Posts Tagged gaming

[Abstract + References] Virtual and Augmented Reality Platform for Cognitive Tele-Rehabilitation Based System – Conference paper

Abstract

Virtual and Augmented Reality systems have been increasingly studied, becoming an important complement to traditional therapy as they can provide high-intensity, repetitive and interactive treatments. Several systems have been developed in research projects and some of these have become products mainly for being used at hospitals and care centers. After the initial cognitive rehabilitation performed at rehabilitation centers, patients are obliged to go to the centers, with many consequences, as costs, loss of time, discomfort and demotivation. However, it has been demonstrated that patients recovering at home heal faster because surrounded by the love of their relatives and with the community support.

References

  1. 1.Aruanno, B., Garzotto, F., Rodriguez, M.C.: HoloLens-based mixed reality experiences for subjects with alzheimer’s disease. In: Proceedings of the 12th Biannual Conference on Italian SIGCHI Chapter (CHItaly 2017), Article 15, 9 p. (2017)Google Scholar
  2. 2.Bozgeyikli, L., Raij, A., Katkoori, S., Alqasemi, R.: A survey on virtual reality for individuals with autism spectrum disorder: design considerations. IEEE Trans. Learn. Technol. 11, 133–151 (2018)CrossRefGoogle Scholar
  3. 3.Cameron, C., et al.: Hand tracking and visualization in a virtual reality simulation, pp. 127–132, April 2011Google Scholar
  4. 4.American Psychiatric Association Diagnostic: Statistical manual of mental disorders. American psychiatric pub. (2013)Google Scholar
  5. 5.Gelsomini, M., Garzotto, F., Matarazzo, V., Messina, N., Occhiuto, D.: Creating social stories as wearable hyper-immersive virtual reality experiences for children with neurodevelopmental disorders. In: Proceedings of the 2017 Conference on Interaction Design and Children (IDC 2017), pp. 431–437 (2017)Google Scholar
  6. 6.Gelsomini, M., Garzotto, F., Montesano, D., Occhiuto, D.: Wildcard: a wearable virtual reality storytelling tool for children with intellectual developmental disability. In: 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) Orlando, FL, pp. 5188–5191 (2016)Google Scholar
  7. 7.Guna, J., Jakus, G., Pogacnik, M., Tomazic, S., Sodnik, J.: An analisis of the precision and reliability of the leap motion sensor and its suitability for static and diynamic tracking. Sensors 14, 3702–3720 (2014)CrossRefGoogle Scholar
  8. 8.Josman, N., Ben-Chaim, H.M., Friedrich, S., Weiss, P.L.: Effectiveness of virtual reality for teaching street-crossing skills to children and adolescents with autism. Int. J. Disabil. Hum. Dev. 49–56 (2011)Google Scholar
  9. 9.Aspoc Onlus (2020). http://www.aspoc.it//. Accessed 04 Apr 2020

Source: https://link.springer.com/chapter/10.1007/978-3-030-58796-3_17

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[ARTICLE] Commercial gaming devices for stroke upper limb rehabilitation: The stroke survivor experience – Full Text

Approximately 30% of stroke survivors experience an upper limb impairment, which impacts on participation and quality of life. Gaming devices (Nintendo Wii) are being incorporated into rehabilitation to improve function. We explored the stroke survivor experience of gaming as an upper limb intervention.

Semi-structured, individual interviews with stroke survivors living within the UK were completed. Interviews were audio-recorded, transcribed verbatim and analysed using Framework methods. Transcripts were coded and summarised into thematic charts. Thematic charts were refined during analysis until the final framework emerged.

We captured experiences of 12 stroke survivors who used Nintendo Wii. Gaming devices were found to be acceptable for all ages but varying levels of enthusiasm existed. Enthusiastic players described gaming as having a positive impact on their motivation to engage in rehabilitation. For some, this became a leisure activity, encouraging self-practice. Non-enthusiastic players preferred sports to gaming.

An in-depth account of stroke survivor experiences of gaming within upper limb rehabilitation has been captured. Suitability of gaming should be assessed individually and stroke survivor abilities and preference for interventions should be taken into consideration. There was no indication that older stroke survivors or those with no previous experience of gaming were less likely to enjoy the activity.

