Posts Tagged gaming
[Abstract] Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Post-Stroke: A Meta-Analysis
[Poster Abstract] GameBall: the development of a novel platform to provide enjoyable and affordable hand and arm rehabilitation following stroke
Purpose: Poor arm recovery post-stroke can lead to increased dependence, reduced quality of life, and is a strong predictor of lower psychological well being following stroke. Effective treatment interventions are characterised by repetitive practice. This repetitive nature can make doing exercises boring, and coupled with a lack of community resources ongoing rehabilitation of the arm is challenging. Therefore effective home-based stroke rehabilitation devices that are motivating and enjoyable to use, and affordable are needed.
Designed for users never expected to regain use of their hands
When returning home from a hospital stay, many stroke patients do not comply with the hand rehabilitation exercises prescribed for them.
Clearly, it’s not because they don’t want to regain use of their hand – it’s just that the exercises are mind-numbingly monotonous, and they soon give up.
Nizan Friedman, founder of Flint Rehabilitation Devices, set out to correct this problem. He dreamt up the idea of the MusicGlove while pursuing his PhD in biomedical engineering at the University of California at Irvine.
As a musician, Friedman’s intent was to combine music therapy and robotics. On his team were David Reinkensmeyer, a rehabilitation robotics expert, and Mark Bachman, a sensor expert and fellow musician.
The three soon realized a robotic hand would be too expensive, so they came up with the idea of using a glove instead. MusicGlove was born, and results were astounding.
“People were trying and crying afterwards,” says Friedman. “People who hadn’t used their hands in months or even years were suddenly seeing benefit.”
How does MusicGlove work?
MusicGlove has fingertip sensors, and plugs into the user’s computer or into the Flint tablet. Musical notes are displayed on a touch screen console. The notes are timed to the rhythm of upbeat songs (think Guitar Hero). Then, while wearing the glove, the user completes specific hand and finger movements in time with the notes.
The program tracks accuracy and speed in performing essential motions such as pincer grasp and key pinch grip, and gives the user immediate feedback on their progress.
What makes MusicGlove different?
Several elements set MusicGlove apart from conventional hand rehabilitation therapy.
First and perhaps most importantly, it motivates users to continue with their therapy regimen long enough to see results. Interacting with the computer and listening to music is fun, and provides a purpose for moving the fingers. Patients typically achieve over 2,000 movements in a 45-minute session.
Second, most conventional hand therapy is designed to help open the hand, but does not retrain the brain to use the hand again.
MusicGlove is unique because it’s designed to encourage neuroplasticity – the process the brain uses to rewire itself after injury.
The more a user plays MusicGlove games, the better their brain becomes at hand control.
Lastly, MusicGlove can change the way clinicians approach hand therapy. Since the device is highly effective without much direct therapist intervention, clinics can provide other intensive services without increasing staff. Farther, MusicGlove records accurate data that helps set goals and track patient progress.
Who can benefit from using MusicGlove?
MusicGlove is intended for people recovering from stroke, spinal cord injury, and neurologic or muscular injury. Those with cerebral palsy, traumatic brain injury, and developmental disability can also benefit from using MusicGlove.
Patients using MusicGlove must be able to touch their thumb to at least one of their fingertips, although mirror therapy can be used for some patients who have no hand movement at all.
Will Medicare cover MusicGlove?
Currently, Medicare does not cover the cost of restorative technology. Therefore, MusicGlove offers a 30-day money back guarantee so that patients and therapists can be certain it’s the right therapy for them.
Also, MusicGlove is FDA approved for purchase without a prescription.
How effective is MusicGlove?
Exercise with MusicGlove has been clinically proven to improve hand function within two weeks, leading to functional gains such as opening doors, typing, toileting independently, and more.
MusicGlove is now used in top rehabilitation programs in the United States, including the Rehabilitation Institute of Chicago and Rancho Los Amigos National Rehabilitation Center. It is backed by the National Institute of Health and the National Institute of Disability and Research Rehabilitation.
