Real Y Series User manual

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REAL y-Series™
USER MANUAL

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Table of Contents
Warning 3
Device Description 3
Indication for Use 4
Contraindications 4
Warnings 4
Precautions 4
Potential Adverse Effects/Events 4
Operating Profile 5
Operating Procedure 5
• Section 1: Getting Started and Charging Components 5
• Section 2: Internet Connectivity (Online Configurations Only) 6
• Section 3: Start-Up System for Patient Use 6
• Section 4: Managing a Therapeutic or Wellness Session 8
• Section 5: System Removal 10
• Section 6: Software Description 10
Technical Specifications 24
Symbol Glossary 24
Technical Information 24

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WARNING! CAREFULLY READ ALL INSTRUCTIONS PRIOR TO USE. OBSERVE ALL
WARNINGS AND PRECAUTIONS NOTED THROUGHOUT THESE INSTRUCTIONS.
FAILURE TO DO SO MAY RESULT IN COMPLICATIONS.
DEVICE DESCRIPTON
The REAL y-Series™ is a digital hardware and software medical device platform
utilizing virtual reality technology designed for use in healthcare and focusing on
physical, neurorehabilitation and/or wellness needs.
REAL y-Series consists of following components:
∙ All-In-One Headset (HMD) with Software Experiences
∙ HMD Controller
∙ Large Sensor
∙ Small Sensors
∙ Sensor Charger (charging station)
∙ Tablet
∙ Router
∙ Router Battery
∙ REAL Sensor Bands
Frequently used features and functions:
Headset (HMD)
∙ The headset provides visual feedback of virtual reality experiences in concert
with the REAL y-Series tablet and large and small sensors.
∙ Plug headset power cord into headset to charge device, ensure y-Series
power cord is plugged into wall outlet.
∙ Press power button to turn on/off headset. The power button is located on
top of the headset.
∙ Press the volume buttons to adjust volume. The volume buttons are located
on the left side of the headset.
HMD Controller
∙ Headset controller is to only be used for troubleshooting or administrative
tasks. It is not used during patient therapy.
∙ The controller is used to access headset settings or control volume.
Large Sensor and Small Sensors
∙ Large and small sensors (WTM and WSMs) are equipped with mechanical
and electrical components that measure motion and direction in physical
space and then translate that information into a virtual environment.
∙ Components are removed or placed back into the sensor charger (charging
station) to activate or charge device.
∙ Components are placed into the sensor bands.
Sensor Charger
∙ The sensor charger charges the sensors. Ensure y-Series power cord is
plugged into wall outlet.
Tablet
∙ Tablet is fitted with a touch screen that allows the user to:
- Launch REAL TherapyView™ application on the tablet
- Log in
- Add or select patient
- Select a therapy experience or activity
- Initialize and sync to sensors
- Select, start, modify, or end therapy session
- View data
- Log out
∙ Plug tablet power cord into tablet to charge device, ensure y-Series power
cord is plugged into wall outlet.
∙ Press power button to power on/off tablet. The power button is on the edge
of the device.
Router and Router Battery
∙ Router allows the REAL y-Series components to communicate with each
other
∙ Router battery provides power to the router when system is not connected to
wall outlet.
∙ Online Configurations Only: Router connects the REAL y-Series to internet
Sensor Bands
∙ Place or remove sensor bands on or from patient.
At full charge, the entire system can last a minimum of 60 minutes and it is
recommended that a therapy session does not exceed 60 minutes. Please sufficiently
charge all components between each session for a minimum of 60 minutes.
In the event of electromagnetic disturbances, the performance of the REAL y-Series
may be affected.
The REAL y-Series is a Type BF Applied Part.
There is no preventive inspection, calibration, or maintenance necessary for the
REAL y-Series besides the initial set up procedure. During the three-year product
lifespan of the REAL y-Series, the device will continue to perform safely without
any routine maintenance. No parts within the REAL y-Series will require inspection
nor maintenance by a service personnel to ensure basic safety during the three-
year product lifespan. Circuit diagrams and calibration instructions are not provided
because service or parts repair is not necessary.
Contact the local REAL representative or Penumbra if the system no longer
stays powered on and connected through the entire recommended duration of a
therapy session.

