Archive for category Video Games/Exergames

[ARTICLE] Benefits and challenges with gamified multi-media physiotherapy case studies: a mixed method study – Full Text

Abstract

Background

The use of gamification in higher education context has become popular in recent years with one aim of enhancing learning motivation, yet, it is unknown how physiotherapy students perceive gamified education experience. Using gamification together with multi-media patient case studies, this study explored whether and how gamified education motivated physiotherapy students’ learning. It also investigated how other factors such as class design and mechanics affected gamified experience.

Method

Six case studies in the subject Neurological Physiotherapy were transformed from paper-based cases to multi-media cases built by iSpring suite 8.1. Simulated, real or animated clients were used. Gamification mechanics such as leaderboards, scoring and prioritisation were embedded in the case studies. These gamified case studies were used in classes with Year-3 students enrolled in this subject. After taking these classes, 10 students participated in two focus groups and 32 students responded to a survey to share their experiences and perceptions on this pedagogy.

Results

Results showed that students perceived gamified education as motivating since this satisfied their competence and social needs and enhanced their self-efficacy. In addition, authentic patient videos, class activities that allowed conflict resolution and reflection, and the use of leaderboards were enablers in this gamified experience.

Conclusion

Future gamified education in physiotherapy can provide authentic experience through class designs and gamification mechanics to foster learning motivation. A suggested mapping of gamified lessons for physiotherapy education is provided based on the results of this study.

Background

Learning is an inherently human activity that involves many complex active and interactive processes. Motivation appears to be a key driver to both initial and ongoing learning, as well as improved learning outcomes [1234]. Gamification, or the use of game elements in non-game contexts [5], promotes achievement, challenge, goal, competition and collaboration to learning [6], which in turn motivates learners [7]. Gamification is thought to enhance motivation and engagement through three levels of processes: cognitive, psychological/emotional and social [89]. At the cognitive level, learners experience processes such as problem-solving and decision-making [10]. At the psychological/emotional level, learners’ positive emotions (e.g. feeling competent) with certain experiences would wire into their memories to enhance further learning of similar experiences [1112]. At the social level, interactions with other learners facilitate knowledge constructions [13]. Gamified education should be structured to promote these processes.

To promote the aforementioned processes, better conceptualisations of gamification are needed. Gamification mechanics are often classified by reward or process-tracking types; namely leaderboards, badges, points (or scores), feedback and prizes [79]. Some educational gamification systems use one type of mechanics while others use a mix-and-match approach. Pedersen and Poulsen [9] found that feedback and points showed an increase in positive outcomes in terms of learning motivations, while other mechanics warrant further investigations. In addition, it is important to differentiate between game-based learning, gamification and serious game. Game-based learning is the use of games (digital or non-digital) as learning tools [14], while gamification does not necessarily include a game but embed game elements (such as competitions) in learning tasks [5]. The term serious game is sometimes used interchangeably with game-based learning as it applies to any game with a purpose other than pleasure; here learning fits into this rationale [81516]. The focus of this study is on gamification rather than game-based learning and serious game.

Gamification has been applied across different disciplines in higher education, such as computer science, mathematics, language and health education [171819]. Currently, there is a lack of literature describing or studying gamification in physiotherapy education. In a recent systematic review on gamification in health care education by Wang, DeMaria [20], only two out of 48 reviewed studies included physiotherapy students as participants. This paucity warrants investigation in the use of gamification in physiotherapy education given its reported benefits on learning.[…]

 

Continue —>  Benefits and challenges with gamified multi-media physiotherapy case studies: a mixed method study | Archives of Physiotherapy | Full Text

Fig. 1 Title pages of the three gamified virtual patient cases

 

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[NEWS] NEOFECT Redesigns Smart Board for Home

Published on May 8, 2019

SmartBoardforHome

NEOFECT has redesigned its Smart Board for Home in reply to feedback from patients recovering from stroke and other musculoskeletal conditions and neurological disorders.

The new Smart Board for Home NextGen includes a smaller surface to help patients use it at home more easily, a redesigned handle to better stabilize the user’s hand and arm, and updated gamified software.

The board size has been reduced from 42 inches to 32 inches so it can fit on most tables. To accommodate the weakened grip of many stroke patients, the redesigned handle includes more straps to better stabilize the user’s arm, ensure appropriate measurement for the post-game metrics, and provide a more secure, comfortable experience, according to the company in a media release.

