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CHAPTER 1

INTRODUCTION

This chapter consist of four part; problem background, objective, scope and
significance of the study.

Problem background explain the severity of stroke.

Objective of this study clarified two objective of the study. Scope of the study describe
the limitation of this study and the contribution of this study is enlighten in part four;
significance of the study.

1.1

Background of the Problem

Stroke is the third largest cause of death and the most common cause of severe
disability in Malaysia. Statistic from National stroke association of Malaysia show
that every year 40,000 people suffer from stroke. Everybody ranging from children to
adult has the potential to get stroke. The mean age of stroke patients in Malaysia is
between 545 and 626 years (Loo & Gan, 2012).

Stroke is a condition whereby blood vessel to the brain is blocked or ruptured,


which will cause brain tissue damaged because of lack of oxygen. When that part of

2
brain tissue dies the function of that brain tissue will be lost. Fainting, unconsciousness
and/or weakness of limbs are main stroke symptoms.

The World Health Organization estimates that in 2001 there were over 20.5
million people suffer from strokes worldwide, 5.5 million of these were fatal. (Dr. A.
Khalek Abd. Rahman, 2012). In Kuala Lumpur Hospital, 1000 stroke cases are seen
per year with 30% - 35%, deaths due to stroke (Nurul Aini HM, Aniza I, 2007).

Based on a study comprised of 49 patients (28 men, 21 women) with a mean


age of 60.2 (range 3580) years. The mean total cost for post stroke treatment in
Malaysia was RM 2352.53 (USD 547.10), of which 36.6% was spent on attendant
care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and
8.5% on out-of-pocket expenses (Akhavan Hejazi, Mazlan, Abdullah, & Engkasan,
2015). 60% of Malaysian population monthly gross income raging from RM 1,760 to
7,049. Workers in rural area population received between RM 1,760 to RM 3,729 per
month (Malaysian Economic Planning Unit, 2014). .Taking into consideration that this
amount did not include expenses such as car loan repayment, house loan repayment,
personal expenses and compulsory contribution such KWSP, LHDN etc., net income
will be lower, this situation will increase their burden in order to get proper treatment
in hospital.

Stroke rehabilitation consist of daily routine physical exercise under the


guidance of physiotherapists. Rehabilitation is used to reduce the disability cause by
the stroke. Rehabilitation activity aim is to help the stroke survivors to learn how to
use their affected part of the body through exercise.

The main focus of rehabilitation activity is to improve the stroke survivor


ability to move their affected limbs as fast as the unaffected limbs move. Several
studies show that the recovery speed be can increase by increasing the duration of
rehabilitation activity. Thus there is a necessity for home-based rehabilitation games

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which can help and inspire patients to do exercises related to therapy in the comfort of
their home (Sanjay Saini, Dayang Rohaya Awang Rambli, Suziah Sulaiman, Zakaria,
& Zakaria, 2012).

Cost in this project, referring to the initial cost needed to set up the
rehabilitation system; the computer hardware system.

1.2

Objective of the study

This project objective is


i.

To develop a low cost game based rehabilitation system as a tool which


can be used as a part of post stroke rehabilitation activity to help stroke
survivor to regain their hand and arm movement ability.

ii.

To develop a monitoring system that allows the rehabilitation process


to be monitored.

iii.

1.3

To test the system clinically at Hospital Sultan Ismail.

Scope of the study

The scope of study is


i.

The rehabilitation will be focus on the rehabilitation of the upper limb


movement of patient with stroke.

ii.

The system can be executed using computer or laptop and mouse as the
graphical user interface.

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iii.

The system will be developed using OpenGL and C++ programming


language.

iv.

Clinical testing will be conducted to verify the effectiveness of the


system.

1.4

Significance of the study

Population of people suffering stroke is increasing dramatically every day.


Even though good treatment program will increase the probability of gaining their
normal live back, not all stroke survivor can afford the treatment cost. Inflation has
the decrease the value of money and increasing the cost for stroke rehabilitation
treatment. This situation led to various research on designing a low cost rehabilitation
system which will provide an option to current rehabilitation treatment.

The

effectiveness of rehabilitation process not solely depending on physical exercise, the


most important aspect is stroke survivors must have a strong believe that they still have
the ability to recover their movement ability and memory. This software will allow
stroke survivors to monitor their own rehabilitation progress and increasing their
motivation. This software will also provide the therapist with numerical evidence to
evaluate their therapy program effectiveness.

CHAPTER 2

LITERATURE REVIEW

This section consists of 11 section. This chapter objective is to provide basic


theoretical background underlying behind this project. Section 2.1 contains brief
description of stroke classification, causes and consequences. Section 2.2 describes
the importance of after stroke recovery treatment and factors that affect the rate of
stroke patient recovery speed. Section 2.3 explain several hand and arm disability
cause by stroke. Section 2.4 contains a general description of how recovery after a
stroke can be carried out at home. Section 2.5 describes how computer games can be
used as part of the activities of after stroke recovery. Section 2.6 and 2.7 clarify the
definition of virtual reality and virtual rehabilitation. Section 2.8 and 2.9 contains
basic information related to computer graphics and how the image is produced by a
computer software. Section 2.10 and 2.11 contained basic information on how the
computer mouse can be used to measure distances hand movements.

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2.1

What is stroke?

Stroke is one of the deadly disease in Malaysia; one of top five major causes
of death and one of the top ten causes for hospitalization in Malaysia (Loo & Gan,
2012). Every year 40,000 people diagnosed with this deadly disease (National stroke
association of Malaysia, 2015). Hospital Kuala Lumpur record show that 30% to 35%
from 1000 patient treated for stroke will end with death (Nurul Aini HM, Aniza I,
2007). Even though in Malaysia most of the stroke patient age are between 54 to 65
year (Loo & Gan, 2012); everybody have potential to get stroke, including children
and babies.

Considering all this fact, research regarding stroke prevention and

rehabilitation is very crucial.

Stroke occurs when blood flow to the brain is blocked. Blood supply essential
nutrient and oxygen to the brain. Insufficient blood supply will cause brain cell
damages and lead to lose control of human body. Stoke effect varies from one person
to the others depending on the location and degree of brain tissue damage, stroke
survivors are likely to suffer cognitive, visual and motor losses. Stroke is divided into
two type as shown in Figure 2.1:

Ischemic strokes; caused by blood clots.

Haemorrhagic strokes; caused by bleeding in or around the brain.

Figure 2.1: Type of strokes

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Ischemic strokes account for 87 percent of all strokes. Ischemic stroke happen
when there is a blood clot that blocks blood flow to a part of the brain. Ischemic stroke
occur when:

Plaque reduce the blood flow to neck or brain. Plaque is a combination


of fat, cholesterol and other substances that build up in the inner lining
of the artery walls. This condition is often referred to as atherosclerosis,
or "hardening of the arteries."

In some situation the plaque origin is from some other part of the body.
When this plaque breaks, the fragments may travel to the brain and
disrupt the blood flow. This is called embolism.

Haemorrhagic strokes occur when a weakened blood vessel in the brain breaks
and bleeds into surrounding brain tissue. This puts too much pressure on blood cells
in the surrounding tissue, cutting off their blood supply and causing damage. About
13 percent of all strokes are haemorrhagic strokes.

The effects of a stroke depend primarily on the location of the obstruction and
the extent of brain tissue affected. Human brain is divided into two hemisphere; right
brain and left brain. Right brain control the left side of human body and the left brain
is responsible for right side of human body.

As one side of the brain controls the opposite side of the body, a stroke
affecting one side of the brain will result in nerve system problems on the side of the
body it affects. For example, if the stroke occurs in the brain's right side, the left side
of the body and the left side of the face will be affected, which could produce any or
all of the following:

Paralysis or weakness on certain part of the side of the body such as hand, arm
and leg.

Vision problems.

Quick, inquisitive behavioural style.

Memory loss.

If the stroke occurs in the left side of the brain, the right side of the body will
be affected, producing some or all of the following:

Paralysis on the right side of the body.

Speech/language problems.

Slow, cautious behavioural style.

Memory loss.

Stroke can affect both sides of the body or may leave someone in a locked-in
state. Stroke patient with locked-in state will lost their ability to speak or achieve any
movement below the neck. The effect of stroke varies depending on the severity of
human brain damage.

