Using dance for stroke rehabilitation

The ABC’s 7.30 program recently featured a unique clinical collaboration between UniSA and the Australian Dance Theatre in which visual special effects from the hit show Proximity were adapted for use by people undergoing rehabilitation for stroke or brain injury. We asked Associate Professor Susan Hillier about the project and the response. 

What is the idea behind this project? What are you trying to achieve?

The idea is to use this augmented visual feedback to engage people during movement rehabilitation. Basically if you get better feedback about what you are doing it helps you improve your performance. So if people with stroke and head injury get this novel visual information about where they are in space and how they are moving they can start making internal corrections and improvements.

It made terrific television. What has been the response since then, both from within rehabilitation circles and elsewhere?

The response was overwhelmingly positive. The visual feedback is so engaging and intriguing; it gets people hooked and wanting to participate. It has reminded us that if something is visually appealing and fun it makes a difference. The two concepts not always present in standard rehabilitation!

Most importantly, has anything happened to help take things further?

We have the equipment set up at the UniSA Physio clinic and people have been coming in to try. We have added some ideas where people get the visual feedback during their movement and then close their eyes and try to reproduce the patterns and then they can visually check what they “felt” against what really happened.

The idea of using video technology to provide visual feedback seems at once ingenious yet obvious.

Video feedback has been used a lot in rehabilitation using normal playback features, as has using a mirror for immediate feedback. We are quite intrigued about why these special effects with enhanced imagery and ghosting are so much more interesting for people. We think it is because it is interactive and high in contrast – the person is centre stage and as large as life therefore very easy to attend to visually. The fun and novelty aspect can’t be ignored either.

It is interesting that the idea actually came from the ADT’s artistic director Garry Stewart. What were he and his team, including dancers, able to bring to the project?

Garry and his team were able to bring in a perspective of what it “felt” like to use the visual imagery and how they used it to improve their own body awareness and therefore performance. It was really refreshing for Garry and I to see the similarities in our work – he is helping dancers “move better” and I am helping people with stroke to “move better”. It’s the same process at different ends of the spectrum. I know the dancers were quite inspired by the people with stroke working so hard to get better and they similarly felt a kind of common process to share.

How much tweaking was needed along the way?

Part of the partnership was that Thomas Pachoud – the video engineer – also attended the trial sessions. So we could make suggestions around the effects and he could reprogram either then and there or go away and come up with whole new ideas. Working together we could both understand both what was possible for the clients and what was possible for the technology. A great process of action research.

What stage is the research at now? And what are the next steps?

As well as trialling the processes at the UniSA clinic I am gathering more definitive data – we have interview data from the first trial. Now I need to get performance data to motivate for perhaps a pilot grant or more…..

Is the ADT’s involvement ongoing?

ADT are keen to continue. After this 6-month trial period we will meet again and work out the next stages in terms of research and development.

How does this project fit in with the broader work you are doing at UniSA on rehabilitation?

My long-term rehab agenda has been to explore better ways to promote recovery after stroke and brain injury – this means how do we foster positive neuroplasticity (change in the brain). In particular I have always been interested in achieving this not only through practice but through enhanced feedback, with the idea that if you have more awareness, more internal feedback, you can learn at a better level by correcting during practice.

Are we making progress in this field? How has thinking around rehabilitation changed over the years?

Training or enhancing sensory feedback has slowly taken a cameo place in rehabilitation but is not routinely used; people still focus mostly on repetition. We are starting to see more uptake in chronic pain and stroke but not elsewhere.

What will the focus be in the years ahead?

Continuing to explore both the effects of these approaches on people’s ability to function independently after catastrophic injury or illness, as well as trying to understand the mechanisms of change in the brain itself that underpin these improvements.