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Archive for category Video Games/Exergames
[ARTICLE] Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients – Full Text
stroke is a central nervous system disease caused by cerebrovascular problems such as infarction or hemorrhage. Stroke may lead to impairment of various physical functions, including hemiplegia, language disorder, swallowing disorder or cognitive disorder, according to the location and degree of morbidity . Among these, hemiplegia is a common symptom occurring in 85% of stroke patients. In particular, upper extremity paralysis is more frequent and requires longer recovery time than lower extremity paralysis [2, 3]. To maintain the basic functions of ordinary life, the use of the upper extremities is essential; therefore, upper extremity paralysis commonly causes problems in performing the activities of daily living .
Robot-assisted rehabilitation treatment has recently been widely investigated as an effective neurorehabilitation approach that may augment the effects of physical therapy and facilitate motor recovery . Robot-assisted rehabilitation treatments have been developed in recent decades to reduce the expenditure of therapists’ effort and time, to reproduce accurate repetitive motions and to interact with force feedback [5, 6]. The most important advantage of using robot-assisted rehabilitation treatment is the ability to deliver high-dosage and high-intensity training .
In rehabilitation patients may find such exercises monotonous and boring, and may lose motivation over time . Upper extremity rehabilitation training using video games, such as Nintendo Wii games and the PlayStation EyeToy games, enhanced upper extremity functions and resulted in greater patient satisfaction than conventional rehabilitation treatment [9, 10, 11, 12, 13].
The objective of this study was to determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison to conventional upper extremity rehabilitation training (OCT) in stroke patients. This study was a randomized controlled trial and we evaluated motor power, upper extremity motor function, daily function and satisfaction. […]
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[Abstract+References] Virtual reality software package for implementing motor learning and rehabilitation experiments
Virtual reality games for rehabilitation are attracting increasing growth. In particular, there is a demand for games that allow therapists to identify an individual’s difficulties and customize the control of variables, such as speed, size, distance, as well as visual and auditory feedback. This study presents and describes a virtual reality software package (Bridge Games) to promote rehabilitation of individuals living with disabilities and highlights preliminary researches of its use for implementing motor learning and rehabilitation. First, the study presents seven games in the software package that can be chosen by the rehabilitation team, considering the patient’s needs. All game characteristics are described including name, function presentation, objective and valuable measurements for rehabilitation. Second, preliminary results illustrate some applications of two games, considering 343 people with various disabilities and health status. Based on the results, in the Coincident Timing game, there was a main effect of movement sensor type (in this instance the most functional device was the keyboard when compared with Kinect and touch screen) on average time reached by sample analyzed, F(2, 225) = 4.42, p < 0.05. Similarly, in the Challenge! game, a main effect was found for movement sensor type. However, in this case, touch screen provided better performance than Kinect and Leap Motion, F(2, 709) = 5.90, p < 0.01. Thus, Bridge Games is a possible software game to quantify motor learning. Moreover, the findings suggest that motor skills might be practiced differently depending on the environmental interface in which the game may be used.
This is a call to survivors of stroke and/or traumatic brain injury to consider demonstrating our newest ‘games’ innovations. We at 3DPreMotorSkill Technologies, LLC research and develop special video game-like technology for survivors.
We have completed two clinical trials with 47 survivors. No survivor was harmed in any way and we do not sell or charge anything for participating in our research.
Our ‘games’ benefit from a natural ability we all have: motor imagery. Motor imagery implies visualizing body movements. If you can ‘think’ of your impaired limb making movements, our ‘games’ present virtual, controllable limbs you can use to act out your ‘thinking.’
Our first clinical trial was published in the Journal of Rehabilitation Research and Development, JRRD Volume 51, Number 3, 2014 Pages 377–390: “Pilot study: Computer-based virtual anatomical interactivity for rehabilitation of individuals with chronic acquired brain injury.”
Our second clinical trial was reported at a conference in The Netherlands (poster sections below). Our full report is under peer review by the journal Frontiers in Human Neuroscience.
Our mission is to help survivors to help themselves by ‘playing’ our self-movement-management ‘games’, called Pre-Action Games & Exercises (PAGEs).