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REAL Sensor Bands are recommended for one hundred uses or until the sensor
bands no longer hold the sensors or its orientation.
Supply mains are electrically isolated in medical equipment to maintain basic safety.
The full expected latency of the device, including movement detection, processing,
and visual representation is 35 milliseconds or less. This value is considered minimal
and sufficiently low enough so that movement can be quickly detected.
INDICATION FOR USE
The REAL y-Series is an immersive virtual reality and display system that interactively
displays and tracks rehabilitation exercises using a combination of virtual
environments and full presence tracked avatars for visual feedback.
CONTRAINDICATIONS
There are no known contraindications.
WARNINGS
If a patient complains of motion sickness, dizziness, headache, eye strain, or fatigue
when using the device, stop use of device immediately.
Use caution when using this device if a patient has a history of vestibular issues or
motion sickness.
PRECAUTIONS
Ensure a safe environment for the patient while performing activities with the device
(i.e. remove any surrounding obstacles and ensure that the patient is unlikely to trip or
fall). Ensure a medical professional is with the patient at all times to prevent any injury.
Be aware of the patient’s limitations in range of motion and avoid device or program
use that could lead to excessive gestures that could injure a patient.
Incorrect placement of the sensors on the patient may result in the avatar appearing
incorrectly or distorted on the headset and tablet.
Damage (mechanical and electrical) may result if the tablet, headset, sensors, and/or
sensor charger are dropped or struck against another object. Device is not intended
for continued use if dropped from higher than 1 meter.
Surface temperature around the headset exhaust may reach 46 °C if operating above
nominal room temperature.
Sensors will transmit inaccurate position data if used near metal including, but not
limited to, wheelchairs, walkers, utility carts, smartwatches and mobile devices.
Headset tracking can be lost or compromised if the front facing camera sensors on
the headset are obstructed or facing highly reflective surfaces.
Third conductor of the AC cord is a functional earth. To avoid risk of electric shock,
this equipment must only be connected to a supply mains with protective earth.
At no time should liquid products be allowed near any device component.
No modification of this equipment is allowed.
Use of accessories, transducers, and cables other than those specified or provided
by the manufacturer of this equipment could result in increased electromagnetic
emissions or decreased electromagnetic immunity of this equipment and result in
improper operation.
Portable RF communications equipment (including peripherals such as antenna
cables, external antennas, smart watches, and mobiles devices) should be used
no closer than 30 cm (12 inches) to any part of the REAL y-Series, including cables
specified by the manufacturer. Otherwise, degradation of the performance of this
equipment could result.
Use of this equipment adjacent to or stacked with other equipment should be
avoided because it could result in improper operation. If such use is necessary,
this equipment and the other equipment should be observed to verify that they are
operating normally.
Accessories such as power adapters and cords should not be replaced by the end
user and should only be replaced by Penumbra. Any changes or replacements of
accessories will likely impact compliance of REAL y-Series.
Use of system with online configurations should be in a secure information
technology environment. Https communication channels must be open.
POTENTIAL ADVERSE EFFECTS/EVENTS
Visual stimulation through head-mounted displays has a small possibility of provoking
an epileptic seizure. Should this occur, stop using the device immediately. Other
possible complications include, but are not limited to, the following:
∙ claustrophobia
∙ discomfort or pain in the head or eyes
∙ disorientation/vertigo/dizziness
∙ drowsiness
∙ eye strain
∙ falls or fractures
∙ headache/migraine
∙ insomnia
∙ light-headedness
∙ motion sickness
∙ nausea
∙ pain
∙ seizure
∙ repetitive strain injury
∙ vision problems
∙ skin irritation
Should any of the above occur, stop using the device immediately.

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OPERATOR PROFILE
Operators of the REAL y-Series should be trained in rehabilitation therapy. Follow
facility guidelines for use and access to account login credentials (if applicable). For
systems with online configurations, the same account login credentials shall not be
used by more than one REAL y-Series at any given time.
Note: These rehabilitation exercises are intended to be conducted in a clinical
environment and prescribed and supervised by a medical professional trained in
rehabilitation therapy. Rehabilitation therapy and technique decisions will vary based
on the clinical judgement of the treating medical professional. A medical professional
must be present at all times to provide direct supervision throughout the course of
therapy.
OPERATING PROCEDURE
SECTION 1: GETTING STARTED AND CHARGING COMPONENTS
1. Remove REAL y-Series case from the shipping container and inspect for
damaged or missing components.
2. Connect the REAL y-Series case to its power cord (AC adapter power cord).
Plug the power cord into a grounded electrical outlet, making sure that it is the
same voltage as indicated on the unit nameplate. Ensure the power receptacle
is connected to a supply mains with protective earth.
3. Ensure sensors with white sides facing forward are in their corresponding size
slots on the sensor charger. LED lights on sensors will show the following:
Solid Green: Full battery
LED Off: Battery dead or sensor asleep
Solid Blue: Connected
Blinking Red: Low battery, charging
Blinking Green: Charging
Blinking Blue: Connecting
4. Ensure the headset is connected to its power cord (USB-C cord). LED light on
top of headset will show blinking red, blinking green or solid green to indicate
charging status.
Large Sensors
Tablet
All-in-One Headset (HMD)
Small Sensors
Sensor Charger
Power Cord