Certain environmental factors, medical conditions, and lifestyle habits increase


the risk of stroke. Some risk factors can be treated or controlled, while other risk
factors cannot (Lindsey Konkel, 2015). Factors that cannot be changed include:

Family history; Stroke often runs in families. Stroke risk may be higher if a
grandparent, parent, or sibling has suffered a stroke in the past.

Age; stroke is most common in adults over the age of 65. According to the
American Stroke Association (American Stroke Association, n.d.); the chance
of having a stroke doubles for each decade of life after 55.

Gender; women have more strokes than men, and strokes kill more women
than men each year.

Race; African Americans, Hispanics, American Indians, and Alaska Natives


have a higher risk of stroke than non-Hispanic whites or Asians.

Personal history of a previous stroke.

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Stroke risk factors that can be prevented or controlled include:

High blood pressure; high blood pressure is the main risk factor for stroke. It
can damage and weaken arteries throughout the body so that they burst or clog
more easily.

High cholesterol; cholesterol is a fatty substance that contributes to plaques in


the arteries that can block blood flow to the brain.

Heart disease; coronary artery disease, the build-up of plaque in the arteries,
can increase your risk of stroke. So can other heart conditions, including heart
valve defects and irregular heartbeat (atrial fibrillation).

Diabetes; people with diabetes are four times as likely to have a stroke as
people without diabetes.

Certain lifestyle habits and conditions can also increase risk of stroke. These
risk factors include:

Smoking.

Poor diet.

Obesity.

Low physical activity.

Stress and depression.

Heavy alcohol use.

Use of illicit drugs, including cocaine and amphetamines.

Person who survive from stroke known as stroke survivor. Stroke survivor is
classified as disable people. In this study, disability is define as difficulty to perform
something that is a normal part of daily life. Stroke survivors will have difficulty to
perform activities of daily living (ADL) such walking, talking, eating, and taking
care of the daily activity such as using toilet, wearing dress and bathing. Furthermore
they will lost the ability to perform instrumental activities of daily living (IADL),
such as housekeeping, using the telephone, driving, and using computers. Treatment
for stroke complications usually involves a combination of therapy and medication.

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2.2

Stroke Recovery and Rehabilitation

Brain injury due to stroke can change the way people move, feel, think, or
speak. The effects are greatest right after the stroke. Over time, most stroke survivor
will make improvements. Rehabilitation helps stroke survivors relearn skills that are
lost when part of the brain is damaged. The stroke rehabilitation objective are to help
stroke survivors live as independently as possible while adjusting to new limitations.
For example, these skills can include coordinating leg movements in order to walk or
carrying out the steps involved in any complex activity. Rehabilitation also teaches
survivors new ways of performing tasks to circumvent or compensate for any residual
disabilities. Individuals may need to learn how to bath and dress using only one hand,
or how to communicate effectively when their ability to use language has been
compromised. Figure 2.2 show three important element in any rehabilitation program;
carefully directed, well-focused, and repetitive practice, same method used to learn a
new skill, such as playing the piano or pitching a baseball.

Repetitive
practice

Wellfocused

Carefully
directed

Figure 2.2: Stroke rehabilitation program implementation strategy

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Rehabilitation therapy begins in the acute-care hospital after the persons
overall condition has been stabilized, often within 24 to 48 hours after the stroke. The
first steps involve promoting independent movement because many individuals are
paralyzed or seriously weakened. Patients are prompted to change positions frequently
while lying in bed to engage in passive or active range of motion exercises to
strengthen their stroke-impaired limbs. Depending on several factors such as the
extent of the initial injury; patients may progress from sitting up and being moved
between the bed and a chair to standing, bearing their own weight, and walking, with
or without assistance. Rehabilitation nurses and therapists help patients who are able
to perform progressively more complex and demanding tasks, such as bathing,
dressing, and using a toilet, and they will encourage patients to use their strokeimpaired limbs while engaging in those tasks. Beginning to reacquire the ability to
carry out these basic activities of daily living represents the first stage in a stroke
survivor's return to independence.

For some stroke survivors, rehabilitation will be an ongoing process to


maintain and refine skills and could involve working with specialists for months or
years after the stroke. The types of therapy will depend on which parts of the brain
were damaged. Stroke survivors may require:

Speech therapy.

Physical therapy and strength training.

Occupational therapy (re-learning skills required for daily living).

Psychological counselling.

Physical and occupational therapy involved a structured activity designed to


regain the ability lost due to stroke by encouraging the use of the affected parts of the
body through repeated motion. Conventional therapy require the stroke survivors to
preform repeated motions under the supervision of the therapist in a one on one
session. Therapy activity is design to suit the stroke survivor capability. The goal is
to get the patients to move their affected limbs as easily as they move their unaffected
limbs.

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Recovery of the upper limb such as hand and arm has a slower progression and
is usually gained through outpatient and home therapy (van der Lee et al., 1999).
Upper limb stroke survivor recovery process start with regaining their ability to move
their shoulder, arm, wrist and hand.

2.3

Post stroke upper limb rehabilitation

Most stroke survivor will suffer weakness or lost ability to upper limb or arm.
Arm movements are produce by moving a group of muscle groups together and this
movement is coordinated by brain. Collaboration between muscles is known as
synergies. Stroke will reduce the coordination between the brain and body, as a
result the muscle synergies will move in abnormal patterns. Normally only one side
of the body will be affected. Stroke can affect stroke patient arm in several way:

Weakness.
Stroke survivors may completely paralyzed or their shoulder, elbow wrist
and/or hand may be weak. This condition will lead to difficulty in reaching,
picking things up or holding onto things.

Coordination problems.
Stroke survivor may have difficulty to plan or coordinate the movements of
their arm; arm doesnt move in the way that they want it to.

Changes in muscle tone.


Stroke survivor with high tone known as hypertonia or spasticity will suffer
stiff or tight muscles. Stroke survivor with low tone called hypotonia, will
suffer floppy or loose muscles.

Subluxation.
Weakness or low tone may allow the top of stroke survivor arm to drop out of
the shoulder socket slightly. This makes arm movements difficult and can be
painful.

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Contracture.
Weakness or high tone may make stroke survivor muscles shorter or joints less
flexible. This makes movements difficult and can be painful.

Arm skate, cone stacking and picking marble are equipment which is
frequently use at occupational therapy unit. Stroke survivor has to repeat the same
activity for 15 20 minutes in one session. Normally in one session a therapist is
required to monitor two or three patient at the same time. Study done by a group
researcher from Taiwan reveal that even though these equipment can produce the
expected outcome there are several weakness such as easy to lose focus because of
boredom, no difficulty setting and no movement record (Huang, Lee, Hsieh, & Chen,
2013).

2.4

Home base rehabilitation

Home based rehabilitation is special therapy program design to suit the stroke
survivor needs. Rehabilitation process will be carry out at the patient house. In current
practice a special team will be form to monitor this program.

Home based

rehabilitation objective is to improve the ability of the stroke survivor to carry out daily
living activity such as grooming, toileting, and other forms of self-care, household
and other day-to-day tasks, as well as leisure activities.

Home based rehabilitation will reduce the frequency of visit to the clinics, this
approach will help stroke survivor reduce their expenses. Due to the low-cost and
availability of the rehabilitation, the therapy could continue until the individual was
satisfied with their ability to independently perform activities of daily living. The
home-based rehabilitation would include an engaging interaction, such as a game, to
maintain the individual's interest (Reed, Ismet Handzic, & Samuel McAmis, 2014).

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Movement activity can be recorded using video or log file. These data can be used by
therapist to evaluate the stroke survivor achievement and can be used to plan further
rehabilitation activity.

2.5

Game based rehabilitation

Combination of conventional rehabilitation and games based activity has


shown significant effect in improving stroke survivor rehabilitation performance.
Various games has been integrated into stroke rehabilitation activity ranging from a
simple card and board game, commercial computer base game, and customised
computer games. Matching the game to the specific deficit is a key to rebuilding lost
skills. Game is use to reduce stroke survivor weakness and increase their confident
level. Crossword puzzle game can be used to overcome memory deficit. Jigsaw
puzzle can increase memory and motor skill ability.