What MusicGlove customers are saying
“Could not possibly rate this device highly enough! I had a stroke as an infant, and was a precocious kid who got bored of “traditional” occupational therapy very early in life – so for the past 15 or so years (I’m 24), I haven’t done much of anything. After a two week trial of the MusicGlove, I regained independent movement of each finger of my affected hand – which is something I have NEVER had! I find myself using my hand to complete tasks at work, which I’ve never done either. Needless to say, I purchased the device and am looking forward to the months and years to come! I will sing the praises of the MusicGlove and Flint for the rest of my life for CHANGING MY LIFE and opening so many doors! THANK YOU, THANK YOU, THANK YOU!!!” – Musicglove user review
“My brother had five strokes two months ago and lost the use and feeling on the right side of his body. The first day he used it was fairly disastrous, and he could barely even touch his thumb to his index finger. The next morning he was touching his thumb to each of his fingers over and over – and when we started up the MusicGlove, the difference in one day was amazing. Within the first week using this product, he was feeding himself, holding a pen, and relearning how to write. After 2 months of use, he has mastered each finger individually (being able to hit at least 95% of the notes on the hard setting) and has now started using two fingers simultaneously. I feel like we hit the lottery, having found this rehabilitation tool, and I highly recommend it to anyone trying to recover from a stroke or brain injury that has affected the fine motor skills in their hand! It has exceeded all of our expectations, and given us hope for a full recovery ahead.” – Musicglove user review
Virtual reality to fight opioids? Yes, researcher says
NASHVILLE — Video games were once Noah Robinson’s only way to cope.
When he couldn’t bear the challenges of growing up as an outsider, he fell into immersive worlds that eased his tensions and helped him feel less alone.
Now, as a graduate student at Vanderbilt University, Robinson is applying the same premise to an unconventional, high-tech therapy that might help addicts get a firmer grip on recovery.
By immersing them in a virtual world of swirling colors and abstract shapes, and then layering psychological principles over that experience, Robinson hopes to help patients separate themselves from the negative emotions and cravings that fuel addiction.
If he succeeds, his mentors believe he could be at the forefront of a groundbreaking new treatment for addicts, one that could prove to be especially significant as the nation battles the deadly opioid crisis.
“The only thing I know for sure is that most of the stuff that we’ve been doing thus far to get our arms around this crisis has not been working,” said Brian Wind, chief of clinical operations at a Murfreesboro, Tenn., location of JourneyPure, an inpatient rehabilitation center where Robinson tests his virtual reality therapy.
“We’ve got to get more proactive, and I believe that trying to find new and innovative solutions that may be of benefit to people is the way to go,” Wind said. “This seems to be just that.”
Goggles and joysticks: Tools to fight addiction?
The treatment itself can seem strange to the uninitiated — strange enough that mentors initially warned Robinson not to mention his interest in virtual reality in his application to Vanderbilt.
Patients strap bulky goggles over their heads and grab onto two joysticks.
From the outside, they look like a mash-up of a cross country skier and a hardcore gamer.
But the screens on the inside of the goggles transport them, and everywhere they look reveals a new corner of a bright and surreal landscape of sunbursts and technicolor swirls.
A headset allows them to communicate with their therapist, who appears in this world in the form of a cartoon avatar.
Different “rooms” in this virtual reality serve different purposes. A therapist might walk a patient through talk therapy in one, while another one designed like a bar gives recovering alcoholics the chance to practice turning down a drink in a low-pressure setting.
Robinson is quick to make one thing clear: This virtual reality, which he calls VR, is different from what people have experienced on their smartphones. It truly floods your senses, and almost completely separates you from your actual surroundings.
His theory is that the distraction of the virtual reality also will separate people from their anxieties and fears, making it easier for them to absorb messages from therapy.
‘Almost innovative beyond its time’
That thinking was driven by his teenage years, when he used role-playing video games like “RuneScape” and online forums to escape the anxiety of realizing he is gay.