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5. Ensure the tablet is connected to its power cord (USB-C cord).
SECTION 2: INTERNET CONNECTIVITY (Online Configurations Only)
Note: Prior to first time use, the REAL y-Series must be configured and connected to
the local internet. To continue using the REAL y-Series over its lifespan, user may be
prompted/required to complete over-the-air software updates.
Connecting to Wi-Fi
1. Turn on tablet by pressing and holding down power button for approximately
5 seconds.
2. Launch the TherapyView application if it is not already open.
3. Press “OK” on the REAL Service prompt.
4. On the log in page, click on the “Network Setup” button in the bottom right
corner.
5. Connect using the desired wireless network name and password.
6. Press the button at the top left of the screen to return to the TherapyView
application home screen.
See Get Connected Guide section in the REAL y-series Quick Start Guide for more
detailed instructions. Continue to Section 3 when the system has secure internet
connectivity.
SECTION 3: START-UP SYSTEM FOR PATIENT USE
1. Unplug power cords from tablet and headset when ready to use and sufficiently
charged.
2. If tablet is not turned on, turn on.
3. Turn on headset by pressing and holding power button for approximately 5
seconds.
4. Place headset on patient’s head in the sequence numbered below. Patient can
immediately begin visually interacting with the environment.
1
2
3
4
Note: Size of headset strap and interpupillary distance can be adjusted for fit. Top of
head pad may be removed temporarily for better fit on larger heads.
Note: Patient can keep eyeglasses on.

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5. Confirm audio can be heard but does not block out the patient’s ability to
communicate; adjust volume on headset as needed.
Hold 5 seconds
6. Remove sensor bands from reusable packaging (sold separately). Each patient
should have their own sensor bands and bands should not be shared between
patients.
7. Remove all sensors from sensor charger.
8. Place small sensors onto bands by sliding them into elasticized loops. For
the hand sensor bands, tighten elasticized loop using the buckle. Place large
sensor into pocket of shoulder band.
9. Once sensors are placed in the bands, put each band onto its corresponding
body part (see image below). Connect hook and loop fasteners of shoulder
band if desired. Make sure the elbow sensor is sitting behind the patient’s
elbow. Adjust bands for comfortable fit, if necessary.
Front View Back View
10. Launch the TherapyView application if it is not already open.
11. Log in and select an existing patient or add new patient. Edit patient
information and avatar settings to match your patient as needed.
Online Configurations Only: Patient information and avatar settings will be
saved to the patient’s profile for subsequent sessions.
12. Once a patient is selected or created, initiate the session by pressing “Start
Session.”

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SECTION 4: MANAGING A THERAPEUTIC OR WELLNESS SESSION
1. Select a therapy or wellness experience and press “Run Experience”.
2. Have the patient sit in a neutral position away from metal components, facing
forward with hands on thighs. Press the button on the tablet screen to calibrate
the sensors.
3. Confirm patient’s avatar in VR space corresponds to patient’s physical
movement. If the avatar looks correct, press “Continue”. If not, recalibrate the
sensors by selecting “Remap Sensors”.
4. Press “Start” to begin an activity. You may also use the Activity Menu to
select a new activity or return to the Experience Selector to switch to other
experiences.
(See Section 6 for more details about therapeutic and wellness experiences).

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5. Always remain with the patient throughout therapy session to provide direct
supervision.
6. Monitor patient view on tablet; select and begin new experiences or activities
as desired.
Note: After 20 minutes of inactivity in TherapyView, the user will be automatically
logged out of the TherapyView application. To start a new session, exit out of
TherapyView completely and return to step 10 in Section 3.
Note: If sensors lose synchronization or headset loses tracking, reset the entire
system. Headset should be turned off and on using the power button. TherapyView
application should be relaunched on the tablet. Sensors should be reset by placing
them in the powered charging station (while the REAL y-Series is plugged in) and
then removing them.
7. When planned therapy activities are complete, press “End” on tablet.
8. View patient results on tablet. You may also switch to the Notes tab for a
summary of session and activity times.
Online Configurations Only: Patient information will be saved to the patient’s
profile for subsequent sessions.