Beside conventional therapy, some therapist include commercial activity


promoting gaming systems as a part of their rehabilitation programs. Commercial
activity promoting gaming systems provide a potentially attractive means to facilitate
exercise and rehabilitation (Matthew J. D. Taylor, McCormick & Teshk Shawis,
Rebecca Impson, 2011). The Nintendo Wii, Sony Eye Toy, Dance Dance Revolution,
and Xbox Kinect are examples of gaming systems that use the movement of the player
to control gameplay.

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2.6

Virtual reality technology

Virtual reality was first introduced by Jaron Lanier in 1987. Virtual reality also
known as Synthetic Experience, Virtual Worlds, Artificial Worlds or Artificial Reality.
Different name propose different definition, but all researcher agree that VR is an
interactive and immersive experience in a simulated world (Mazuryk & Gervautz,
1996).

Virtual reality allow user to explore a three-dimensional (3D) world produced


by computer system.

3D Images will change continuously depending on the

orientation and input provided by the user (Wiederhold, 2006).

Virtual reality

experience varies from non-immersive to fully immersive depending on the degree to


which the user is isolated from the physical surroundings when interacting with the
virtual environment (Saposnik & Levin, 2011). Visual in immerse virtual reality is
supply through head-mounted display. Their view of the virtual world is controlled
through head movements. The virtual environment is seen at full-scale. Non-immerse
virtual reality refers to all systems that do not involve the use of head-mounted displays
to control the user's view of the virtual environment. Instead, users view the virtual
environment on a two-dimensional flat screen, and interact with it through a variety of
motion-detecting interfaces.

Virtual reality experience consist of four key element virtual world, immersion,
sensory feedback and interactivity. A virtual environment is a real world environment
simulation created using computer software and is experienced by the user through a
human machine interface. In the real world human use eyes, nose, ears and skin to
detect changes in their environment, same principle applied in virtual world,
information about environmental changes in virtual world is send to the user senses
using human machine interface such as head mounted display (HMD) and data glove.
Virtual reality device create a feeling of being inside and a part of virtual world, this
experience is known as immersion. Sensory feedback refers to the ability of virtual

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reality system to react to user movement. Interaction is defined as the ability of the
user to move and interact with object in virtual world.

Virtual reality has a wide range of application in various field such as military,
education, entertainment, fashion and engineering. Virtual reality has become an
important tools in medical training and treatment process. Virtual reality allow
medical student to perform virtual surgery and reduce the effect of trial and error
during learning process.

Limited number of rehabilitation centre and high treatment cost has motivated
many researcher to develop game based rehabilitation. Games based rehabilitation
offer a cheaper rehabilitation therapy for stroke survivors. Virtual reality can also be
integrate with robotic technology to perform robotic surgery. This surgery will be
controlled by human surgeon but the surgery is done by robotic arm to reduce error.

2.7

Virtual rehabilitation

Rehabilitate is originate from Latin word "habilitas", means to make able


again. Rehabilitation does not reverse or undo the damage caused by an injury or
illness, but rather helps restore the individual to optimal health, functioning, and wellbeing. Virtual rehabilitation is a process which combining virtual reality (VR)
hardware and simulation in improving the effect of rehabilitation process (Burdea,
2002).

Virtual reality provide interactive simulation which the users has the

opportunities to engage in environments that appear and feel similar to real world
objects and events (Sheridan, 1992). VR allows the Users to interact with displayed
images, move and manipulate virtual objects and perform other actions in a way that
attempts to immerse them within the simulated environment thereby engendering a
feeling of presence in the virtual world (Weiss, Kizony, Feintuch, & Katz, 2006).

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Rate of success in virtual rehabilitation is affected by three fundamental factor
as shown in Figure 2.3; repetition, feedback and motivation (Maureen K. Holden,
2005). Repetition play important role in rehabilitation process. Repeating the same
movement for several time will increase the movement speed. Repetition drawbacks
is unmotivated, when same movement is repeated for a long time, it will cause
boredom. Repetition must accompanied with motivation. The repeated practice must
be linked to incremental success at some task or goal. This can be achieved by setting
different level of difficulty and feedback system.

Feedback
Repitition

Motivation

Succes virtual
rehabilitation
Figure 2.3: Virtual rehabilitation success factor

The use virtual rehabilitation as a part of stroke survivor rehabilitation program


has positive impact in improving the stroke survivor upper limb and ADL function.
Virtual rehabilitation provide an enjoyable rehabilitation tool and has the ability to
increase stroke survivor confidence to regain the hand arm movement ability (Laver,
George, Thomas, Deutsch, & Crotty, 2015).

Most researcher use haptic equipment such as data glove to simulate 3D


environment. Virtual person known as avatar or virtual person is used to represent
user in the virtual world. Several game based on daily activities such as pick and place,
bowling game and water pipeline fixing has been simulated. Table 2.1 listed several
research on virtual rehabilitation.

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Table 2.1: Previous virtual rehabilitation research
Title
Year Detection Method
Researcher
A Virtual Reality Based 2004
CyberGlove and a Adamovich, Merians,
Exercise System for
Rutgers Master
Boian,Tremaine, Burdea,
Hand Rehabilitation
II-ND haptic
Recce and Poizner
Post-Stroke
glove.
The Rehabilitation
2009
Vision based
Mnica, Bermde, Esther
Gaming System: a
tracking system
and Paul.
Review
A study to evaluate a
2010
Virtual glove
Penny, David, Steven,
low cost virtual reality
Marion, Louise, Andy,
system for home based
Fran, Kate and Andy
rehabilitation of the
upper limb following
stroke
Interactive
2013
Microsoft
Nahid, Mindy, Joyce and
Virtual Reality Game
Kinect
Philippe.
based Rehabilitation
camera
for Stroke Patients
Glove Based Virtual
2014
Data glove
Aswad , Khairunizam,
Reality (VR)
Nazrul, Shahriman, Hazry
Interaction for the
and Zuradzman
Purpose of
Rehabilitation
Game-based virtual
2015
Low cost camera Ngoc Bien Pham
rehabilitation system
for upper extremity
using low-cost camera

Two major obstacle in implementing virtual rehabilitation is high cost and


require high technical skills (Jonathan Halton, 2008). To overcome this limitation,
low cost home base virtual rehabilitation system has become a popular topic in virtual
rehabilitation research, the aim of this system is to design a low cost rehabilitation
games which will allow stroke survivors to practice their rehabilitation activity in
comfort of their home. In early stage, most of virtual rehabilitation game use data
glove as input devices, data glove allow the program to record the hand movement and
finger flexure effectively. As the cost of glove is expensive, researcher seek a lower
cost alternative. Nowadays, many researcher use low cost camera to detect hand
movement. This project will use an optical mouse as input device.

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2.8

Computer graphics system

A computer graphics system consist of six main element as shown in Figure


2.4.
1. Input devices.
2. Central Processing Unit.
3. Graphics Processing Unit.
4. Memory.
5. Frame buffer.
6. Output devices.

Most graphics systems contain a keyboard and a pointing device. The most
common pointing devices are the mouse, joystick and data tablet. Each pointing
device equipped with one or more buttons.

Pointing device provide positional

information to the processor.

Central
processor

Graphic
processor

CPU
Memory

CPU
Memory

Frame
buffer

Figure 2.4: Computer graphic elements

Before optical mouse was invented, mechanical mouse is use as a pointing


device. A mechanical mouse is a computer hardware input device comprised of a

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metal or rubber ball in its underside. Moving the mouse causes the ball to roll, and
sensors inside the mouse detect the movement of the ball and consequently send
signals to the cursor on the screen. Mechanical mouse use a pair of encoders to send
two orthogonal direction information to processor. Central processing unit (CPU) will
convert this information into a convenient coordinate system and use it to produce
graphics or execute specified action define by the computer program.

Graphics processing unit (GPU) is used to produce 3D image. Graphic system


produce of a group of picture elements, or pixels know as image. Pixel are stored in a
frame buffer; a part of computer memory. Computer memory act as a brain in
computer system. Frame buffer is an area of computer memory used to hold the frame
of data that is continuously being sent to the screen. Each pixel corresponds to a
location or small area, in the image. Pixel or picture element as shown in Figure 2.5
is one coloured dot on the screen.

