Training Simulation for Rehabilitating Motor Skills after Injury

Operating heavy equipment typically requires the coordinated use of both hands and feet to move levers, joysticks, steering wheels, and pedals.

For that reason, simulated work that “mimics” real work can truly help develop the skills required to operate heavy equipment [links to the blog categories “Simulation for Training” and “Developing Skills”]

But it’s also true that simulation intended for training, i.e. to help someone learn what to do, can be put to work for rehabilitation, i.e. to help someone “regain” motor skills after an injury.

This is especially important in the case of a Traumatic Brain Injury (TBI), because “regaining” motor skills now means helping the brain “re-learn” what to do, and that takes

• lots of repetition (drill and practice)
• detailed measurement, in order to track improvement.

In general, physical therapy targets regaining “gross” motor skills e.g. moving your body, whereas occupational therapy is focused on regaining “fine” motor skills e.g. using your hands [1].

In this blog post, we describe how one Occupational Therapist used Simlog’s “Hydraulic Excavator” Personal Simulator to help someone who suffered such a TBI.

Background

A modern snowmobile can weigh more than 600 pounds and travel at speeds over 90 miles per hour. Sadly, snowmobiling accidents are responsible each year for hundreds of deaths and thousands of injuries in North America. Excess speed, alcohol, driver inexperience, and poor judgment are the leading causes [2], and the accidents often lead to neurological injury [3].

The Patient

Before his snowmobiling accident, the patient, a middle-aged adult male, was an experienced excavator operator and owner of a construction industry company.  As a result of that accident, he suffered a traumatic brain injury (TBI) with severe cognitive and physical consequences.  In particular, operating an excavator was no longer possible because this requires the coordinated movements of two joysticks using both hands, and the patient had lost most of the use of his right hand.

About the Simulator-Based Occupational Therapy

For that reason, the Occupational Therapist chose Simlog’s “Hydraulic Excavator” Personal Simulator for rehabilitation, with a focus on regaining the use of that right hand, with the goal of eventually returning to work as an excavator operator. Here’s what the Occupational Therapist told us afterwards:

Overall, the Simlog Personal Simulator has been an effective tool in my patient’s rehabilitation, and the product was very focused or linked to our patient’s goals.  

The 12 Simulation Modules allowed us to start with short tasks, with opportunities for breaks in-between simulator sessions, and then move on to tasks that are more continuous in nature and take longer to perform. The simulation results were used to track progress without difficulty.

In this way, my patient was especially motivated to practice tasks that he would (once again) perform when he returns to work.

In particular, because operating the simulated excavator requires the coordinated movements of both the left and right hands, he became more confident (over time) about using his right hand, and increased the regular use of his right hand in other daily functional activities (such as eating). 

More generally, the Personal Simulator provided a meaningful activity for my patient that helped him increase the amount of time he could concentrate on the simulated work that resembled his real work tasks.  

Outcome

According to the Occupational Therapist, the patient regained enough mobility after just 6 weeks with the Personal Simulator to be able to complete the simulated tasks with sufficient speed and accuracy. This was made possible thanks to

• the 37 unique Performance Indicators built into the Simlog simulation software that together comprehensively evaluate the simulated work
• target values (benchmarks) for those Performance Indicators as provided by Simlog for typical operator training

In this way, the patient was able to “track” his ongoing improvement (in 37 different ways) while keeping “in sight” the final “goal”, i.e. how well the simulated work “ought” to be done by a new operator getting ready to “graduate” to real work.

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References

[1] Magill, R., Anderson, D., Motor Learning and Control: Concepts and Applications, McGraw Hill, 12^th edition, 2021.

[2] “Snowmobile Injuries in North America”,  Clinical Orthopedics and Related Research, 2003.

[3] Plog, B. et al, “Neurologic Injury in Snowmobiling”, Surgical Neurology International, 2014.