PAGEs are easy and fun to play. First, you see a realistic virtual limb on a computer screen. The virtual limb represents your impaired limb. You control it to make realistic physical movements. A standard computer mouse is used to point the cursor to all or part of the virtual limb and click and drag it to simulate unimpaired movements.
While controlling the virtual limb a signal is automatically sent to a wearable hand movement device (WHMD). The WHMD physically and mildly manipulates your impaired left hand. The result is mental and physical feedback to you.
A limited number of survivors (approximately five) of stroke and/or traumatic brain injury will be selected to play PAGEs games. All games are free to volunteers and will take about 30 minutes to complete, here in Tallahassee.
- be 21 years of age or older
- have a moderate to mildly impaired (hemiparetic) left hand
- have consulted your physician, therapist and family and be in sub-acute or less intense therapy
- be responsible for their own consent and transportation to and from a location within Tallahassee
- be willing to try-out for selection (approximately 15 minutes).
- All we need for the selection try-out is you and an aide, if you like. Please email interest to email@example.com and be sure to add “WHMD” to the “Subject:” line, so that your response is read. Send any details you wish, such as left hand impairment and date of brain injury.
Imagine being in pain, but happily distracted from your suffering by being totally immersed in floating lazily down a river or tossing fish to hungry otters that pop up out of nowhere. Such scenarios of a 360-degree world are possible via virtual reality (VR), whereby a patient sits in a chair wearing a head visor connected to a computer and holds a small wireless device in his or her hand to change direction.
“Although [VR] is very early in its inception for treating painful conditions, we are hopeful that VR will interest other research and payors,” said James Choo, MD, owner and medical director of Pain Consultants of East Tennessee, in Knoxville, which conducted two clinical studies of VR. “I think there is a lot of potential for VR, especially if you marry VR to other pain treatments that are not widely available but that we know work, such as cognitive-behavioral therapy and mindfulness meditation for lower back pain.”
However, he added that few pain psychologists are practicing in the United States, and cognitive-behavioral therapy is time-consuming. “We have never had scalable treatments that work and that can be highly disseminated,” Dr. Choo said. “With VR, if you have the right software, there is an enormous potential to disseminate that type of care to millions of people rather than just a handful of patients who have access to the one pain psychologist that might be in their region.”
Similarly, mindfulness-based instruction through VR may be plausible.
“The effects of the type of VR program that we used derive from a game,” Dr. Choo said. “It is not just a passive immersive experience of looking around at the scene. You are actually playing a game—interacting with the environment itself. Besides distracting pain, VR is fun, like playing a video game.”
Dr. Choo said the immersive experience of being in a virtual environment and simply being distracted from pain are helpful. In addition, “perhaps even the immersive experience has its own analgesic effect,” he said. “But we do not understand quite yet the neuropathways that are being affected that cause the analgesic effect. Once we do, then we will be able to better target the type of VR programs that best suit the patient and their particular pain needs.”
Ted Jones, PhD, a clinical psychologist at Pain Consultants of East Tennessee, heard a conference speaker last year refer to VR as a syringe, meaning its effect “depends on the content.” He added, “Historically, since the late 1980s, VR has been used for procedural pain—basically for burn pain and injections in an inpatient setting or a burn unit. However, the majority of pain [treated by clinicians] is outpatient pain. So we are taking what has been used for inpatient procedural pain and using it for outpatient pain.”
To date, VR treatments at the clinic have been isolated to two completed studies, using software called Cool! developed by Firsthand Technology.
“What we have found is that if you give someone doses of VR, it cuts their pain dramatically,” said Dr. Jones, who was principal investigator of both trials. “However, there is no [long-term] effect. A week later, the patient is right back where he or she started, both painwise and depression-wise and stresswise. It is similar to a person coming to a pain clinic, giving them a dose of medicine and sending them home.”
The first study, conducted in 2015 and published last year in PLOS ONE (2016;11:e0167523), consisted of 30 patients with chronic pain. Participants were asked about their pain before and after a single, five-minute session of VR conducted at the clinic.
“The study decreased pain by 55% to 60%,” Dr. Jones said. “VR is like distractionon steroids, because when your brain is in a virtual world, it is like you are there. In comparison, morphine reduces pain by only one-third.”