As he grew up and came out, he no longer craved the escape. But the impact of technology on his life lingered in the back of his mind.
While working as a research fellow at the National Institutes of Health in 2014, he began experimenting with virtual reality.
He bought virtual reality equipment of his own and quickly realized he could pair the same kinds of technologies he once enjoyed with innovative therapy to provide a healthy way to confront tough issues.
“I was just escaping, but what I saw with the VR is that its power could be used for a therapeutic purpose, not just escape,” said Robinson, who is now 26. “I realized the potential.”
Robinson was convinced the idea had legs. And when he applied to get his Ph.D. in clinical psychology at Vanderbilt, he wanted to weave it into his work.
In 2017, a campus innovation hub known as the Wond’ry gave him space and funding to buy more equipment and pursue his goal.
“It is a big, hairy, audacious goal that he’s trying to achieve,” said Robert Grajewski, executive director of the Wond’ry. “It’s almost innovative beyond its time.”
When VR appears in therapy, ‘smiles start to emerge’
Robinson wasn’t initially sure how and where to apply the technology. It had barely even been discussed as a tool in psychology.
He came to JourneyPure for his work as a clinical psychology student and started testing the VR during sessions in 2017. Then something clicked.
“When I saw that patient who had so much pain put on the VR and start smiling and laughing, I felt chills and thought, ‘This is it,’” he said.
Reflecting on about 60 patients who have used it since, Wind was similarly optimistic.
“It’s rewarding to observe it when from underneath the big bulky mass you see smiles start to emerge,” he said. “They come out on the other side with an increase in positive emotions and a decrease in negative emotions.”
That’s a combination that can help prevent relapse, Wind said.
Now Robinson is committed to testing virtual reality in a scientific study that will attempt to quantify their anecdotal observations. Robinson and nine undergraduate Vanderbilt students with the university’s Hollon Research Group are working on the project, which should continue into the summer.
The hope is that patients will eventually be able to take VR equipment home, where they could have instant access to help when they need it.
As the project has moved further along, Robinson noticed a shift toward acceptance for his unorthodox idea, perhaps driven by the urgent need to find new treatments for opioid addicts.
When he presented information on the project at Harvard University earlier this month, people peppered him with questions.
“It’s a new direction. People are very excited about it,” he said. “Because it’s unusual, I guess.”
Robinson’s ambitions for the technology and its applications seem boundless — he plans to devote his career as a psychologist to refining its use.
“It feels like a calling, honestly.”
Robotic technology designed to assist rehabilitation can potentially increase the efficiency of, and accessibility to, therapy by assisting therapists to provide consistent training for extended periods of time, and collecting data to assess progress. Automatization of therapy may enable many patients to be treated simultaneously and possibly even remotely, in the comfort of their own homes, through telerehabilitation. The data collected can be used to objectively assess performance and document compliance as well as progress. All of these characteristics can make therapists more efficient in treating larger numbers of patients. Most importantly for the patient, it can increase access to therapy which is often in high demand and rationed severely in today’s fiscal climate. In recent years, many consumer-grade low-cost and off-the-shelf devices have been adopted for use in therapy sessions and methods for increasing motivation and engagement have been integrated with them. This review paper outlines the effort devoted to the development and integration of robotic technology for rehabilitation.
[Abstract] Survivors of chronic stroke – participant evaluations of commercial gaming for rehabilitation
Implications for Rehabilitation
Although there is an increase in rehabilitation programmes geared towards those with chronic stroke, we must also consider the participants’ perception of those programmes.
Incorporating participant feedback may increase enjoyment and adherence to the rehabilitation programmes.
The VR experience, as well as provision of feedback and instruction, are important aspects to consider when developing a VR programme for stroke survivors.
VR for rehabilitation may be a feasible tool for increasing the survivors’ confidence in completing ADL post-stroke.