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Section 5: SYSTEM REMOVAL
1. Remove sensors and bands.
2. Remove headset from patient’s head.
3. Power off headset by pressing and holding onto the power button for
approximately 5 seconds.
4. Log out of the TherapyView application.
5. Clean headset and sensors with institutional approved sanitizing wipes* as
needed.
6. Ensure REAL y-Series Case is plugged in.
7. Connect tablet and headset to their respective power cords. Red or green LEDs
should be noted on the headset.
8. Return all sensors to sensor charger. Red or green LEDs should be noted on
sensors when placed correctly in the charging station.
9. Store and label bands for future individual patient use.
10. Sufficiently charge all components after each use and prior to next use for a
minimum of 60 minutes.
Note: Standard operation is to power cycle and relaunch the system between therapy
sessions to re-establish system connections.
*Handle the lenses on the headset carefully to avoid smears or scratches. Wipe
lenses with a soft cloth for cleaning. Clean outer and inner plastic components of
headset with institutional approved sanitizing wipe. Do not use petroleum-based
compounds, acids, caustics, or chlorinated solvents to clean or lubricate any
parts. Use water-based solvents for cleaning. UV light can be used to clean plastic
components of sensors but should be avoided for the headset. Neoprene side of
sensor bands can be wiped down using an institutional approved sanitizing wipe.
REAL y-Series Case Instructions:
REAL y-Series is housed in a travel case that may be locked with the attached
combination lock that secures the zipper. The combination lock should
be turned to the red dot position at all times. If the combination lock is turned away
from the red dot, turn it to the red dot position.
How to reset the combination lock:
1. Set all combination dials to the following: (0-0-0 default)
2. Find the hole located to the right of the dials. Use a paper clip or similar tool
to press down on the reset button until an audible “click” is heard.
3. Set personal combination by turning the dials to display the desired set of
numbers, e.g. 2-8-7.
4. Push the slide button located on the left of the dials towards the direction of
the arrow and the reset button will push back up. An audible “click” will be
heard.
5. Remember the personal combination. If reset is necessary, set the dials to
the previous set combination and repeat steps 2 to 4 above.
How to use the combination lock:
1. To unlock: Turn the dials to the correct combination. Push the slide button
on the left of the dial towards the direction of the arrow to unlock.
2. To lock: Put the loop portion of the zipper into the slots of the lock, then turn
the dials randomly to conceal the personal combination to lock.
Section 6: SOFTWARE DESCRIPTION
REAL y-Series contains a variety of experiences with a multitude of activities that
incorporate clinically recognized, existing therapeutic, functional, and wellness
exercises to facilitate motor learning, cognitive function, memory, and relaxation.
Settings for each experience and their activities will involve parameters such as
turning on and off avatar features and environmental factors. While using the
REAL y-Series, the HCP remains responsible for the patient’s safety and the
appropriateness of individual exercises including range of motion (ROM) attempted
and any other limb or joint limitations unique to that patient.

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REAL Home
REAL Home is a peaceful, serene lakeside experience to acclimate patients to VR.
The REAL Home experience moves at its own pace and provides a secure space for
patients to spend as much or as little time as they wish here before, in-between, and
after activities. Patients can listen to music, birds chirping, lapping water, and wind
chimes as they enjoy the tranquil lakeside and grow comfortable in this virtual space.
Happy Valley™
Happy Valley experience immerses the patient in a delightful world of penguins
that supports physical rehabilitation, cognitive function, and wellness. Happy Valley
includes a total of 18 therapeutic and wellness activities.
Hide and Seek™ Activity
Hide and Seek can be used with or without a displayed avatar tracking the patient’s
body as it primarily relies on cervical proprioception and range of motion (ROM). Hide
and Seek puts the patient in a pastoral setting with a number of animated animals
that react to the patient’s acknowledgement of them.
Visually scanning the environment, patients are tasked with finding a small penguin
by hovering a blue gaze pointer on the penguin by turning and rotating their head to
exercise their cervical range of motion. The penguin will then disappear and reappear
in a different location. The pointer is positioned to represent the patient’s vertical
midline and is itself a useful tool as some patients in neurorehabilitation have lost
their sense of body position resulting in “midline shift.” The blue pointer provides
a visual, external cue to their true body midline helping them relearn centering
themselves. Hide and Seek encourages visual scanning of the patient’s environment,
an important functional ability, and cognitive recognition of nameable animals,
objects, and environmental locations in their immediate surrounding. At the end of
the patient’s session, the patient can visualize overall progress they made during the
session in the form of virtual “rewards.”
HCPs may adjust various activity parameters using the TherapyView application.