The second study, performed last year at the clinic, involved 10 patients with neuropathic pain. The protocol was three sessions of VR, each lasting 20 minutes and spaced one week apart.
“Pain was cut by roughly 70%, due to the longer exposure sessions and multiple treatments,” Dr. Jones said. “There was also a lingering effect. Most patients reported that their pain continued to be less for about one day on average after each session.”
‘Still Out of Reach’
However, depression, anxiety, beliefs about pain and how to cope with pain did not change over time. “In other words, VR did not provide patients any emotional or cognitive benefit,” Dr. Jones said.
Dr. Jones said a single VR unit costs between $3,000 and $4,000. Although it’s a dramatic drop from the previous $8,000 cost, “it is still out of reach for most patients,” he said. “Further, many of the units currently available have a lot of wires and require a high-end machine. You cannot take it home with you—physically or financially.”
To address these shortcomings, Pain Consultants of East Tennessee and the University of Tennessee plan on conducting a pilot study of 10 to 20 patients this fall with the portable Samsung Gear VR, which has an easy-to-use headset and some pain and relaxation applications, along with a Fitbit fitness mobile device to detect activity level and record pain.
“We will determine if daily VR home use is effective, which should be the case, based on our two previous studies,” Dr. Jones said. “Using VR at home several times a day is like being prescribed a pain reliever to be taken two or three times daily. VR has the chance to replace as-needed pain medicine at home.”
The occupational therapy department at the pain clinic is also scheduled to incorporate VR into therapy for conditions such as phantom limb pain and stroke pain. “For this application, VR acts like a mirror, so patients can see and restore movement,” Dr. Jones said.
Despite enthusiasm about VR for pain, there are several hurdles and challenges to make the modality effective in the clinical space. Besides no payors yet, “we need more in-depth studies to show its efficacy for [specific] conditions,” Dr. Choo said.
Apart from employing VR as simply a game, VR may be used as a substitute therapist in certain cases, or for biometric functioning and rehabilitation. “These are completely different programs,” Dr. Choo said. “Therefore, we have to be very specific on the types of software programs we use and the way they deliver care.”
For instance, VR could be used to help patients meditate or provide biofeedback.
“One of the key [goals] is for VR to become a scalable model,” Dr. Choo said. “The unit we are using is not portable. But in the future, we envision all VR units being extremely portable, easy to use and accessible.”
Dr. Jones added, “VR has a lot of potential. We just need to match it to the right patient at the correct setting and the right cost.”
[EDITORIAL] ADVANCING GAMING TECHNOLOGY IN NEUROLOGICAL REHABILITATION – Pakistan Journal of Neurological Sciences (PJNS)
Samreen Sadiq, Lahore College of Physical therapy, firstname.lastname@example.org
Iqra khan, University Institute of Physical Therapy, University of Lahore
The consumption of gaming technology has recently gain unexpected signiﬁcance in medical health care for neurological rehabilitation. With increasing interest in exergames study, numerous deﬁnitions and terminology have been introduced to describe this term. Researchers from health-related background acknowledged the fact that engaging in video gaming was not always sedentary and might act as a means to ensure more physical work. Simplifying the terminology exergames are those types of gaming technology or multimedia communications that necessitate the player to perform physical activity during play.
However, health related researchers were hesitant to use the terminology of exergaming, their descriptions shared a mutual purpose of enhancing physical activity level. Two similar terms were deﬁned to explain that concept known as activity promotion and active video gaming. For instance, videogames that promote physical activity were described as those video games that have capability to enhance physical movements during screen period whereas active video gaming may give new opportunities to transform the conventional sedentary attitude into physical active behavior. The chief impression of using such terminology is to discriminate engaging in video gaming that encourage active attitude from those resulting in inactive behavior.’
The growing utilization of exergaming and the expansion of diverse software’s by ground breaking minds in gaming industry have inadvertently opened new ways to address goals of neurological rehabilitation. The common aims of rehabilitation include improvement in balance, enhancing functional movements as well as to promote ﬂexibility. The chief reason for integrating video gaming in neurological rehabilitation is to enhance patient motivation, strict adherence to treatment procedure and to ignore boring training.