“We took patient feedback and completely revamped the Smart Board for Home NextGen,” says Scott Kim, co-founder and CEO of San Francisco-based NEOFECT USA.

“This new model still has all the fun, measurable qualities patients can use at home, but now we’ve reduced even more barriers so that people of all abilities can gain back function in their hands and upper arms.”

Patients play games on the Smart Board for Home NextGen by placing their forearm in a cradle and moving their arm across the board. All movements are virtually mimicked on a Bluetooth-connected screen in real time. The gamified software also features an updated AI-powered algorithm to curate a more customized experience for each patient.

The Smart Board for Home NextGen games mimic real-world motions to rehabilitate users’ upper arms and shoulders, including new games like “Air Hawk” and “Tennis.”

Additionally, NEOFECT is developing a dual-player game for patients to use at home, which will be available in summer 2019.

[Source(s): NEOFECT, Business Wire]

Source:
http://www.rehabpub.com/2019/05/neofect-redesigns-smart-board-home/

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[NEWS] VA and Microsoft partner to help vets rehab with new Xbox controller – Video

Microsoft and the Department of Veterans Affairs have announced a new collaboration to help veterans with limited mobility get back in the game.

Thanks to the new Xbox Adaptive Controller a game controller made for people with limited mobility. The tech giant is helping provide Xbox controllers and services to vets as a part of their therapeutic and rehabilitative activities to help challenge muscle activation and hand-eye coordination and increase participation in social and recreational activities.

“This partnership is another step toward achieving VA’s strategic goals of providing excellent customer experiences and business transformation,” VA Secretary Robert Wilkie said. “VA remains committed to offering solutions for Veterans’ daily life challenges.”

Gaming is a popular activity among the military and vet community — but using a traditional game controller is a big obstacle for many injured veterans, and losing out on this activity was a big blow for many in the community.

“We’re looking for platforms for veterans to interact with each other, and the Xbox Adaptive Controller can be that access point to get involved in this world and in the gaming community,” said Dr. Leif Nelson of the National Veterans Sports Programs & Special Events at the VA.

And while many still see playing video games as a lonely activity, it is actually the opposite for many.

“Gaming is now everywhere in the world, and while people tend to think of it as isolating, we’re finding that it actually has the opposite effect and can increase interactions with other veterans and folks who are non-veterans. I think this can be a tool in the rehabilitation process to achieve a lot of different goals,” Dr. Nelson said.

Jeff Holguin, who was discharged for the U.S. Coast Guard after an injury, used gaming as a way to cope with the depression and post-traumatic stress disorder. After losing a career in the military, he lost part of his identity and felt adrift in the civilian world. And so he turned to gaming.

“It gave me an outlet, a virtual efficacy within a world that I didn’t feel like I had a place in anymore,” Holguin said. “I made a lot of social connections and friends through that virtual space.”

Mike Monthervil, a U.S. Army veteran injured in Afghanistan, sees gaming as a big help in his recovery. “I think gaming is helping soldiers like myself getting back to doing what they love and bringing joy into their lives.”

And the benefits extend beyond the social. 

“We can assign a number of therapeutic values to gaming,” said recreation therapist Jamie Kaplan. “It’s fine motor skills, gross motor skills, decision-making ability, information processing, cognitive processing and we’re able to use the game in their treatment plans.”

Microsoft is donating the controllers, game consoles, games, and other adaptive equipment in the hopes of bringing gaming to veterans with spinal cord injuries, amputations, and neurological or other injuries at 22 VA medical centers across the US. 

“We owe so much to the service and sacrifice of our Veterans, and as a company, we are committed to supporting them,” Microsoft CEO Satya Nadella said. “Our Xbox Adaptive Controller was designed to make gaming more accessible to millions of people worldwide, and we’re partnering with the U.S. Department of Veterans Affairs to bring the device to Veterans with limited mobility, connecting them to the games they love and the people they want to play with.”

via https://connectingvets.radio.com/articles/va-and-microsoft-partner-help-vets-rehab-new-controller

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[Abstract] Effectiveness of Virtual Reality Using PS4 Gaming Technology in Stroke Rehabilitation for Improving Upper Limb Function-A Pilot Study

Background: Hemiparesis resulting in functional limitation of an upper extremity and lower limb is common among stroke survivors. Virtual reality is one of the way of improving motor function in stroke, limited evidence is available on the efficacy of virtual reality for stroke rehabilitaton.