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Catch & Glow™ Activity
Catch & Glow is designed to help the patient exercise cervical proprioception and
ROM. This activity takes place in a low-stimulation, nighttime environment, where the
patient is tasked to focus on and control a small penguin with their head movement
to catch fireflies that appear in a specific pattern. This activity provides a range of
challenges to help focus on the patient’s gaze stability, oculomotor and visual control,
and postural and cervical control. The HCP can control the complexity of the activity
by adjusting various activity parameters.
Hot Air Balloon Activities
Hot Air Balloon is a family of activities designed to help the patient work on trunk and
core control, Base of Support, strength, centering, and postural proprioception. By
leaning their torso in a certain direction, and holding it there against gravity, they fly a
hot air balloon in that same direction. To fly the balloon away and towards them, the
patient uses thoracolumbar flexion and extension, and to fly from left to right involves
thoracolumbar flexion to the left or right. This set of activities provides a range of
challenges focusing on enhancement of trunk control, postural stability, and dynamic
balance, all of which are foundational to body function. HCPs may adjust various
activity parameters.
Balloon Pilot™ Activity
Balloon Pilot takes place near the ground. The patient-controlled balloon
is tethered to the ground to limit balloon travel and encourage simple torso
centering, trunk mobility, and dynamic weight shifting. The patient can pilot the
balloon on-tether to nearby interactive objects, such as the trees and the bell.
Bumper Band™ Activity
Bumper Band takes place halfway up the mountainside. The patient uses trunk
extension, flexion, as well as lateral flexion to steer an untethered balloon to bump
other balloons with band members in them, back to the performance stage.
Summit Rescue™ Activity
Summit Rescue takes place at the peak of the mountain where the patient steers
the balloon to rescue hikers and bring them back to the safety of the chalet.
The patient is asked to counteract different obstacles using cognitive planning,
problem solving, and trunk control movements.

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Sunrise™ Activities
The Sunrise family of activities focuses on simple shoulder flexion. The patient holds
their arms out straight in front of them and raises their arms up and over their head in
a motion that ideally, is pure shoulder flexion with a maximum, healthy ROM of 180
degrees. This exercise may be done passively with HCP assistance or actively by the
patient themselves. This exercise encourages postural alignment and symmetrical
shoulder flexion.
When this motion is initiated, a Sun rises up from beyond the horizon in proportion
to the patient’s shoulder flexion ROM. The Sun also rotates in the sky and translates
side to side, depending on the patient’s postural symmetry. When the patient’s arms
are horizontally and vertically symmetric, and their torso is in vertical alignment with
their pelvis and head, the Sun will be smiling broadly and high in the sky straight
ahead of the patient.
If the patient’s posture exhibits asymmetry or other compensating characteristics, the
Sun’s position and the expression on its face will alter from the “ideal” state, thereby
providing the patient an external visual cue as to their posture, and allowing them to
learn via alternative references, what is proper, non-compensating posture. Maximum
shoulder flexion ROM achieved during this activity will be stored as a session output
for the HCP’s record. HCPs may adjust various activity parameters through the tablet.
Sunrise Activity
As the patient fully lowers and fully raises their arms to the best of their ability,
the lighting in the virtual world will exhibit night-time or daytime according to the
sun’s position, thus greatly accentuating the activity and feedback of a simple
coordinated arm raise. There is a rep counter on the tree to count the number of
reps the patient completes. Optional mirror therapy setting available.
Harvest™ Activity
Harvest involves growing a variety of vegetables by raising and lowering one’s
arms a number of times in order to trigger the appearance of day- night cycles.
This activity creates an incentive for the patient to do multiple repetitions of this
exercise if called for by the patient’s rehabilitation or wellness plan. Optional
mirror therapy setting available.
Ice Cave™ Activity
Ice Cave involves freeing a variety of Cave Penguins from ice blocks by raising
and lowering one’s arms a number of times in order to trigger the appearance of
day-night cycles. This activity creates an incentive for the patient to do multiple
repetitions of this exercise if called for by the patient’s rehabilitation or wellness
plan. Optional mirror therapy setting available.
Bird Forest Activities
The Bird Forest family of activities incorporates standard functional exercises
including dynamic reaching and pronation/supination requiring the patient to reach
out with one or both hands to pick up birds and place them into nests. Patients have
opportunities to reach from low to high, high to low, from left to right and vice versa
to practice functional reach. These exercises mimic standard functional exercises that
would be practiced during rehabilitation to help the patient regain skills necessary to
live at home with a degree of functional independence, and perform activities of daily
living (ADL) such as unpacking groceries, cooking, unloading a dishwasher, self-care,
etc. HCPs may adjust various activity parameters
Free Birds™ Activity
In Free Birds, the patient uses functional movements to pick up and place birds
into nests. Optional setting to include pronation and supination therapy by
instructing patients to pick up and place birds into their nests.

