Opportunities of Markerless Motion Detection Systems for Use in Neurological Rehabilitation: A Qualitative Study on Patient and Therapist Perspective

Research Article

Austin J Robot & Autom. 2015; 2(1): 1009.

Opportunities of Markerless Motion Detection Systems for Use in Neurological Rehabilitation: A Qualitative Study on Patient and Therapist Perspective

Knippenberge¹* and Spoorena1,2

¹PXL-Healthcare, PXL University College, Guffenslaan39, Belgium

²Faculty of Medicine, Hasselt University, Belgium

*Corresponding author: Knippenberge, PXLHealthcare, PXL University College, Belgium

Received: November 10, 2015; Accepted: december 28, 2015; Published: december 31, 2015


Background: Markerless motion detection systems such as Microsoft Kinect are promising systems in client-centered task oriented training in central nervous disorders, but therapists and patients have specific expectations and requirements for use in rehabilitation. Therefore the aim of this study is to assess expectations and requirements of therapists and patients towards the use of Microsoft Kinect in neurological rehabilitation.

Methods: A qualitative design was used in which seven focus groups were performed with patients with neurological disorders (n = 15) and physio- and occupational therapists (n = 22) in four rehabilitation centres. The grounded theory was used to analyse data.

Results: Two main themes were identified: knowledge-use-experience and expectations and requirements. It was found that knowledge, use and experience cannot be separated as they are connected. Therefore, to use Microsoft Kinect in rehabilitation, people need knowledge and experience with the system. In order to be useful in rehabilitation, Microsoft Kinect system needs to be easy to use independently, easy to set up, low cost and small. The system should also provide patients and therapists with feedback of their performance and/or results.

Conclusions: As knowledge and experience with Microsoft Kinect are very important before and during first use, it seems important to inform therapists and patients about the advantages of Microsoft Kinect as opposed to robotic devices or marker-based motion detection systems. By integrating the expectations and requirements in future research, opportunities are created for using Microsoft Kinect into a new client-centered task oriented system in upper limb neurological rehabilitation.

Keywords: Motion detection system; Nervous system diseases; Rehabilitation; Qualitative research; Opportunities


Central nervous system diseases such as stroke, multiple sclerosis (MS) and spinal cord injury cause serious impairment of the upper limb. The motor, sensory and cognitive impairments that occur in the upper limb, affect the performance of activities of daily life, sports and leisure activities. More specifically, they reduce functional independence and thus the quality of life of the individual.

Studies [1,2] have shown the importance of upper limb rehabilitation in the early stages after injury. Furthermore, these studies provided evidence that a task-oriented client-centered approach in upper limb rehabilitation is more beneficial than treatment as usual. However, a task-oriented client-centered approach needs more individualized therapy and is therefore more time consuming and costly for therapists and rehabilitation centres. Hence a new approach is needed to be able to administer task-oriented client-centered therapy in neurological rehabilitation without extra costs and therapists.

Technology-based systems, such as robotics and motion detection systems, are promising. Robotics have gained acknowledgement as it is indicated that robotic therapy can improve long term effects on motor-control aspects (e.g. muscle activation patterns) [3]. But robotics is also very expensive, is often complex in set up and need more space. Also, users need specific knowledge and/or skills to be able to work with the robotic device. Motion detection systems might counteract the disadvantages reported in robotics [4,5].

Motion detection systems have been used for some time. The traditional marker-based system, that is considered as the goldstandard and known as VICON, is predominantly laboratory based. For this system, the therapist needs detailed knowledge of anatomy, knowledge of how the system works and experience with the system. On the other hand there are Markerless systems, such as the Microsoft Kinect sensor for use with Xbox360. This system can be used immediately after setup, without specific knowledge or skills. Studies have demonstrated good level of agreement between VICON and Microsoft Kinect with regards to valid assessment of postural control movements and reproducibility of functional assessment in upper and lower limb [4,5,6].

Although Markerless motion detection systems such as Microsoft Kinect have a lot to offer in rehabilitation settings, adapted applications regarding the usefulness of these systems in upper limb neurological rehabilitation are scarce, as well as research. To gain insight into the opportunities of the Microsoft Kinect in upper limb neurological rehabilitation, the expectations and requirements of the Microsoft Kinect according to the users in neurological rehabilitation need to be known. Therefore the aim of this study is to assess the expectations and requirements of Microsoft Kinect according to users, patients as well as therapists, to be used in rehabilitation. These expectations and requirements will be taken into account for further development of the system within neurological task-oriented and client-centered upper limb rehabilitation.


A qualitative design was used to analyse data obtained from a series of focus groups in which semi-structured interviews were performed with 1) patients with neurological disorders and 2) occupational- and physiotherapists in four different rehabilitation centres. Participants were asked questions with regards to general use of technology in daily life, use of technology in rehabilitation setting and use of Microsoft Kinect in rehabilitation. In order to familiarize participants with the Microsoft Kinect, a demonstration was shown with self-made examples, during the focus groups. All focus groups were audio-recorded and led by the same moderator.

Patients were included when diagnosed with multiple sclerosis, stroke or spinal cord injury. Therapists had at least two years of experience in neurological rehabilitation. For each group (i.e. patients versus therapists) a separate, but similar interview guide was made. Approval of the appropriate ethical committees was fulfilled and informed consent was obtained from all interviewed subjects before participation.

Qualitative data analysis was conducted using grounded theory [7]. The audio recordings of the semi-structured interviews of the focus groups were transcribed ad verbatim before coding was performed. Open coding on the transcripts followed the structure of the focus group and interview guides. Axial coding was applied, on themes arising from the open coding. Then a comprehensive thematic analysis scheme was prepared (selective coding) before reviewing the scheme and cross-checking the findings against the original transcripts to confirm the findings.


Firstly, a short representation of the characteristics of participants will be given. Then the main results will be presented regarding the two main themes that were identified after coding: 1) the triangle of knowledge-use-experience and 2) expectations and requirements of the markerless motion detection system Microsoft Kinect (Figure 1).

Citation: Knippenberge and Spoorena. Opportunities of Markerless Motion Detection Systems for Use in Neurological Rehabilitation: A Qualitative Study on Patient and Therapist Perspective. Austin J Robot & Autom. 2015; 2(1): 1009. ISSN:2471-0407