Methods: In this pilot study 2 parallel groups involving stroke patients, we compared the feasibility, safety and efficacy of virtual reality using the sony PS4 gaming technology to evaluate upper limb motor improvement. The primary feasibility outcome was the total time receiving the intervention. The… primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with wolf motor function test and Spasticity Grading at 4 weeks after intervention. OUTCOME MEASURE: WOLF Motor function test and Box and Block test.

Result: This study shows that mean values obtained from WOLF motor function test showed no statistical significance and the mean values of Box and Block test showed statistical significance.

Conclusion: This study concludes that the PS4 gaming technology is a feasible, safe, and potentially effective intervention to enhance motor function recovery in patients with a recent stroke.

Indian Journals

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[NEWS] Video Game-Integrated Training Device Helps Stroke Survivors Regain Arm Function

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Word writing text Rehab. Business concept for course treatment for drug alcohol dependence typically at residential

A new video game-led training device called a myoelectric computer interface (MyoCI), invented by Northwestern Medicine scientists, is enabling severely impaired stroke survivors to regain function in their arms after sometimes decades of immobility.

When integrated with a customized video game, the device helped retrain stroke survivors’ arm muscles into moving more normally. Most of the 32 study participants experienced increased arm mobility and reduced arm stiffness while using it, and retained their arm function a month after finishing the training, according to a study published recently in Neurorehabilitation and Neural Repair.

Many stroke survivors can’t extend their arm forward with a straight elbow because the muscles act against one another in abnormal ways, called “abnormal co-activation” or “abnormal coupling.”

The Northwestern device identifies which muscles are abnormally coupled and retrains the muscles into moving normally by using their electrical muscle activity (called electromyogram, or EMG) to control a cursor in a customized video game. The more the muscles decouple, the higher the person’s score, a media release from Northwestern University explains.

“We gamified the therapy into an ’80s-style video game,” says senior author Dr Marc Slutzky, associate professor of neurology and of physiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurologist. “It’s rather basic graphics by today’s standards, but it’s entertaining enough.”

“The beauty of this is even if the benefit doesn’t persist for months or years, patients with a wearable device could do a ‘tune-up’ session every couple weeks, months or whenever they need it,” adds Slutzky, whose team designed the original device. “Long-term, I envision having flexible, fully wireless electrodes that an occupational therapist could quickly apply in their office, and patients could go home and train by themselves.”

Slutzky also is studying this method on stroke patients in the hospital, starting within a week of their stroke.

Abnormal coupling of muscles leaves many stroke patients with a bent elbow, which makes it difficult to benefit from typical task-based stroke-rehabilitation therapies, such as training on bathing, getting dressed and eating.

Only about 30% of stroke patients in the United States receive therapy after their initial in-patient rehabilitation stay, often because their injury is too severe to benefit from standard therapy, it costs too much, or they’re too far from a therapist. This small, preliminary study lays the groundwork for inexpensive, wearable, at-home therapy options for severely impaired stroke survivors, the release continues.

“We’re still in the very early stages, but I’m hopeful this may be an effective new type of stroke therapy,” Slutzky states. “The goal is to one day let patients buy the training device inexpensively, potentially without even needing insurance and use it wirelessly in their home.”

Patients in the study were severely impaired – could only slightly move their arm and extend their elbow – and had had their stroke at least 6 months prior to beginning the study. The average patient was more than 6 years out from their stroke, and some were decades out.

After Slutzky’s intervention, study participants could, on average, extend their elbow angle by 11 degrees more than before the intervention, which was a pleasant surprise, Slutzky comments.

This type of treatment only requires a small amount of muscle activation, which is advantageous for severely impaired stroke patients who typically can’t move enough to even begin standard physical therapy. It also gives feedback to the patient if they’re activating their muscles properly.

To identify which muscles were abnormally coupled, study participants attempted to reach out to multiple different targets while the scientists recorded the electrical activity in eight of their arm muscles using electrodes attached to the skin. For example, the biceps and anterior deltoid muscles in the arm often activated together in stroke participants, while they normally shouldn’t.