Figure 2.5: Computer graphic pixel

Resolution refer to number of pixel in the frame buffer, resolution determines


the detail of an image display on screen. Computer display resolution refers to the
number of pixels that can be displayed on a computer screen, computer display
resolution is expressed in terms of the number of pixels on the horizontal axis and the
number of pixel in vertical axis. For example, monitor with 1366 x 768 resolution,
width is 1366 pixel and height is 768 pixel. Dots per inch (dpi) or maximum number
of dot in one inch is a measure of the sharpness or the density of illuminated points on
a display screen. Most computer screen have a resolution of 72 or 96 pixels per inch.

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Processor function is to assign values to the pixels in the frame buffer that best
represent the entities based on the specifications of graphical primitives such as lines,
circles, and polygons, generated by application programs. For example, a triangle is
specified by three vertices, but to display a triangle is outline by the three line segments
connecting the vertices, the graphics system must generate a set of pixels that appear
as line segments to the viewer. The actual drawing or filling in of the pixels between
each vertex to make the lines is called rasterization or scan conversion.

In early graphics systems, the frame buffer was part of the standard memory
that could be directly addressed by the CPU. Today, virtually all graphics systems are
characterized by special-purpose graphics processing units (GPUs), custom-tailored
processing unit to carry out specific graphics functions. The GPU can be embedded
either on the mother board of the system or on a graphics card. The frame buffer is
accessed through the graphics processing unit and usually is on the same circuit board
as the GPU.

2.9

Interactive computer graphic

Interactive computer graphic can be define as a computer system that allows


user to interact with the graphical information presented on the display using one or
more input devices. Interactive computer graphic was introduced by Ivan Sutherland.
Figure 2.6, summarized the basic concept of interactive computer graphic. Human
machine interaction in computer system is done using the input device. In programmer
view, input device can be divided into two categories; physical and logical device.

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User sees an
image on the
display

User react using


interactive device

Images change
according to
users input

Figure 2.6: Interactive computer graphic concept

Physical device is computer hardware such as keyboard and mouse, on the


other hand logical device is computer software. Logical device is a statements line
such as printf and scanf in C programming language and cin and cout in C++
programing language. All these statement is use by the programmer to get response
from the user.

Physical and logical input device send input to an application program in two
steps; measure process and device trigger. The measure process is how the device
respond based on the user action. The trigger of a device is a physical input on the
device with which the user can signal the computer. For example, the measure of a
keyboard contains a group of character such as hello world!, and the trigger can be
the return or enter key. For a pointing device such as optical mouse, the measure
includes the position, and the associated trigger can be a button on the pointing device.
In an environment with multiple input devices, each device has its own trigger and
each device will run a measure process. Each time that a device is triggered, an event
is generated. The device measure, with the identifier for the device, is placed in an
event queue.

This process of placing events in the event queue is completely

independent of what the application program does with these events. This process is
shown in Figure 2.7

Trigger
process

Trigger

Measure
process

Measure

Event
queue

Await event

Figure 2.7: Interactive computer graphic measure process

Program

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2.10

Mouse as tracking device

Nowadays computer mouse has become a standard device for all personal
computer. Computer mouse was invented by Douglas Engelbart of Stanford Research
Centre in 1963. The mouse was officially called an X-Y Position Indicator for a
Display System (Mueller, 2011). Traditional mouse consist of a small rubber ball
which will rolls when the mouse is move across the table top. Information regarding
this ball movement will be converted into electrical signals and transmitted to the
computer across the cable.

The standard mouse consists of several components:

A housing that user hold in their hand and move around on table top.

A method of transmitting movement to the system; either ball/roller or


optical sensors.

Buttons (two or more, and often a wheel or toggle switch) for making
selections.

Wheel for vertical scrolling. Some wheels tilt for horizontal scrolling
or can be pressed to act as a button.

An interface for connecting the mouse to the system. Conventional


mice use a wire and connector, whereas wireless mice use a radio
frequency (RF) or infrared (IR) transceiver in both the mouse and a
separate unit connected to the computer to

Interface the mouse to the computer.

Even though ball type mouse as illustrated in Figure 2.8 are considered
obsolete, understanding their working principle will provide the basic understanding
on how mouse can be used as a tracking device. Figure 2.9 show basic construction
of a ball mouse. A ball mouse consist of a rubber ball mounted on two rollers; one for
x-axis movement detection and the other one for detecting up and down movement
changes in y-axis direction. As the mouse move, rubber ball will move the roller which

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will cause either one or both wheel to rotate. When mouse is move in side by side
direction only x axis wheel will turn. On the other hand when mouse is move in
upward or downward direction y axis wheel will turn. When the mouse is move in an
angle both wheel will move. These rollers are typically connected to small disks with
shutters that alternately block and allow the passage of light produce by the led. Small
optical sensors detect movement of the wheels by watching an internal IR light blink
on and off as the shutter wheel rotates and chops the light. These blinks are
translated into movement along the axes.

Figure 2.8: Ball mouse

Figure 2.9: A Typical mechanical mouse with ball and shafts


Adapted from (Ian McLoughlin, 2011)

Roller ball mouse required frequent maintenance as it will trap dust as it is


moving. To overcome this problem, optical mouse is introduced by Agilent

25
Technologies in 1999. The first generation optical mouse actually uses a tiny camera
to take thousands of pictures every second. Some of the early mouse used a sensor
that required a special grid-marked pad. Although these mice were accurate, the need
to use them with a pad caused them to fall out of favour. Recently, mouse use optical
technology to detect change in movement and they have no moving parts of their own
(except for the scroll wheel and buttons on top). Todays optical mice need no pad;
they can work on virtually any surface. This is done by upgrading the optical sensor
from the simple type used in older optical mice to a more advanced CCD (charge
coupled device. This essentially is a crude version of a video camera sensor that
detects movement by seeing the surface move under the mouse. An LED or diode
laser provides light for the sensor.

Beside the normal use such as selecting, dragging, hovering, and clicking.
Several research such as listed in Table 2.2 has been done to seek the possibilities to
use mouse as motion sensor. The motivation of this study is mouse provide an accurate
position measurement with a lower cost, compare to industrial sensor.

Table 2.2: List of research using mouse as tracking sensor


Title
The optical mouse
as a twodimensional
displacement
sensor
The optical mouse

Year
2002

Application
Optical mouse as a two
axes displacement sensor.

2003

Optical mouse as

for vibratory

vibratory displacement

motion sensing

sensor

Digital readout

Researcher
T.W. Ng

Automated data

Ng, Cheong and

manometer using

acquisition from a simple

Sheridan

an

U-tube manometer using

optical mouse

an optical mouse.

Using optical
mouse sensors for

2003

Ng and Ang

2007

Optical mouse sensors as


contactless

W.P.H. Kamphuis

26
sheet position

sheet displacement

measurement

sensors

2D position

2010

Study the effect of mouse

measurement with

sensor accuracy to

optical laser

position measurement

Michal and Milan

mouse sensor
Long range
measurements

2013

Optical mouse sensors as


contactless optical
measurement device.

Paulo, Higinio,
Julia and Pedro

using a
contactless
low cost optical
sensor

2.11

Mouse resolution and hand movement distance

Optical mouse detect movement using Complementary Metal Oxide Silicon


(CMOS) sensors. CMOS in mouse will take an image of the pixel and determine the
size of that pixel. CMOS sensor operate by comparing images and computer use this
information to determine the mouse movement direction and distance. CMOS sensor
can capture up to 12000 frames per second. Image processing feature in mouse
software enable the CMOS sensor to see less than one pixel. This process in known
as fractions of pixels, where a pixel is divided into a smaller size.