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Nest Hop™ Activity
In Nest Hop, the patient uses functional movements to pick up a single bird and
place it into a series of nests, under an optional time limit. When a target nest
has been filled, a new target nest will appear, and the patient will have to move
the bird from the previous nest to the new target nest. Optional setting to include
pronation and supination therapy by instructing patients to pick up and place the
bird into nests.
Bird Match™ Activity
In Bird Match, the patient uses functional movement to pick up a bird and place it
into a nest with its matching-colored ribbon. Optional setting to include pronation
and supination therapy by instructing patients to pick up and place the birds into
their nests.
Sports Park Activities
In the Sports Park family of activities, the patient must move their upper extremities
to intercept a Chuckleball™ coming at them, in a time dependent manner. These
activities require quick cognitive processing and visual-motor integration to succeed,
and thus are more advanced activities for a neurorehabilitation patient. Other primary
skills being challenged are reflective movements, dynamic postural control, visual
recognition, and motor control. HCPs may adjust various activity parameters.
Chuckleball Activity
The patient fends off approaching Chuckleballs by deflecting them with their
hands or head. This activity is designed to challenge reflexive movements,
dynamic control, visual recognition, and motor control.
Chuckleball Arena™ Activity
Designed to exercise trunk control and functional reach, the patient must defend
their goal using their hands or head as a penguin tries to score with a Chuckleball.
Using cognitive skills, the patient must predict the trajectory and reach for a
certain location to block and hit the Chuckleball into the opposing goal or into
other characters within the environment to collect points. The HCP can control
how fast the ball travels towards the patient, the direction and distance the patient
must reach to block the ball, and the number of balls to be kicked at the patients.
Flying Fish™ Activity
Designed to facilitate trunk stability and functional reach, patients will test their
reactive movement by blocking blue fish with their hands or head or dodging
red spiky fish. Fish may turn from blue fish, which should be deflected, to red
spiky fish, which need to be avoided. This requires extra cognitive processing to
decide, under time pressure, which fish should be contacted, and which should
be avoided, in addition to predicting where the fish are coming and integrating
proper movement to accomplish the task.
Creative Canvas Activities
The Creative Canvas family of activities is table-top based, designed to support
functional reach, fine motor control, and cognitive abilities. These activities
incorporate simple cognitive and creative elements through selecting colors, painting
pictures, and stamping images, while providing a therapeutic experience. For patients
who cannot benefit from more advanced functional reach activities, the activities
in Creative Canvas allow patients to focus on rehabilitation of their cervical range
of motion. The activities also include a canvas angle setting that allows the HCP to
adjust for more able patients to experience more advanced arm reach and fine motor
control. HCPs may adjust therapy settings and difficulty through various activity
parameters.
Paint by Numbers™ Activity
In Paint By Numbers, the patient will fill in empty cells of an image with the required
matching color and number by selecting the color and filling in the image with

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various brush strokes. Besides using the left or right hand to select colors and paint
on the canvas, the patient can utilize Gaze Painting Mode. This mode allows the
patient to select paint colors from a palette and paint on the canvas using only the
gaze pointer, providing a cervical motion exercise variation. The patient also has
the ability to access a hand palette in the non-painting hand, to help promote two
handed interaction within the activity. The HCP can control the level of complexity by
choosing the number of color selections available.
Free Paint™ Activity
Free Paint allows the patient to express their own artistic creativity, without
restrictions. This activity has two modes: Blank Canvas and Coloring Book. There are
no rules, goals or tasks that need to be completed; the patient can paint whatever
they would like on a canvas. Using the paintbrush, the patient chooses a color
from the color palette or paint swatches to paint the canvas. The patient also has
the ability to access a hand palette in the non-painting hand, to help promote two
handed interaction within the activity.
Free Stamp™ Activity
Free Stamp allows the patient to express their creativity by selecting and stamping
down images onto a provided canvas background to create their own artistic
compositions. There are no rules, goals or tasks that need to be completed. This
activity helps provide a free form cognitive exercise encouraging the patient to
combine stamps together creatively to construct their own scene and story. Three
sets of stamp collections are available to the patient: Happy Farm, Happy Trails, and
Happy Geometry. The patient also has the ability to access a hand palette in the non-
stamping hand, to help promote bimanual coordination within the activity.