Then, to retrain the muscles into moving normally (ie, without abnormally co-activating), the participants used their electrical muscle activity to control a cursor in a customized video game. The two abnormally coupled muscles moved the cursor in either horizontal or vertical directions, in proportion to their EMG amplitude, the release continues.

For example, if the biceps would contract in isolation, the cursor would move up. If the anterior muscles would contract in isolation, the cursor would move to the side. But if the muscles would contract together, the cursor would move diagonally.

The goal was to move the cursor only vertically or horizontally – not diagonally – to acquire targets in the game. To get a high score, participants had to learn to decouple the abnormally coupled muscles.

Muscles tend to produce more electrical muscle activity when contracting isometrically (without moving) compared to when moving the arm freely, but the ultimate goal of this training is to enable home use. One goal of this study was to see if participants could benefit without restraining the arm as much as with restraining the arm.

Participants were broken into three groups: 60 minutes of training with their arm restrained; 90 minutes of training with their arm restrained; and 90 minutes of training without arm restraints. Overall, arm function improved substantially, in all groups and there was no significant difference between the three groups, the release concludes.

[Source(s): Northwestern University, News-Medical Life Sciences]

 

via Video Game-Integrated Training Device Helps Stroke Survivors Regain Arm Function – Rehab Managment

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[NEWS] New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

News-MedicalA Virtual Reality Therapy game (iVRT) which could introduce relief for patients suffering from chronic pain and mobility issues has been developed by a team of UK researchers.

Dr Andrew Wilson and colleagues from Birmingham City University built the CRPS app in collaboration with clinical staff at Sandwell and West Birmingham Hospitals NHS Trust for a new way to tackle complex regional pain syndrome and to aid people living with musculoskeletal conditions.

Using a head mounted display and controllers, the team created an immersive and interactive game which mimics the processes used in traditional ‘mirror therapy’ treatment. Within the game, players are consciously and subconsciously encouraged to stretch, move and position the limbs that are affected by their conditions.

Mirror therapy is a medical exercise intervention where a mirror is used to create areflective illusion that encourages patient’s brain to move their limb more freely. This intervention is often used by occupational therapists and physiotherapists to treat CRPS patients who have experienced a stroke. This treatment has proven to be successful exercises are often deemed routine and mundane by patients, which contributes to decline in the completion of therapy.

Work around the CRPS project, which could have major implications for other patient rehabilitation programmes worldwide when fully realised, was presented at the 12th European Conference on Game Based Learning (ECGBL) in France late last year.

Dr Wilson, who leads Birmingham City University’s contribution to a European research study into how virtual reality games can encourage more physical activity, and how movement science in virtual worlds can be used for both rehabilitation and treatment adherence, explained, “The first part of the CRPS project was to examine the feasibility of being able to create a game which reflects the rehabilitation exercises that the clinical teams use on the ground to reduce pain and improve mobility in specific patients.”

“By making the game enjoyable and playable we hope family members will play too and in doing so encourage the patient to continue with their rehabilitation. Our early research has shown that in healthy volunteers both regular and casual gamers enjoyed the game which is promising in terms of our theory surrounding how we may support treatment adherence by exploiting involvement of family and friends in the therapy processes.”

The CRPS project was realized through collaborative working between City Hospital, Birmingham, and staff at the School of Computing and Digital Technology, and was developed following research around the provision of a 3D virtual reality ophthalmoscopy trainer.

Andrea Quadling, Senior Occupational Therapist at Sandwell Hospital, said “The concept of using virtual reality to treat complex pain conditions is exciting, appealing and shows a lot of potential. This software has the potential to be very helpful in offering additional treatment options for people who suffer with CRPS.”

via New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

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[Abstract] Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial

Abstract

BACKGROUND: Virtual reality and interactive video games could decrease the demands on the time of the therapists. However, the cost of a virtual reality system and the requirement for technical support limits the availability of these systems. Commercial exergames are not specifically designed for therapeutic use, most patients with hemiplegic stroke are either too weak to play the games or develop undesirable compensatory movements.

 

AIM: To develop Kinect2Scratch games and compare the effects of training with therapist-based training on upper extremity (UE) function of patients with chronic stroke.

DESIGN: A randomized controlled single-blinded trial.

SETTING: An outpatient rehabilitation clinic of a tertiary hospital.