Mouse resolution is the number of pixels per inch that the optical sensor and
focusing lens see when the mouse move. Mouse resolution is measured using Dot
per Inch (DPI). Franois Morier, Logitech Senior Engineer define mouse resolution
as the translation between hand movement and the distance covered on the screen. It
is just a factor of relation between, I move one inch, how many pixels I have covered
on the screen. This is the resolution (Wes Fenlon, 2015). In theory, if a mouse has

27
1000 DPI, then, if the mouse move one inch (2.54 cm), the mouse cursor will move
1000 pixels. Higher resolution cause the mouse moves faster and requires less effort
to get across the screen. Low resolution make a mouse moves slower and requires
more effort to get across the screen, but offers better precision. Higher resolution
displays may require higher resolution or higher mouse DPI to attain the same amount
of on-screen movement.

There are two way to change a mouse resolution; using Window mouse
properties setting and in game sensitivity setting function. In Windows, mouse settings
are controlled using the mouse properties dialog box as shown in Figure 2.10. The
Window mouse properties setting is actually a multiplier, when the slider is set at 6/11
it will keep a 1:1 ratio; for each mouse count, the cursor will move by 1 pixel. If the
slider is set higher, the pixel will skipping since window will try to move the cursor
faster than sensor's count.

Figure 2.10: Mouse properties dialog box

As shown in Figure 2.10, Windows mouse properties provide Enhance Pointer


Precision (EPP) option. EPP function is to smoothen the movement of the mouse
pointer. When EPP is enabled, the pointer moves smoothly without any visible breaks
in motion. When EPP is disabled, the pointer move a bit jerkily. For example, when
the mouse sends data that it has been moved one unit to the right, without the enhanced

28
pointer precision and the pointer speed slider located at 6/11 (= no scaling) the pointer
will also move one unit to the right. This could be called as "one-to-one" or 100%
speed. Lower pointer speeds is achieved by delaying the pointer movement until the
mouse has sent enough units to the given direction. At 50% speed the mouse has to
send 2 counts to the right before the pointer moves one count.

Mouse DPI refers to a mouses hardware capabilities, while sensitivity is


software setting. Default value for Windows mouse sensitivity is 6/11. Mouse
sensitivity setting can be adjusted by changing the in-game mouse sensitivity value or
by selecting a higher or lower mouse DPI value.

CHAPTER 3

RESEARCH METHODOLOGY

This section described the research methodology implemented in this project.


This project implementation is divided into two part; software development and
system verification. Software development is carry out in three step system problem
definition, problem solving and testing and verification. System verification is done
in three ways; discussion with expert, user feedback and observation. This program is
develop in three different version, after every version is completed program will tested
and verified. After completing the final version, three experiment has been conducted,
this experiment is carried out to determine the relationship between mouse hardware
with hand movement distance required to move cursor from one to another point,
comparing the accuracy of single DPI mouse with multi DPI mouse and study the
effect of in game sensitivity setting to hand movement distance while playing with the
JDS rehabilitation games. Result of this experiment is discuss in chapter 4.

30
3.1

Research methodology

This project objective is to develop a system with the ability to record stroke
survivor hand arm movement information while they are practicing their hand and arm
rehabilitation to regain their upper limb movement ability. This system is named as
JDS (Jamal Dan Shokor) rehabilitation games. JDS rehabilitation games is inspired
by arm skating exercise. In this exercise stroke survivor is required to move their arm
and hand with the assistance of arm skate as shown in Figure 3.3.

Flow chart in Figure 3.1 explain the process of developing the JDS
rehabilitation games. This process is started by defining the problem. Once the
problem has been identified a flow chart which represent the solution will be produced,
later this flowchart known as pseudocode will be transferred into programming
language such as C++ to develop the solution to the problem.

JDS rehabilitation games is develop in several version. Once the program has
successfully develop, this program will be test and verify. Verification is done by
obtaining feedback either from expert, user or observation. Once the verification has
been done, improvement will be conducted based on expert or users input.

31

Start

Define the problem

Design algorithm to solve problem


No
Test and verify the program

Working correctly?
Yes
End

Figure 3.1 : Software development process

3.2

Problem definition

Stroke survivor will suffer several disability such as memory loss, loss ability
to communicate and paralyzed some part of their body. Stoke effect is different from
one patient to the other, this study will focus on developing a home based rehabilitation
games to help the stroke survivor to regain their upper limb movement activity. Based
on observation made at Hospital Sultan Ismail rehabilitation unit, activity such as cone
stacking (Figure 3.2), picking up small objects such as marbles and transferring it into
to another place and arm skating (Figure 3.3); moving the affected arm on table top
using the affected arm is used to help stroke survivor to regain their hand and arm
movement ability. In order to get the benefit of this exercise, stroke survivor has to

32
repeat this exercise for several time, this will lead to boredom and motivation lost.
Another disadvantage is there is no indicator for showing degree of the rehabilitation.

Figure 3.2: Cone stacking

Figure 3.3: Arm skating

Research done by several researcher in several part of the world has proven
that computer games can be used as a tool in stroke rehabilitation. Computer
program will allow different set of difficulty to be set, to suit the user requirement.
Computer program can also be used to record the rehabilitation progress. Therapist
can used the recorded data to monitor their rehabilitation activity effectiveness.
These data can be converted into graphical chart and can be display at certain place
which can be seen by the stroke survivor so that they can monitor their own
rehabilitation progress.

3.3

Rehabilitation games (version 1)

This version serve as the basic foundation of this project. This game is develop
base on object matching games. The objective of this games is to detect the hand
movement location based on the mouse cursor position coordinate. Cursor location
will be shown on the console window as shown in Figure 3.4. Besides moving the
cursor to specific location, user must match the object shape and colour to get the
correct match. Objective of this activity is to improve the user motor and cognitive

33
skill. Figure 3.5 show the snapshot of the program. Before terminating the program,
user need to copy the coordinate location recorded on the console windows and paste
it into a notepad file. Then therapist can used formula shown in Figure 3.6 to calculate
the hand movement distance. Figure 3.7 show the pseudocode of this program.

Figure 3.4: Cursor location information

Figure 3.5: Version 1 snapshot

= (2 1 )2 + (2 1 )2
Where:
1 , 1 =
2 , 2 =
Figure 3.6: Distance formula

34

Start

Draw 8 different shape with 4


different color at 8 different location

Place the cursor at the screen center as the


starting point

Use keyboard button to change


the cursor shape and colour

Once user move the mouse to new location record the


new cursor location coordinate

Display
Congratulation

Yes

Correct match?

No

Display Sorry no
match found

Esc button
press

End

Figure 3.7: Rehabilitation game version 1 pseudocode

This version verification is done by conducting a presentation to Dr Sharon


Khor, rehabilitation physician at Hospital Sultan Ismail, Johor Bahru. From the
discussion following weaknesses has been identified:

It is difficult to measure motor and cognitive skills improvement at the same


time. This project should focus on how to measure the motor skill because
there a lot of application available in the market to measure cognitive skill.

This application will be more effective if the point is arrange in circular


shape, same like a dart board.

35

The data collection and analysing method must be simplified.

User must be motivated to move their hand as fast and as far as they can
while doing this activity.

This point has been used as a guideline to create rehabilitation games version 2.

3.4

Rehabilitation games (version 2)

Rehabilitation game version 2 is an upgrade version of rehabilitation games 1.


This version arrange the point in circular shape as shown in Figure 3.8. Objective of
this game is to provide a tools that can be use by therapist to calculate the hand
movement speed. This application is build using four circle with four different radius.
Circle in this application is develop using formula shown in Figure 3.9. In this formula
i represent the point location and j represent the maximum number of points. For
example circle 1 radius in Figure 3.8 is 50 and the maximum number of point is 8.
The weakness of this application is there is a gap between points. The other weakness
is when centre point is moved to another location it will leave a blank space. It will
cause difficulty to the user to locate the centre point. To overcome the gap problem
the maximum number of point is increase and new circle as shown in Figure 3.10 is
produced, in this version the maximum number of point for circle 1 is increase from 8
to 240. Even though this method has create a better circle shape the circle is not
smooth because the rectangle shape point is used. As a solution rectangle shape point
is change to a round point shape and the result is shown in Figure 3.11.

36

Figure 3.8: Dart board point arrangement

= + ( cos ((360 )
))
180

= + ( sin ((360 )
))
180
:
=
= , =
= , =
Figure 3.9: Circle coordinate calculation formula

37

Figure 3.10: Circle with rectangle point shape

Figure 3.11: Circle with round point shape

Rehabilitation games version 2 is also equip with instruction to guide the user
how to use this program effectively. Hand movement data in this program is recorded
into a log file located outside of the program. This program also has a calibration
option which will allow user to set the hand movement distance required to move from
one end to the other end. Figure 3.12 show the snapshot of the console windows.