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Mad Tavern™ Activity
Mad Tavern is a pain distraction activity using distraction techniques where the
patient is surrounded by animated characters in a cozy tavern setting. Visually
scanning the environment, the patient interacts with each character by using the
blue gaze pointer by turning and rotating their head to exercise their cervical range
of motion. The patient’s pointer is positioned to represent the patient’s upper body
vertical midline and triggers a series of short stories within the tavern. This activity is
designed for practicing visual processing skills and cognitive aspects for focus and
attention.
Island Antics™
Island Antics experience is designed for patients who need to work on upper body
reconditioning and motor functions. It transports patients to a city of antics where
they get to be a celebrated hero tasked to help island citizens using multi-directional
movements to complete tasks. Island Antics includes 4 activities that support
therapeutic motions to exercise trunk control, functional reach, reaction time, fluid
movements, postural control, coordination, and cross-body movements.
Island Antics promotes big and dynamic movements to improve postural stability,
coordination, encourage full upper-body movement, to help address impairments
like resting tremor, postural instability, bradykinesia, hypokinesia, depressed moods,
and loss of cognitive function (sustained attention, difficulty changing strategies
quickly). Functional deficits that can result from such symptoms can include a sense
of weakness during functional activities, and impaired balance and posture. High
intensity exercises require high effort, increased amplitude, increased repetitions, and
accuracy.
Make island improvements with big movements!
Save the Seagulls™ Activity
Using trunk control, functional reach, and cross body motions, patients are tasked
with fending off UFO drones poaching seagulls by tossing them back like frisbees.
A UFO Mothership has descended upon Island Antics and is planning to abduct
the island seagulls. A swarm of mini-UFOs will approach the seagulls on top of the
building in front of the patient. When a UFO reaches their selected seagull, the UFO
tractor beam will turn on and begin to abduct the seagull. The patient will need to
reach out utilizing trunk control, functional reach, and cross body motions to fend off
UFOs by touching and tossing them back like frisbees. Each successful UFO toss will
knock a piece of equipment off the UFO Mothership causing damage. Once all the
pieces of equipment on the UFO Mothership are destroyed, all UFOs in the scene will
return to the UFO Mothership and all together they will blast off back into Space.

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Citizen Crossing™ Activity
Using trunk control, functional reach, and dynamic balance, patients are asked to
help citizens across a street being blocked by a giant beached whale. A giant whale
is beached in the middle of Island Avenue after crashing through civilian pathway
bridges and preventing the citizens from crossing safely. The citizens need the
patient’s help to cross the road and continue their way to work. Using trunk control,
functional reach, and dynamic balance, the patient must reach out to pick up the
citizen and follow the path visualization to place the citizen on the other side of the
street. Once the patient has successfully helped the island citizens cross the road,
the patient is asked to free the whale by launching her back to the ocean in one swift
upwards movement.
Leaks and Levers™ Activity
Leaks and Levers concentrates on shoulder flexion and extension to turn various
valves and pull different levers. Patients use these therapeutic motions to fix the
city’s plumbing system by turning valves to unblock pipes. Too many sea creatures
are getting flushed and blocking the island’s pipes. Seated in front of a control panel
of pipes and valves, the patient is tasked with fixing the city’s plumbing system
by turning valves to unblock pipes. Using shoulder active range of motion (ROM),
strength, and multi-directional arm movement patterns, the patient turns the valves
and pulls the levers. Upon successfully turning the valves and pulling the levers, the
sea creatures will be sent back to the sea.