An important question which rises in mind is could those clients who are involved in neurological rehabilitation through gaming technology capitalize on its entertainment value? Motivating a person’s interest is probably a key to strict exercise adherence. The utilization of gaming technology is limitless. A research was done to evaluate efﬁcacy of Wii Ninetedo in Parkinson’s disease patients and the impact of integrating exergaming for the management of childhood obesity. Case reports utilizing exergaming have been described for improving balance and gait parameters in patients suffering from neurological condition known as stroke. The practice of exergames were found to be effective in improving exercise tolerance and adherence in Multiple Sclerosis patients. A study on efﬁcacy of Wii Fit was also conducted to evaluate the balance problems among Cerebral palsy children and the results suggested that Nintendo Wii provides entertaining, safe and effective means in conjunction with traditional management to improve balance of cerebral palsy children.
The safety of these emergent devices as medical equipment is questionable and whether there is need to give approval to these devices by governing authorities before using them. The concerned issue should be emphasized keeping in consideration the risks, dangers and adverse effects associated with the use of this exergames technology. Several case reports of injuries have been identiﬁed with utilization of this gaming technology for example shoulder joint dislocation, pulmonary disorder, tendon and ligamentous tear. Another case was reported about primary spontaneous pneumothorax in an old man with initial presentation following prolonged period of playing Nintendo Wii. Commonly reported injuries include overuse strain injuries, joint injuries and has been named as Wiiitis by authors. Terminology mostly used to describe such injuries associated to to Wii-habilitation include Wii Shoulder, Wii Knee and Nintendinitis.
Worldwide utilization of this novel technology has been implemented and various international scholars showed strong interest in integrating the use of exergaming for neurological rehabilitation. Global attention has been focused to this technology and paper based work has been presented in World Confederation for Physical Therapy. A lot of document based work displayed in Amsterdam was also put together on this speciﬁc topic, some were initial researches but they depict a worldwide interest in this emergent technology. Previous literature have focused the remarkable and extraordinary effects of exergaming on upper extremity function, daily living activities and posture control. This novel technology can efﬁciently provide opportunity to neuro patients to accomplish maximal repetition of movement and tasks and provide a better possibility in comparison to traditional techniques. In Pakistan, a similar paper highlighted the application of exergaming as an effective and innovative tool for stroke rehabilitation. It was suggested that this tool offers a collaborative activity and the cost of video games is less as well as ensure easier implementation. So, it is the chief responsibility of concerned professionals to deliver a complete rehabilitation protocol so that optimal functioning level can be achieved. It enables the person to perform activities of daily living independently. This novel technology lessens the full time help of physical therapist and home-based management can also be manageable in future. Therefore, it is correct time to use this technological advancement for assistance in neurological rehabilitation to attain best outcome in small period.
The debate on emergent technologies is relatively noteworthy in rehabilitation and physical therapy practice. This forward technology shift and use of other analogous devices offer countless choices for rehabilitation extending from heart rate measuring and respiratory rate monitoring tools, to diagnostic and education applications. It now seems possible to foresee the effect and impact of this emergent technology in rehabilitation ﬁelds. It is pretty clear that technology has substantially improved the delivery of rehabilitation services and exer-gaming is likely to positively inﬂuence neurological rehabilitation in the future.
[Abstract] A novel approach to integrate VR exer-games for stroke rehabilitation: Evaluating the implementation of a ‘games room’
[Abstract] An adaptive self-organizing fuzzy logic controller in a serious game for motor impairment rehabilitation
FACULDADE DE ENGENHARIA DA UNIVERSIDADE DO PORTO
Serious Games for Health Rehabilitation
Paula Alexandra Carvalho de Sousa Rego
Serious Games are growing into a significant area spurred by the growth in the use of video games and of new methods for their development. They have important applications in several distinct areas such as: military, health, government, and education. As such, their purpose is to be used for other purposes than pure entertainment, which is normally associated with the concept of game. The interest for Serious Games arises from the fact that games have a set of features that makes them very effective to engage users and keep their motivation at higher levels.