38
As shown in Figure 3.12, log file name is given based on the user name specified by
the user, console will also provide information on the log file location. Mouse speed
will determine the amount of hand movement required to move from one end to other
end, smaller number of mouse speed will produce a longer hand movement distance.
Figure 3.13 show the rehabilitation games version 2 pseudocode.

Figure 3.12: Rehabilitation games version 2 console output.

39

Start

Request user name

Create log file base on user name input

Display instruction

Create 5 circle with different radius and color

Record hand movement coordinate in log file

Esc button press

End
Figure 3.13: Rehabilitation games version 2 pseudocode

This version verification is done by conducting a discussion by having a


discussion with my supervisor Dr Jamaludin Mohd. Taib. From the discussion
following the following weaknesses has been identified:

This program still used manual calculation, as this program will be used by
various education background, the distance calculation should be made by the
program.

This program can only use to measure the hand movement distance only,
additional features must be added to create a rehabilitation tools.

40
3.5

Rehabilitation games (version 3)

Rehabilitation game version 3 is develop in several version. This section will


only discuss about the final version of this project, this version is named as JDS
rehabilitation games. This game package consist of four set of application; JDS Pong,
JDS bouncing ball, JDS connecting the dot and JDS hand movement speed calculation
tools. Each program except JDS pong is attach with a log file.

Based on feedback obtain from Hospital Sultan Ismail, Rehabilitation Unit


staff and observation on patient rehabilitation activity, these strategy are embedded to
create the final version this project:

Clear instruction must be provided.

Several difficulty level must be set from easy to hard.

User must be inform about their achievement at the end of every session.

A control feature must be included to make sure that user follow the given
instruction and stay focus on their activity.

3.5.1

JDS pong

JDS pong is inspired by from the table tennis games. The aim of this games is
to provide an activity which will help stoke survivor to regain vertical hand and arm
movement ability. This games allow the user to the hand movement distance to move
from one end to the other end based on their hand movement ability. Similar to original
table tennis game, the player will play this games with computer as their opponent.
The window border will act as the wall, each time the ball hit the wall and ball will
change its direction. The objective of this game is to prevent the ball from hitting the
bottom wall. If the ball hit the bottom wall, the computer will get a point and the ball

41
speed will increase, if the player manage to obstruct the ball movement using his bat
he will get points. Point is assign randomly by the computer based the ball location
on the bat. To play this game, user only need to put his hand and move the mouse to
the left or right side of the screen. Axis align bounding box method is used to carry
out collision detection test. Mouse movement will cause the bat to move according to
the hand movement direction. Once the user press S key to stop the game, program
will show the user achievement; either he win or lost. If the user score is higher than
computer score. Figure 3.15 to Figure 3.17 show a screen shot of this game. Figure
3.18 show the pseudocode.

Figure 3.14: JDS pong console windows

42

Figure 3.15: JDS pong games screen shot

Figure 3.16: Player win statement

Figure 3.17: Player lose statement

43

Start

Select difficulty level


False
Right value entered?

True
Set cursor speed

Esc button pressed

Create application windows

Move the ball

Ball hit the bat

Ball hit the wall

True

Increase player
score

Ball hit the bottom wall

False

Change the ball


movement direction

True
Increase computer score and ball speed

End

Figure 3.18: JDS pong games pseudocode

3.5.2

JDS bouncing ball

JDS bouncing ball objective is to provide a vertical and horizontal hand


movement therapy using 2D game. JDS bouncing ball demonstrate the application of
collision detection principle and counter controlled repetition loop in creating an

44
animation. In this game, ball will bounce from wall to wall. Ball is drawn using
counter repetition control loop. Every time the ball hit the wall, the ball will change
its direction and speed is increase. The games objective is to encourage the player to
move his hand according to ball movement pattern. Player can stop the ball movement
by clicking the left mouse button. The target is to place the cursor on the ball area to
pause the ball movement. When the ball movement is stopped, program will compare
current pixel with specified pixel. Ball movement can be resume by clicking the
mouse button once again. This game will endure until the player press S to stop the
ball movement or press X to exit the game. This game involved two type of
movement: hand and arm movement, and finger movement. Hand and arm movement
is required to move cursor across the screen. Finger movement is needed to press the
mouse button to stop and resume the ball movement. Figure 3.19 show the JDS
bouncing ball screenshot and Figure 3.20 show the pseudocode of JDS pong games.

Radius 1

Radius 2
Radius 3
Figure 3.19: JDS bouncing ball screen shot

45
Start
Select
difficulty
level

False

Right value entered?

True
Set cursor speed

Create application
windows

Move the ball

Ball hit the wall

True
Change the
ball movement
direction
Mouse button
pressed (1)

Stop ball
movement

Cursor located
on the ball?
False

Print You
missed, try
again

True

Print You hit the


ball

Mouse button
pressed (2)

Esc button pressed

End

Figure 3.20: JDS bouncing ball game pseudocode

46
3.5.3

JDS connect the dot

JDS connect the dot is develop based on kids dot connecting activity. The
objective of this game is to enhance hand movement in various direction while the user
use the mouse to connect a set of dot to create certain shape. Five shape with different
level of difficulty has been selected for this activity. Figure 3.21 and Figure 3.22 show
the JDS connecting the dot screenshot.

Figure 3.21: JDS connect the dot games

Beside enhancing the user hand movement, while playing this games user need
to adhere certain rules; user cannot quit the game before all the dot is connected, on
the other hand user must comply the maximum number of mouse click to complete
this game. Error message as shown in Figure 3.23 and Figure 3.24 will be display if
the user fail to comply the rules. Message in Figure 3.25 will be display if the user
manage to complete the given task. Figure 3.26 show the pseudocode.

47

Figure 3.22: JDS Connecting the dot console display

Figure 3.23: Uncomplete task message

48

Figure 3.24: User exceed the maximum attempt allow

Figure 3.25: User successfully complete the game

49

Start

Select hand
movement
ability level

Right value entered?

True
Set cursor speed

Select object
shape
False

Right value entered?

True
Esc button pressed

Display
window and
draw shape

Player click mouse


button (position 1)

Player click mouse


button (position 2)

Draw line
from position
1 to position 2

End

Figure 3.26: JDS connect the dot pseudocode

False

50
3.5.4

JDS hand movement speed calculation tool

JDS hand movement speed calculation tool as shown in Figure 3.27 is design
to provide tools to measure hand movement speed. User can use information from this
application to compare the hand movement speed between the affected limbs and the
unaffected limbs, the rehabilitation goal is to train the affected limb so it can move as
fast as the unaffected limb.

In this application mouse click location is used to determine the distance


between two points. New location will be recorded based on mouse button state (up
or down). Every state will produce a new location. Figure 3.28 show the JDS hand
movement speed calculation tool pseudocode.

Figure 3.27: JDS hand movement speed calculation tools snap shot

51

Start

Request user name

Print greeting

Create log file based on user name

Log file created?

True

Print file name and location

Enter hand movement ability

Correct value entered?

False

True
False

Perform hand movement


distance calibration

Record start time

Create console and application


window

Mouse button press

Esc button pressed

Record time and location

End

Mouse button release

Record time and location

Perform hand movement speed


calculation

Figure 3.28: JDS hand movement speed calculation tools pseudocode

52
JDS hand movement speed calculation tool application windows size is set to
700 x 700 pixel. This create a coordinate system ranging from 0 to 700 in x axis and
0 to 700 in y axis. All mouse click location detected by JDS hand movement speed
calculation tool will be recorded in log a file. Besides recording the cursor location,
this program also record the time duration taken to move for initial point to end point.
This data will use by the program to calculate the hand movement speed using the
formula shown in Figure 3.29. Output of the program is shown in Figure 3.30.