POPULATIONS: Thirty-three patients with chronic hemiplegic stroke.

METHODS: We developed 8 Kinect2Scratch games. The participants were randomly assigned to either a Kinect2Scratch game group or a therapist-based training group. The training comprised 24 sessions of 30 minutes over 12 weeks. The primary outcome measure was the Fugl-Meyer UE scale and the secondary outcome measures were the Wolf Motor Function Test and Motor Activity Log. Patients were assessed at baseline, after intervention, and at the 3-month follow-up. We used the Pittsburgh participation scale (PPS) to assess the participation level of patients at each training session and an accelerometer to assess the activity counts of the affected UE of patients was used at the 12th and 24th training sessions.

RESULTS: Seventeen patients were assigned to the Kinect2Scratch group and 16 were assigned to the therapist-based training group. There were no differences between the two groups for any of the outcome measures post-intervention and at the 3-month follow-up (all p>.05). The level of participation was higher in the Kinect2Scratch group than in the therapist-based training group (PPS 5.25vs. 5.00, p=0.112). The total activity counts of the affected UE was significantly higher in the Kinect2Scratch group than in the therapist-based training group (p<.001).

CONCLUSIONS: Kinect2Scratch game training was feasible, with effects similar to those of therapist-based training on UE function of patients with chronic stroke.

via Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial – European Journal of Physical and Rehabilitation Medicine 2019 Feb 15 – Minerva Medica – Journals

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[WEB SITE] Seize life with both hands

Engaging stroke rehabilitation exercise through smart games.

 

The NeuroBall allows users to complete upper limb rehabilitation exercise by playing games. It intelligently adapts to your ability and becomes increasingly challenging as you progress.

“It’s amazing!

After 4.5 years, to still feel you can achieve things”

Learn more

Developed with stroke survivors and therapists

Comprehensive upper limb exercise

Train all key movements including flexion and extension, side-to-side and grasping.

Adapts to your ability

Games change to your movement ability and become more challenging as you progress

Measures progress

Monitor engagement and performance over time and see real progress.

 

Don’t just take our word for it

Richard Sealy, Physiotherapist

 

 

The NeuroBall is fun and engaging. It allows you to track progress and see your achievements. The games motivate you to keep playing and reach the next level. It is fantastic because this repetitive practice is essential for progress. It builds physical strength and also trains the neurological pathways too.

via Neurofenix – Home

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[NEWS] Telemedicine-Delivered Arm Rehab Results on Par with In-Person Clinic

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Rehab muscle training for elbow joint

 

Post-stroke arm motor function recovery progressed just as well, whether the exercises were performed via home-based telemedicine or in an office environment, according to a randomized trial discussed recently at the International Stroke Conference.

Improvement in arm motor function on the Fugl-Meyer scale was 7.86 points with telerehab versus 8.36 points at day 30, which met noninferiority criteria, Steven Cramer, MD, of the University of California Irvine, reports, in a media release from Medpage Today.

Arm recovery exceeded the minimal clinically important difference in both groups and didn’t differ between rehab strategies by aphasia status.

“What we’re trying to do with home-based telehealth does not compete with or replace traditional rehab medicine. It is expanding tools,” Cramer adds.

ISC session moderator Louise McCullough, MD, PhD, of the University of Texas Health Science Center at Houston, agreed but noted some advantages to rehab from home.

“If we can optimize it… there could be huge cost savings,” she comments, “and especially for people in rural areas, like lots of Texas does not have access to rehab. It might be 2 hours away. This gives more options for people.”

The NIH StrokeNet trial included 124 adults who were 4 to 36 weeks post-ischemic or hemorrhagic stroke and had a baseline arm motor Fugl-Meyer score of 22 to 56 on the 66-point scale.

Treatment consisted of 36 sessions (18 supervised) of 70 minutes each, over 6 to 8 weeks. Intensity, duration, and frequency of therapy were matched between groups. Participants were randomized to therapy at home via telemedicine or in a traditional clinic setting with the same Accelerated Skill Acquisition program (impairment focused, task specific, and with intensive engagement), the release explains.

Telerehab patients started their supervised sessions with a video conference where they worked with the therapist.

For the 15 minutes of the session that was functional training, the in-clinic group got functional tasks whereas the home-based group got functional games. “This is not your father’s Wii game,” Cramer notes, in the release.