From the above discussion, the design of computer games can offer valuable contributions to develop effective games in the rehabilitation area. In rehabilitation programs, one of the major problems reported are related to the motivation and engagement of patients in the exercises training sessions using traditional therapy approaches. Patients rapidly lose their interest and get bored doing the, usually repetitive, rehabilitation tasks.
This thesis addresses Serious Games for Health Rehabilitation (SGHR), and provides an indepth study and survey of the existent games and features. With this study we were able to devise a taxonomy that enables researchers and practitioners to use a systematic approach to study, classify and compare SGHR. This taxonomy is validated by a set of experts in the interrelated domain of knowledge. The research led us to identify and propose several important features and guidelines to include in SGHR. As a result, we propose, discuss and describe a framework for the development of serious games. The framework integrates a set of features of natural and multimodal interaction, social interaction (collaboration and competitiveness) and progress monitoring, which can be used to increase the motivation of the patients during the rehabilitation process.
To validate the proposed framework and features, a set of serious games were developed. These games are intended to be used in rehabilitation sessions, and their main goal is to increase the users’ motivation during the rehabilitation process. The developed games were designed based on well established rehabilitation systems and rehabilitation tasks. We describe the design and implementation of the games with respect to our proposed framework. The resulting game platform includes a set of features, such as competitiveness, collaboration and handicap mechanisms, with the aim of promoting the engagement and motivation of the patients involved in the rehabilitation process. The resulting system is a Web platform that enables games to be played online, making it more accessible to all users, including patients in rehabilitation. Besides that, the web platform provides a low cost solution to patients training and enables home rehabilitation, in addition to traditional therapy.
Final experiments were performed in order to validate the proposed framework and provide scientific evidence that it is possible to use serious games for health rehabilitation to increase the motivation of users. Experiments were conducted with healthy people and elderly users. The scores achieved in all the tests used were quite good with emphasis for the very good SUS and IMI scores achieved.
[Abstract] A Longitudinal EMG Study of Complex Upper-limb Movements in Post-stroke Therapy. 1: Heterogeneous EMG Changes despite Consistent Improvements in Clinical Assessments
Post-stroke weakness on the more-affected side may arise from reduced corticospinal drive, disuse muscle atrophy, spasticity, and abnormal co-ordination. This study investigated changes in muscle activation patterns to understand therapy-induced improvements in motor-function in chronic stroke compared to clinical assessments, and to identify the effect of motor-function level on muscle activation changes.
Electromyography (EMG) was recorded from 5 upper-limb muscles on the more-affected side of 24 patients during early- and late-therapy sessions of an intensive 14-day program of Wii-based Movement Therapy, and for a subset of 13 patients at 6-month follow-up. Patients were classified according to residual voluntary motor capacity with low, moderate or high motor-function. The area under the curve was calculated from EMG amplitude and movement duration. Clinical assessments of upper-limb motor-function pre- and post-therapy included the Wolf Motor Function Test, Fugl-Meyer Assessment and Motor Activity Log Quality of Movement scale.
Clinical assessments improved over time (p<0.01) with an effect of motor-function level (p<0.001). The pattern of EMG change by late-therapy was complex and variable, with differences between patients with low compared to moderate or high motor-function. The area under the curve (p=0.028) and peak amplitude (p=0.043) during Wii-tennis backhand increased for patients with low motor-function whereas EMG decreased for patients with moderate and high motor-function. The reductions included: movement duration during Wii-golf (p=0.048, moderate; p=0.026, high), and Wii-tennis backhand (p=0.046, moderate; p=0.023, high) and forehand (p=0.009, high); and the area under the curve during Wii-golf (p=0.018, moderate) and Wii-baseball (p=0.036, moderate). For the pooled data over time there was an effect of motor-function (p=0.016) and an interaction between time and motor-function (p=0.009) for Wii-golf movement duration. Wii-baseball movement duration decreased as a function of time (p=0.022). There was an effect on Wii-tennis forehand duration for time (p=0.002) and interaction of time and motor-function (p=0.005); and an effect of motor-function level on the area under the curve (p=0.034) for Wii-golf.
This study demonstrated different patterns of EMG changes according to residual voluntary motor-function levels despite heterogeneity within each level that was not evident following clinical assessments alone. Thus, rehabilitation efficacy might be underestimated by analyses of pooled data.