, =

( )
()

:
=
Figure 3.29: Hand movement speed calculation formula

Figure 3.30: JDS HMCT speed calculation output

53
3.6

Effect of mouse hardware to DPI to hand movement distance validation

Introduction:
Optical mice contain a light emitting diode (LED) and a little camera. As the
mouse move around, the light shines on the surface below the mouse and the camera
takes hundreds of pictures per second. The mouse compares the pictures and
determines the direction which the mouse is moving. The mouse then sends this
movement data to the computer as mouse input, and the computer moves the cursor
across the screen.

The pixel is originated from the word picture element; is the basic unit of
programmable colour on a computer display or in a computer image. The physical
size of a pixel depends on the resolution for the display screen. Display screen
resolution is the number of pixels or individual points of colour contained on a display
monitor. If the display screen display resolution is set to its maximum resolution, the
physical size of a pixel will equal the physical size of the dot pitch or the dot size of
the display. The dot pitch is measured in millimetres (mm) and a smaller number
means a sharper image. In desktop monitors, common dot pitches are .31mm, .28mm,
.27mm, .26mm, and .25mm. Personal computer users will usually use .28mm or finer.

Optical sensor resolution number of pixel that can be fitted into one inch. For
example if the pixel size 0.03 mm or 30 micron, the mouse DPI is 840 DPI. Dots per
inch (DPI) refer to the number of image that a mouse sensor can take for every inch it
is moved. The higher a mouses DPI, the farther the cursor will move on screen when
the mouse is move. A mouse with a higher DPI setting detects and reacts to smaller
movements. Some mouse models include dedicated buttons (DPI on-the-fly buttons)
which can be used to instantly adjust the mouse sensitivity (DPI).

54
Experiment objective:
Objective of this study is to validate the effect of mouse hardware DPI to hand
movement distance to move computer cursor using JDS hand movement speed
calculation tools.

Equipment:
1. Complete set of computer.
2. JDS hand movement speed calculation tools software.
3. Graph paper.
4. Ruler
5. Cellulose tape.
6. Logitech G502 Proteus Core Tuneable Gaming Mouse (Figure 3.31).

Figure 3.31: Logitech G502 Proteus Core Tuneable Gaming Mouse

Experiment procedure:
1. Launch JDS hand movement speed calculation tools software.
2. Stick a graph paper on flat surface.
3. Set Logitech G502 DPI to 1200 DPI.
4. Follow instruction given in the JDS hand movement calculation tools to
record the hand movement distance required to movement the cursor 50 pixel
from the centre of the screen. Use the graph paper to measure the hand
distance and record the result. Repeat this each measurement for 3 times.

55
5. Repeat step 4 to measure the hand movement distance of 100, 200 and 300
pixel from the centre of the screen.
6. Record the result.
Result of this experiment will be discuss in chapter 4.

3.7

Comparison between normal and gaming mouse to hand movement

distance

Introduction:
Gaming mouse is a special mouse design to use with computer games. Gaming
mouse typically employ a wide array of controls and buttons and have designs that
differ radically from traditional mice. Gaming mouse is equip with DPI switch known
as on the fly DPI which enables user to adjust the mouse's sensitivity to a faster or
slower pointer speed. In gaming mouse, DPI increment is produce by subdividing
those pixels into smaller increments, this is done using sensor algorithm. Changes in
DPI value will affect the accuracy, but it will produce a much more sensitive system;
reduce the distance to produce a single count.

DPI is defined as the number of pixel that a mouse can count in one inch. For
example, to move 1000 pixel on screen will required the user to move their hand for 1
inch. Using this relationship formula as shown in Figure 3.32 is develop.

2.54
= (
)

:
= .
=
Figure 3.32: Hand movement distance calculation formula

56
Experiment objective:
Objective this study is investigate the effect of mouse sensor DPI to hand movement
distance required to move the cursor from one point to other point. This study will
compare the hand movement distance required to movement cursor from the centre
of the screen to specific location using Logitech M325 mouse and Logitech M502
mouse.

Equipment:
1. Complete set of computer.
2. JDS hand movement speed calculation tools software.
3. Graph paper.
4. Ruler
5. Cellulose tape.
6. Logitech G502 Proteus Core Tuneable Gaming Mouse.
7. Logitech M325 mouse (Figure 3.33).

Figure 3.33: Logitech M325 mouse

Experiment procedure:
1. Launch JDS hand movement speed calculation tools software.
2. Stick a graph paper on flat surface.
3. Set Logitech G502 DPI to 1000 DPI.
4. Follow instruction given in the JDS hand movement calculation tools to
record the hand movement distance required to movement the cursor 50 pixel

57
from the centre of the screen. Use the graph paper to measure the hand
distance and record the result. Repeat this each measurement for 3 times.
5. Repeat step 4 to measure the hand movement distance of 100, 200 and 300
pixel from the centre of the screen.
6. Repeat step 4 and 5 using Logitech M325 mouse.
7. Record the result.
Result of this experiment will be discuss in chapter 4.

3.8

Effect of mouse sensitivity to hand movement distance validation

Introduction:
Mouse sensitivity determine the speed or how fast the cursor will move across
the computer screen. Higher mouse sensitivity will produce a quick response and
reduce the hand movement distance to move the cursor across the computer screen.
On the other hand, low sensitivity will reduce the cursor movement speed and increase
the hand movement distance to move the cursor across the screen.

Window operating system provide mouse properties dialog box as shown in


Figure 3.34 which provide pointer speed adjustment option that allow user to change
the mouse cursor speed. In JDS rehabilitation games, mouse sensitivity is change by
changing the in game sensitivity value. Relationship between hand movement distance
and in games mouse sensitivity setting is given by formula in Figure 3.35.

58

Figure 3.34: Mouse properties dialog box

= (

2.54
)

:
= .
=
=
2.54 = .
Figure 3.35: In games sensitivity setting effect calculation formula

Experiment objective:
Objective of this experiment is to validate the effect of in game sensitivity setting to
hand movement distance to move computer cursor in JDS rehabilitation games. In

59
games sensitivity setting can be adjusted using the hand ability movement option in
JDS rehabilitation games.

Equipment:
1. Complete set of computer.
2. JDS hand movement speed calculation tools software.
3. Graph paper.
4. Ruler
5. Cellulose tape.
6. Logitech M325 mouse

Experiment procedure:
1. Launch JDS hand movement speed calculation tools software.
2. Stick a graph paper on flat surface.
3. Set the hand ability value to 1.
4. Follow instruction given in the JDS hand movement calculation tools to
record the hand movement distance required to movement the cursor 50 pixel
from the centre of the screen. Use the graph paper to measure the hand
distance and record the result. Repeat this each measurement for 3 times.
5. Repeat step 4 to measure the hand movement distance of 100, 200 and 300
pixel from the centre of the screen.
6. Repeat step 4 and 5 with the hand ability setting is change to 2, 3 and 4.
7. Record the result.
Result of this experiment will be discuss in chapter 4.

60
3.9

JDS hand movement speed calculation tools calibration

The accuracy of hand movement distance calculation in JDS hand movement


speed calculation tools is influenced by the mouse hardware DPI value. JDS hand
movement speed calculation is equipped with calibration option as shown in Figure
3.36 which will allow user to set the mouse DPI value.

Figure 3.36: JDS hand movement speed calculation tools calibration option

61
3.10

Hand movement chart

Every game except JDS Pong is equip with a log file. Log file will record
information such as user name, program start time, program stop time, hand movement
start time, hand movement stop time and cursor location. Cursor location referring to
the distance measured in pixel from screen center to the destination.

Log file content is different based on the games objective. JDS bouncing ball
game log file as shown in Table 3.1 will record the mouse click location made by the
user and determine whether the user manage to hit the ball or not. Table 3.2 show
connect the dot log file content this log file only record the coordinate location and
time duration.