The games could be set to emphasize targets in specific parts of the visual field and could vary in speed, range of motion, target size, and cognitive demand. Input devices to play the games ranged from a squeezing device to a “whack-a-mole” mallet and a gun.

Patients’ preference to go to clinic appears to be because of that live social interaction. McCullough continues. “We now know social isolation is very common. But if you have low vision or you live alone, it’s really difficult to get to clinic. So now we have to get it so the preference is to do it at home.”

“I think that social interaction is going to be really important to fold into our telemedicine and telehealth platforms for whatever disease,” she adds.

[Source: Medpage Today]

 

via Telemedicine-Delivered Arm Rehab Results on Par with In-Person Clinic – Rehab Managment

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[ARTICLE] Validation of a Kinect V2 based rehabilitation game – Full Text

Abstract

Interactive technologies are beneficial to stroke recovery as rehabilitation interventions; however, they lack evidence for use as assessment tools. Mystic Isleis a multi-planar full-body rehabilitation game developed using the Microsoft Kinect® V2. It aims to help stroke patients improve their motor function and daily activity performance and to assess the motions of the players. It is important that the assessment results generated from Mystic Isle are accurate. The Kinect V2 has been validated for tracking lower limbs and calculating gait-specific parameters. However, few studies have validated the accuracy of the Kinect® V2 skeleton model in upper-body movements. In this paper, we evaluated the spatial accuracy and measurement validity of a Kinect-based game Mystic Isle in comparison to a gold-standard optical motion capture system, the Vicon system. Thirty participants completed six trials in sitting and standing. Game data from the Kinect sensor and the Vicon system were recorded simultaneously, then filtered and sample rate synchronized. The spatial accuracy was evaluated using Pearson’s r correlation coefficient, signal to noise ratio (SNR) and 3D distance difference. Each arm-joint signal had an average correlation coefficient above 0.9 and a SNR above 5. The hip joints data had less stability and a large variation in SNR. Also, the mean 3D distance difference of joints were less than 10 centimeters. For measurement validity, the accuracy was evaluated using mean and standard error of the difference, percentage error, Pearson’s r correlation coefficient and intra-class correlation (ICC). Average errors of maximum hand extent of reach were less than 5% and the average errors of mean and maximum velocities were about 10% and less than 5%, respectively. We have demonstrated that Mystic Isle provides accurate measurement and assessment of movement relative to the Vicon system.

Introduction

In the past decade and quite rapidly in the past five years, Natural User Interfaces (NUIs) and video games have grown in popularity in both consumer applications and in healthcare []. Specifically, physical rehabilitation (e.g., physical and occupational therapy) has embraced novel NUI applications in clinics, hospitals, nursing homes, and the community []. Robotic systems have long included game-based and NUI-based user interfaces and most robotic devices provide some form of physical assistance to the patient and/or haptic feedback []. With the release of the Nintendo Wii in 2008, many NUI applications for healthcare moved away from bulky, expensive robotics and embraced the portable nature of movement and gesture recognition devices and systems. One of the biggest breakthroughs for this field came in 2010 when Microsoft released the Kinect sensor to accompany its Xbox console system. Within days and weeks of the Kinect’s release, hackers, universities, and companies began to exploit its markerless movement sensing abilities for educational and healthcare use. Since then, there has been an exponential increase in the number of studies that report the use of the Kinect as the input device for a NUI-based rehabilitation game or feedback application [].

In 2014, Jintronix was the first company to receive FDA approval for its rehabilitation game system that uses the Microsoft Kinect. There are a number of similar companies that utilize the Kinect sensor including SeeMee [], VirtualRehab [], Reflexion Health [], MIRA [], MotionCare360 [], and 5Plus Therapy []. Many of these systems are marketed for delivering rehabilitation therapy in the home setting. This type of delivery is termed “tele-rehabilitation” and can involve remote monitoring by the therapist or virtual sessions over teleconferencing software []. For telerehabilitation or remote sessions, it is imperative that the data the therapist receives from the system or movement-sensing device (such as the Microsoft Kinect) are accurate and reliable. If the therapist plans to use the data for documentation or for reimbursement from a health insurance company, the data ought to be as accurate as current clinical tools (e.g., goniometers).