Stroke is considered to be a major cause of serious, long-term disability in Europe.1 Within the UK, hemiparesis affects up to 80% of the estimated 1.3 million stroke survivors2 and is persistent, with 30–66% still experiencing difficulties with arm movement or function 6 months after their stroke.3 Stroke upper limb impairment is a top research priority for stroke survivors and healthcare professionals.4 Intensive, repetitive and functional movements are considered most effective in promotion of recovery5 and commercial gaming devices (e.g. Nintendo Wii) encourage high repetition of arm movements.6 Some stroke rehabilitation services have introduced commercial gaming devices to address upper limb impairment.7 However, little information is available on the stroke survivor experience of this intervention.8 In order to be able to inform future research and aid health professionals in making clinical judgements about suitability of intervention, optimising adherence and facilitating implementation, it is important to capture the perspectives of stroke survivors.

Celinder and Peoples9 interviewed nine Danish stroke survivors who played Nintendo Wii within a pilot inpatient rehabilitation programme. The study focused on physical and cognitive rehabilitation and concluded that Nintendo Wii could be used to promote engagement in leisure activities. Wingham et al.10 interviewed 18 stroke survivors who used Nintendo Wii as part of a home-based upper limb rehabilitation programme. They reported high usage rates within the home and the intervention was found to be acceptable to both stroke survivors and caregivers. Limited information was however captured on factors that influence engagement in upper limb rehabilitation. In addition, Lewis et al.11 in their literature review (three articles including participants with chronic neurological conditions) concluded that use of virtual reality offered increased enjoyment and motivation compared to traditional rehabilitation. The aim of our qualitative study was to explore whether use of commercial gaming devices for upper limb rehabilitation was acceptable to stroke survivors and to capture their experience of this intervention. A pragmatic stance was taken to this study where investigations are not necessarily aligned to a particular qualitative research method.[…]

Continue —-> Commercial gaming devices for stroke upper limb rehabilitation: The stroke survivor experience – Katie Thomson, Alex Pollock, Carol Bugge, Marian C Brady, 2020

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[Abstract] Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Post-Stroke: A Meta-Analysis

Abstract

Objective

To investigate the efficacy of virtual reality (VR)- and gaming-based interventions for improving upper extremity function post-stroke, and to examine demographic and treatment-related factors that may moderate treatment response.

Data Sources

A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, SCOPUS, Ovid MEDLINE and EMBASE databases for articles published between 2005 and 2019 (PROSPERO Registration number 95052).

Study Selection

Articles investigating gaming and VR methods of treatment for upper extremity weakness were collected with the following study inclusion criteria: 1) participants aged 18 or older with upper extremity deficits, 2) randomized controlled trials or prospective study design, 3) Downs-Black rating score of >= 18, and 4) outcome measure was the Wolf Motor Functioning Test (WMFT), the Fugl-Meyer (FM) or the Action Research Arm Test (ARAT).

Data Extraction

Thirty-eight articles met inclusion criteria. The primary outcome was proportional improvement on the WMFT, FM, or ARAT. The following individual or treatment factors were extracted: VR/gaming dose, total treatment dose, chronicity (> or < 6 months), severity of motor impairment, and presence of a gaming component.

Data analysis

Random effects meta-analysis models were utilized to quantify 1) the proportional recovery that occurs following VR/gaming, 2) the comparative treatment effect of VR/gaming versus conventional physiotherapy, and 3) whether the benefit of virtual reality differed based on participant characteristics or elements of the treatment.

Results

On average, VR/gaming interventions produced an improvement of 28.5% of the maximal possible improvement. Dose and severity of motor impairment did not significantly influence rehabilitation outcomes. Treatment gains were significantly larger overall (10.8%) when the computerized training involved a gaming component versus just visual feedback. VR/gaming interventions showed a significant treatment advantage (10.4%) over active control treatments.

Conclusions

Overall, VR/gaming-based upper extremity rehabilitation post-stroke appears to be more effective than conventional methods. Further in-depth study of variables impacting improvement, such as individual motor presentation, treatment dose, and the relationship between the two, are needed.

via Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Post-Stroke: A Meta-Analysis – ScienceDirect

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[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.

First page of article

via GameBall: the development of a novel platform to provide enjoyable and affordable hand and arm rehabilitation following stroke – Physiotherapy

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[WEB SITE] MusicGlove: Improve Hand Function in Two Weeks Through Music and Gaming

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

via MusicGlove: Improve Hand Function in Two Weeks Through Music and Gaming

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[WEB SITE] Virtual reality to fight opioids? One researcher aims to treat addiction with joysticks

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.”

Kristin Evans a Detox Therapist and Clinical Masters Social Worker at JourneyPure at the River in Murfreesboro experiences a virtual reality gaming program that Noah Robinson Clinical Psychology Doctoral Student at Vanderbilt uses to help rehab patients on Thursday, Feb. 22, 2018. Robinson, who monitors what Evans is experiencing, tries to encourage all the therapists to try out the program so they can recommend the therapy to their patients.
HELEN COMER/DNJ

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.