JDS hand movement speed calculation tools log file as shown in Table 3.2 will
record the hand movement coordinate and calculate the hand movement speed. The
JDS log file will record the hand movement coordinate (pixel), hand movement
duration (seconds), hand movement distance (cm) and hand movement speed (cm/sec).
All calculation is done automatically by the program. Data recorded by the log file
can be use by the therapist and stroke survivors to monitor their rehabilitation progress

Table 3.1: JDS bouncing ball log file content


User name:
Begin date :

test1
17/03/2016

Begin time:

Point

1
2
3
4
5
End date :

505
336
344
154
217
17/03/2016

13:28:48

389
451
218
176
145
End time:

Hit target
Hit target
Missed target
Missed target
Hit target
13:29:15

62
Table 3.2: JDS connecting the dot log file content

User name:

test1

Begin date :
Shape:
Point

Begin
17/03/2016 time:
Square
X

1
2
3
4
5
End date :

70
69
628
69
631
17/03/2016

Time taken
to complete:

12:30:00

70
629
630
71
71
End time:

12:30:16

Hours

0 Minutes

16

Seconds

Table 3.3: JDS hand movement speed calculation tools log file

User name: test1


Begin date 18/03/2016
:
Point
X
Y
1
2
3
4
5
6

350
130
350
34
349
675
End date : 18/03/2016

Begin time:

13:00:43

Distance Duration
(Cm)
(Second)
348
628
349
14
351
16

Speed
(Cm/Second)

Location

2.2512

2.2512 Zone 5

2.92894

1.46447 Zone 5

2.95927

1.47964 Zone 5
13:01:07

End time:

Chart in Figure 3.37 is produce by plotting the coordinate value from the JDS
bouncing ball games log file. Plotting the coordinate value from JDS connecting the
dot log file will produce hand movement chart as shown in Figure 3.38.

63

Figure 3.37: JDS bouncing ball hand movement pattern chart

JDS connecting the dot hand movement chart


600

Y coordinate

500
400
300
200
100
0
0

100

200

300

400

500

600

X coordinate

Figure 3.38: JDS connecting the dot hand movement pattern chart

64
3.11

Conclusion

JDS rehabilitation games is design to produce a rehabilitation activity using


computer games with the ability to record the user hand movement ability. Several
factor such as the user hand movement distance ability, level of difficulty and
motivation is considered in developing this games. JDS hand movement speed
calculation tools is design to compare the hand movement speed of the affected and
non-affected hand. Therapist can used this data to plot a hand movement chart to
record the rehabilitation activity progress.

Repetition and high motivation is the most important factor in increasing the
rehabilitation activity success. Repetition will cause boredom. In this game different
level of difficulty is used to reduce the boredom effect. This system will also provide
feedback in term of score to increase the user motivation.

In general this project has achieve its objective to produce a system which has
the ability to help stroke survivors to regain their upper limb movement ability, but the
effectiveness of the system can only be measured when the stroke survivor and
rehabilitation unit staff has the desire to use this system as a part of their rehabilitation
activity. Wise man says you can lead a horse to water, but you cannot make it drink.

CHAPTER 4

RESULT AND DISCUSSION

This chapter will discuss the result and finding from experiment describe in chapter 3.
Experiment result show that mouse hardware DPI and in games sensitivity setting
value in JDS rehabilitation games has direct influenced to hand movement distance to
move cursor from one point to the other point.

4.1

Relationship between mouse hardware DPI and hand movement distance

This test is done using Logitech G502 Proteus Core Tuneable Gaming Mouse,
this mouse has the pointer setting option as shown in Figure 4.1 which allow user to
change the mouse DPI setting from 200 DPI to 12 000 DPI. The objective of this
experiment is to validate the effect of different mouse DPI to the hand movement
distance required to move from one point to other point. In this experiment the hand
movement distance to move from the centre of the screen to certain location is
recorded in Table 4.1.

Relationship between mouse hardware DPI and hand

movement distance can be represented as; higher mouse DPI will decrease the hand
distance required to move from one to another point, lower mouse DPI with lead to
higher effort to move cursor from one to another point.

66
Table 4.1: Mouse DPI Vs Hand movement distance
Mouse model:

Logitech Proteus core G502


Distance from centre of the screen (pixel)

Mouse DPI

50

100

200

300

1200

16

24

1000

10

20

30

800

12

24

36

600

16

32

48

400

12

24

48

72

200

27

54

108

162

Figure 4.1: Logitech G502 pointer setting application.

Chart in Figure 4.2 illustrate the relationship between the mouse DPI and hand
movement distance. Using the chart, we can conclude that user has to move his hand
further to move from one point to other point when using a mouse with lower DPI for
example to move 300 pixel on computer screen with 200 DPI mouse the user must
move his hand for 162 mm, on the other hand the user only need to move 28 mm to
move the same distance on screen with 1000 DPI mouse. Relationship between hand
movement distance and cursor movement distance is govern by equation in Figure 4.3.
This study show that mouse hardware DPI value will influence the hand movement
distance to move cursor from one to another point.

67

Figure 4.2: Mouse DPI vs hand movement distance

1200 = 0.08
1000 : = 0.1
800 : = 0.12
600 : = 0.16
400 : = 0.24
200 : = 0.24
Figure 4.3: Relationship between mouse DPI and hand movement distance

4.2

Effect of single DPI mouse and multiple DPI mouse to hand movement

distance

This section will study the effect of single DPI and multi DPI mouse to the
accuracy of hand movement distance calculation using JDS hand movement
calculation tools. Objective of this section to choose a mouse which will provide a
better accuracy during the measurement process using JDS hand movement
calculation tools.

68
In this study the hand distance taken to move from one point to another point
using two type of mouse; single DPI mouse, Logitech M 325 and Logitech M502,
gaming mouse with variable DPI setting is recorded and compared. Measurement
will be carry out using 1000 DPI setting.

Table 4.2 show the hand movement distance required to move the cursor along
to 4 different location from the centre of the screen using location variable DPI mouse.
The relationship the mouse and hand movement distance as shown in Figure 4.4 is
govern by formula in Figure 4.5.

Table 4.2: Hand movement distance using Logitech Proteus Core G502
Mouse model:
Cursor
distance
Hand distance
(Pixel)
actual (mm)
50
5
100
10
200
20
300
30

Logitech Proteus core G502


Error
Hand distance
Different
percentage
theory (mm)
(mm)
(%)
1.27
3.73
294%
2.54
7.46
294%
5.08
14.92
294%
7.62
22.38
294%

Figure 4.4: Comparison between actual and theoretical hand movement distance
using Logitech M502 mouse

69

= 0.1
Figure 4.5: Relationship between hand and cursor distance using Logitech Proteus
Core G502

Table 4.3 show the hand movement distance required to move the cursor
along to 4 different location from the centre of the screen using location single DPI
mouse. The relationship the mouse and hand movement distance as shown in Figure
4.6 is govern by formula in Figure 4.7.

Error between theoretical and actual hand movement distance required to move
from one point to the other point using Logitech G502 mouse is 294%, on the other
hand the error between theoretical hand movement and actual hand movement
distance required to move from one point to the other point using Logitech M325
mouse is 2.56%, this result show that between Logitech G502 and Logitech M325,
Logitech M325 will produce a better accuracy to measure the hand movement
distance.

Table 4.3: Hand movement distance using Logitech M325 mouse


Mouse model:
Cursor
distance
(Pixel)
50
100
200
300
Average

Logitech M325
Hand distance
actual (mm)
1.2
2.5
5.0
7.5

Hand
distance
theory (mm)
1.27
2.54
5.08
7.62

Different
(mm)
-0.07
-0.04
-0.08
-0.12

Error percentage
(%)
-5.51%
-1.57%
-1.57%
-1.57%
-2.56%

70

Figure 4.6: Hand movement distance using Logitech M325

= 0.025
Figure 4.7: Relationship between hand and cursor distance using Logitech M325

4.3

Effect of in game sensitivity

This section will study the effect of in game mouse sensitivity setting to the
hand movement distance while playing the JDS rehabilitation games. Experiment
result is shown in Table 4.4. Relationship between the in games sensitivity and hand
movement distance required to move from one point to other point in shown in
Figure 4.8; lower in games sensitivity value will force the hand to move further
compared to high in game sensitivity value for the same cursor movement distance.

71
Table 4.4: Effect of in games sensitivity value to hand movement distance
Cursor movement (Pixel)
50
100
200
300
In game sensitivity
Hand movement distance (mm)
0
1
2
5
8
0.1
25
50
100
150
0.2
12.5
25
50
75
0.3
8
16
32
50
0.4
6
12
25
38

Figure 4.8: Effect of hand in games sensitivity setting to hand movement distance

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