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Coconut Chuck™ Activity
Using a giant slingshot, patients send coconuts over the ocean and onto floating
cargo ships by exercising functional reach and trunk movement. A coconut will
be knocked off the palm tree and slide down the path to a giant slingshot. Using
functional reach and trunk movement, the patient must reach out to pull the slingshot
and send the coconuts through the air onto the floating cargo ships. Once the
coconut is resting in the giant slingshot, the patient should reach forward and lean
back while pulling arms back as far as possible. Upon completing that movement,
the coconut will launch out in the sky, over the ocean, and onto the cargo ship. After
all coconuts have been launched to the cargo ship, the patient must pull down on a
chain to activate the work whistle, which causes the cargo ship to depart towards the
main island. Utilize one or two hands to activate the slingshot. Slingshot paths can be
created to be longer or shorter based on patient needs.
Mindful Market™
Welcome to Mindful Market, where patients can engage in a lively marketplace that
emphasizes high-level cognitive skills, performing instrumental ADLs (Activities of
Daily Living), and stimuli tolerance. Recover executive functions, working memory,
sequencing and sorting abilities, and resilience to stimulation by volunteering at
multiple small businesses in the charming market square. Make savory sandwiches,
feed the market’s animals, and flex your monetary skills as you volunteer your unique
skills for the benefit of the townspeople’s enthusiastic entrepreneurs.
Designed to rebuild confidence in cognitive skills, this virtual space offers differing
stimulation levels and challenge settings that can help support community re-entry.
These therapeutic and wellness activities can be utilized to help patients ease back
into the workplace. All activities take place in environments with adjustable settings
tailored to patient needs. Mindful Market contains three visual stimulation levels, so
therapists can determine what level of visual detail is most suitable for the patient.
Sandwich Shop™ Activity
Take on the role of a chef in Sandwich Shop, fulfilling sandwich orders for customers to
help build sequencing and working memory skills. The patient is in front of a sandwich
making station, like a real kitchen environment, where they can utilize different
countertops to the left, right, and in front of them to access sandwich ingredients.
Customers arrive one at a time to request their orders, which are listed in steps on large
tickets for the patient to see. Sandwich sequences are communicated to the patient
through images of ingredients listed from top to bottom. Once the order is complete,
lift the order and present it to the customer at the window. Customers will respond with
facial expressions and actions to convey their sandwich satisfaction. If an incorrect
order is made, a customer may show confusion or mild disappointment.

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Harvest Helper™ Activity
Help a local farmer sort her delivery of animal feed while the animals clamor for their
food. Catch items as they’re thrown to improve ability to concentrate in a distracting
environment. The farmer unloads her delivery of animal feed by tossing each item to
the patient. The farmer picks up an item from the tractor trailer and tosses the item
when the patient indicates they are ready to catch by placing their hands up to match
the outline shown in the activity. As the patient catches each item the farmer throws,
they can increase resilience and ability to concentrate around audio stimulation as
they sort each item in its place. Sort each item using object recognition and place
each item on the correct pallet in front of the patient. The farmer will provide reactions
when the patient places the animal feed on the correct pallet. There are three pallets
to choose from and each pallet will have an example of the item that the farmer
throws.
Stamp Stand™ Activity
Designed to improve memory and money management skills, patients will sell
postage stamps and help customers stay within their designated budget. Use mental
math and working memory to get as close to the customer’s budget as the patient
can. Use the calculator for additional assistance.
Music in Motion™
Engage in musically driven exercises by using therapeutic motions like visual
scanning, core control, and shoulder flexion in reactive environments in a fantastical
virtual world. Music in Motion is an entertaining music-themed VR rehabilitation
experience designed for upper extremity and cognitive rehabilitation. Clinicians can
utilize this experience to deliver engaging and effective rehabilitation exercises to
support patients who suffer from neurological disorders. Encouraging movement

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early during the rehabilitation process is key to regaining function in affected
extremities.
Rhythm relies on varying parts of the brain (frontal and parietal cortices, as well as
the cerebellum) to stimulate motor pathways and encourage neural reorganization.
Patients may utilize rhythm combined with music therapy to promote recovery of lost
function.
Music in Motion has four activities in two environments that can be customized by
the clinician to fit each patient’s rehabilitation needs by modifying range of motion
and speed of each activity. Combining rehab with rhythm, patients are asked to move
their body to the music and hit notes while gathering prizes as a reward for their hard
work. This allows them to keep track and visualize their progress session by session.
Song Safari™ Activity
Utilize cervical ROM and visual scanning to spot various candy critters hiding within
the sweet or beach environment. To spot each candy critter, hold the gaze-pointer
on the critter hiding in the environment. Each critter will peek out from behind various
objects and then hide again. After successfully spotting each critter, they will jump
out and perform a celebratory animation before hiding again.
Lean into the Music™ Activity
Use cervical range of motion, trunk control, and core stabilization to steer and elevate
the flying bird toward various targets. Steer and control the bird by leaning the torso –
lean back to raise the bird, lean forward to lower the bird, or lean left and right to
guide the bird in those directions. The bird will spin if it is lined up with the targets.
Reach for the Rhythm™ Activity
Utilize trunk control, dynamic balance, and functional reach to touch colored targets
with the appropriate hand (right or left) as they fly by. Red targets are caught with the
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