Noah Robinson, a clinical psychology doctoral student at Vanderbilt University, monitors what Kristin Evans, a detox therapist, sees while using a virtual reality gaming system Feb. 22, 2018.
Helen Comer / DNJ

‘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.”

Noah Robinson Clinical Psychology Doctoral Student at Vanderbilt and practicum student at JourneyPure at the River helps Kristin Evans a Detox Therapist and Clinical Masters Social Worker at JourneyPure at the River in Murfreesboro adjust the virtual reality goggles on Thursday, Feb. 22, 2018, before her VR gaming session.
HELEN COMER/DNJ

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.”

via khou.com | Virtual reality to fight opioids? One researcher aims to treat addiction with joysticks

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[WEB SITE] TherapWii – game suggestions

Why TherapWii

Gaming activates and is fun to do! In a playful and often unnoticed way skills are trained. Adolescents grow up in a digital world; they enjoy gaming and do it frequently. For adults and elderly gaming has been shown to be a useful type of therapy.

In a virtual environment moving, executing, learning and enjoying are appealing; if circumstances or limitations keep you from going to the bowling alley or playing an instrument, gaming can broaden your boundaries.

Gaming with the Wii can complement therapy, can make therapy more attractive, intenser and more provocative.

TherapWii has been developed to support therapists in an effective and specific way while using the Nintendo Wii and offer options to game in the home environment.

TherapWii is the product of an exploratory research project done by the Special Lectorship Rehabilitation at the Hague University. The results of this project can be found by clicking on the header ‘research’ at the end of the page.

How does TherapWii work?

Per therapy goal there are three colored tabs to help find the most suitable games. Each game lists specific information in text and symbols. There is also a level of difficulty; by moving the cursor over this button you see more information.

User information is saved in ‘explanation and tips’. To enhance this section you can email recommendations and suggestions to the email address listed below.

TherapWii has been developed, also for home use, so that experience lead to personal growth.

Advice for game adjustments

It is important that the therapist stays close to the patient’s goals and abilities and adjusts the game program appropriately. If you, as therapist, want to make the game easier, more difficult or more daring, you can change the instruction, implementation or setting.

A few examples:

Physical: strength (add weights to the arms or legs or change the starting position); balance/stability (play while standing on an instable foundation (ball, mat). Or play the games while sitting on a stationary bicycle!

Cognition: create double tasks (ask mathematics, questions or riddles); spatial orientation or visual adjustments (play with one eye covered or in front of a mirror).

Social-emotional: stimulate cooperation or competition (create bets or role-playing).

Let us know if you have other ideas to make the games more provoking.

How are the games rated?

The games were tested by several professionals (physical therapists, occupational therapists and sport therapists). Differences in opinion or scores were discussed and voted on.

Give us feedback, corrections and advice, we will adjust the TherapWii program monthly and will use your suggestions.

Which ability do you choose?

Social-Emotional

Physical

Cognitive

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[Abstract] The Present and Future of Robotic Technology in Rehabilitation – SpringerLink

Abstract

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.

Source: The Present and Future of Robotic Technology in Rehabilitation | SpringerLink

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[Abstract] Survivors of chronic stroke – participant evaluations of commercial gaming for rehabilitation

Abstract

Purpose: There has been an increase in research on the effect that virtual reality (VR) can have on physical rehabilitation following stroke. However, research exploring participant perceptions of VR for post-stroke rehabilitation has been limited.
Method: Semi-structured interviews were conducted with 10 chronic stroke participants (10 males, mean age = 72.1, mean time since injury = 38.6 mos.) who had recently completed an upper extremity VR stroke rehabilitation programme.
Results: Four main themes emerged: ‘the VR experience,’ ‘functional outcomes,’ ‘instruction,’ and the ‘future of VR in stroke rehabilitation,’ along with nine sub-themes. Participants illustrated the positive impact that VR training had on their functional abilities as well as their confidence towards completing activities of daily living (ADL). Participants also expressed the need for increased rehabilitation opportunities within the community.
Conclusion: Overall, participants were optimistic about their experience with VR training and all reported that they had perceived functional gain. VR is an enjoyable rehabilitation tool that can increase a stroke survivor’s confidence towards completing ADL.

  • 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.

Related articles

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Source: Taylor & Francis Online

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[ARTICLE] Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation – Full Text HTML/PDF

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Background

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 [1] 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 [2]. 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 [79]. 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 [1012]. 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.

Continue HTML —>  Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation | Journal of NeuroEngineering and Rehabilitation | Full Text

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