Source: Taylor & Francis Online
[ARTICLE] Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation – Full Text HTML/PDF
The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming.
We performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire.
In the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p < .001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p = .074), significantly shorter travel distance (p < .001), higher movement efficiency (p < .001) and higher performance scores (p < .001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance.
Gaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.
Dealing with the social and economical burden resulting from the high number of stroke survivors with permanent disability represents a major challenge for modern societies. The challenge becomes yet higher taking into account the enduring aging of the population worldwide  that will consequently result in the increase of the number of individuals with age related diseases such as stroke. For the particular case of the USA, estimates indicate that by 2030, ~4 % of the population will have experienced a stroke, with related costs expected to rise from $71.55 billion to $183.13 billion between 2012 and 2030 . New strategies have to be found to face this upcoming scenario, otherwise it will represent a large burden on healthcare systems and caregivers.
One approach relies on home-based rehabilitation, so that stroke survivors can continue their rehabilitation program after hospital discharge with minimal supervision. Home-based stroke rehabilitation has been increasingly addressed during the last years, and while showing promising results in terms of feasibility and impact on recovery [3, 4] it also poses a number of technical and human challenges. In the concrete case of computer-based rehabilitation, current technology allows offering training scenarios adjusted to the characteristics of users, with detailed progress reports and remote monitorization. Moreover, one of the main advantages relies on the fact that most of these applications have protocols that promote hundreds of task-specific movement repetitions. There is evidence that the conjunction of these two factors, increased number of repetitions and task-specificity, is an important ingredient to achieve reorganization of cortical maps after stroke [5, 6]. Here, technology based solutions can play an important role to increase functional movement practice and impact recovery. There are however challenges when deploying such technologies in the home. One challenge relates to the definition of rehabilitation approaches that are adequate for a home environment. What is the most effective strategy to support users when they have to use these systems on their own or with minimum supervision? Self-managed computerized rehabilitation should be straightforward to use, tailor exercises to the profile of users, address function, set goals, improve self-efficacy, provide instantaneous feedback on performance and be engaging [7–9]. A second challenge in home-based approaches in general is long-term treatment adherence. It has been observed that compliance tends to decrease over time below recommended levels for reasons such as insufficient familiarity with technology, competing commitments, or simply lack of motivation [10–12]. Hence, it is important to investigate what characteristics should be included in such systems so that stroke survivors feel more engaged and motivated to use these tools in a systematic way over long periods of time.
[ARTICLE] Commercial gaming devices for stroke upper limb rehabilitation: a survey of current practice
Purpose: Stroke upper limb impairment is associated with disability in activities of daily living. Gaming (Nintendo Wii) is being introduced to rehabilitation despite limited evidence regarding effectiveness. Little data exists on how gaming is implemented resulting in a lack of clinical information. We aimed to gather therapists’ opinions on gaming.
Methods: A survey was posted to therapists, identified from stroke services across Scotland. A second survey was posted to non-responders. Survey data were analysed using descriptive statistics and thematic coding.
Results: Surveys were sent to 127 therapists (70 stroke services) and returned by 88% (112/127). Gaming was used by 18% of therapists, 61% (68/112) stated they would use this intervention should equipment be available. The most commonly used device was Nintendo Wii (83% of therapists using gaming) for 30 min or less once or twice per week. Half of therapists (51%) reported observing at least one adverse event, such as fatigue, stiffness or pain. Gaming was reported to be enjoyable but therapists described barriers, which relate to time, space and cost.
Conclusions: Gaming is used by almost a fifth of therapists. Adverse events were reported by 51% of therapists; this should be considered when recommending use and dosage.
Implications for Rehabilitation – Commercial gaming devices are reported to be used by 1/5th of therapists for stroke upper limb rehabilitation, 3/5ths would use gaming if available. – Adverse events were reported by 51% of therapists; this should be considered when recommending use and dosage. – Current use of gaming in practice may not be achieving intense and repetitive upper limb task-specific practice.