Only one of the listed companies has validated the measurement capabilities of their systems and of the Microsoft Kinect. Kurillo and colleagues evaluated their system used in 5Plus Therapy against the Impulse motion-capture system (PhaseSpace Inc., San Leandro, CA) and found that it had good accuracy of joint positions and small to large percentage errors in joint angle measurements []. However, this study had a small sample size of only 10 subjects and used the first version of the Kinect sensor in its validation. Additionally, the movements used in the assessment were only within a single plane for each movement and all participants were seated during data collection.

Other researchers have validated the Kinect’s measurement and tracking capabilities for both general and specific applications. Hondori and Khademi [] provide an excellent summary of the work completed prior to 2014. It should be noted that all of these studies evaluated the first version of the Kinect. Following the release of the Kinect V2 sensor, most researchers have focused their validation efforts on gait and posture applications []. The Kinect V2 has good-to-excellent tracking and measurement capabilities for gait-specific parameters and clinical outcomes. However, many of these studies tracked only the lower limbs. Furthermore, gait is a relatively consistent, rhythmic motion that is consistent across participants, even in rehabilitation populations (i.e., one foot in front of the other). The full-body movements that participants are not limited to specific planes and could choose to use either hand have not been studied in current and prior comparisons of the Microsoft Kinect and optical marker-based motion capture systems.

We have developed software called Mystic Isle that utilizes the Microsoft Kinect V2 sensor as the input device []. Mystic Isle is designed as a rehabilitation game and has shown good results in improving motor function and daily activity performance in persons with chronic stroke []. The software initially used the first version (V1) of the Microsoft Kinect as the input device and we completed a study that compared it to the OptiTrack optical system []. Based on a visual analysis, we demonstrated that for the hand and elbow, the Kinect V1 has good accuracy in calculating trajectory of movement. For the shoulder, the Kinect V1 tracking abilities limit its validity. Although these findings are promising, the types and number of movements used in the study were limited to those in a seated position and mostly in one plane of movement (e.g., sagittal). Furthermore, the tracking capabilities of the Kinect V2 have substantially improved in the past 7 years and include more data points (joints) for comparison.

The current Mystic Isle game involves multi-planar, full body movements. Designed for individuals with diverse abilities, games can be played in a sitting or standing position, depending on the therapy treatment plan. In standing, the player is able to move around in the 3-dimensional space, akin to real-world rehabilitation. Few studies have evaluated the tracking and measurement capabilities of the Microsoft Kinect V2 for full-body, multi-planar movements in both sitting and standing. The purpose of this study was to determine the spatial accuracy and measurement validity of the Microsoft Kinect V2 sensor in a NUI rehabilitation game in comparison to a gold-standard marker-based motion capture system (Vicon).

Materials and methods

Participants

Participants were recruited via convenience sample at the University of Missouri- Columbia campus. Participants were included if they: 1) were over the age of 18, 2) could understand conversational English, and 3) had no medical conditions which prevented them from playing video games. The study has been approved by the Health Sciences Institutional Review Board at the University of Missouri with the approval number IRB 2005896 HS. All potential participants were screened and all subjects provided written informed consent before beginning the study.

Mystic Isle

Mystic Isle is a platform for rehabilitation that allows a user to interact with a virtual environment by using their body (Fig 1). The Mystic Isle software was created in Unity 3D and Mystic Isle allows the tracked user to interact with virtual environments and objects in a 3-D world. Using Mystic Isle, specific movements, distances, and locations of objects can be tailored to the abilities and requirements of the user. The system uses the Microsoft Kinect V2 camera to track participant movements. The Kinect V2 tracks 20 discrete points/joints on the body of the user. Both gross motor (stepping, jumping, squatting) and fine motor (waving the hand, turning the palm facing up, open/close hand) movements can be tracked. The Kinect V2 tracks the user in 3-dimensional space and then inputs the data in real time to the associated software, Mystic Isle. The Kinect V2 tracks and records the x, y, and z coordinates (and confidence) of each discrete joint at either 15 or 30 frames per second.

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Fig 1
Mystic Isle game environment.(a) A virtual avatar collecting targets in a Kinect-based rehabilitation game, Mystic Isle. (b) A participant playing the game with Vicon markers on the body. Joint data of game trials were recorded by a Kinect and the Vicon system for validation.

[…]

Continue —>  Validation of a Kinect V2 based rehabilitation game

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