can be performed at any time after the display of the set affected limb by the display means. The pain treatment support system according to any one of claims 1 to 3.   The adjustment of the motion of the affected limb by the adjusting means is a virtual reproduction of the motion of the healthy limb in the real space in the range of motion or momentum of the affected limb in the virtual space that operates in synchronization with the motion of the healthy limb in the real space. The pain treatment support system according to any one of claims 1 to 4, wherein the system is relatively restricted in relation to the range of motion or the amount of exercise of the healthy limb in the space.   Among the limbs, healthy limbs are virtual healthy limbs generated based on the predetermined data of the patient instead of real limbs in the real space, and the movement of the virtual healthy limbs is the limb breakage in the real space. The myoelectric potential signal is acquired at the end, and the movement corresponding to the acquired myoelectric potential signal is displayed in the virtual space as the movement of the healthy limb. The pain treatment support system according to 1.   The storage means stores data indicating the current position of the affected limb and the ideal position as a healthy limb, and the image generation means stores the current position and ideal position data from the storage means. 7. The readout apparatus according to claim 3, wherein the display unit displays the combined data in a visible manner in a superimposed manner so that both can be identified. Pain treatment support system. A pain treatment support method for providing visual feedback to a patient complaining of phantom limb pain, thalamic pain, and other neuropathic pain by using an image of a limb body generated in a virtual space,
Generating a virtual space in which the patient can stereoscopically view;
Among the limbs composed of the affected limb in the real space of the patient and the healthy limb opposite to the affected limb, the position and size of the arm leg are set as the first detection, and the position and size of the limb are set to the second. Detecting as detection;
Receiving the results of the first detection and the second detection, and calculating the position and size in order to reproduce each detected position and size in the virtual space so as to be visible;
The images of the arms and legs and the limbs of the calculated position and size are combined to generate an image of the limb in the virtual space, and at least asymmetric with the healthy limb, and the patient's brain Generating an image in which the affected limb perceived within is set based on the main complaint / complaint of the patient;
The movement of the affected limb corresponding to the movement of the healthy limb in the real space of the patient is displayed as a moving image in the virtual space based on the set image, and is set and displayed in the virtual space. Adjusting the position, size and movement of the affected limb;
A method for supporting pain treatment, comprising:   A step of storing the generated limb body image data in association with unique ID data for each patient, and when there is already stored image data, the corresponding image data is read by the ID data A step of resetting the read and displayed image when there is a change in the main complaint or complaint of the patient, and updating the reset image data as the stored image data The pain treatment supporting method according to claim 8, further comprising: a step.   The setting is at least one of a joint angle setting of the affected limb in the virtual space, a length setting by extending or contracting the arm leg or limb of the affected limb in the longitudinal direction, and a width setting by expanding or contracting the affected limb in the short direction. The joint angle setting, length setting, and width setting are changed while the patient is viewing the set affected limb after the set affected limb is displayed by the display means. The pain treatment support method according to claim 8, wherein the pain treatment support method is performed.   The adjustment adjusts the positional relationship between the environment in the virtual space and the limb body, and the relative range of motion of the affected limb that operates in synchronization with the motion of the healthy limb is relative to the range of motion of the healthy limb. The pain treatment support method according to any one of claims 8 to 10, wherein the pain treatment support method is defined as follows.