Posts Tagged Serious games

[Abstract] Design and Implementation of a Wearable Device for Motivating Patients With Upper and/or Lower Limb Disability Via Gaming and Home Rehabilitation

Abstract

Stroke survivors often suffer from a permanent or partial disability that restricts the movement of the hands, arms and/or legs. To help patients recover, rehabilitation should be at an earlier stage of the injury. Without motivation, it would be challenging for patients to successfully engage in the recovery process which can sometimes be painful of inconvenient. The application of wearable devices, games and Internet-of-Things (IoT) can create a motivating atmosphere to facilitate the rehabilitation process of patients while enabling remote monitoring of their health and progress. This paper presents the design and implementation of a rehabilitation system for aimed at helping stroke patients suffering from upper limb disability that exploits IoT by integrating gaming and wearable technology.

via Design and Implementation of a Wearable Device for Motivating Patients With Upper and/or Lower Limb Disability Via Gaming and Home Rehabilitation – IEEE Conference Publication

, , , , , , , , , , , ,

Leave a comment

[Abstract] Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology

ABSTRACT

Background

Nowadays, information technologies are being widely adopted to promote healthcare and rehabilitation. Owing to their affordability and use of hand-free controllers, vision-based systems have gradually been integrated into motor rehabilitation programs and have greatly drawn the interest of healthcare practitioners and the research community. Many studies have illustrated the effectiveness of these systems in rehabilitation. However, the report and design aspects of the reported clinical trials were disregarded.

Objective

In this paper, we present a systematic literature review of the use of vision-based serious games and virtual reality systems in motor rehabilitation programs. We aim to propose a research methodology that engineers can use to improve the designing and reporting processes of their clinical trials.

Methods

We conducted a review of published studies that entail clinical experiments. Searches were performed using Web of Science and Medline (PubMed) electronic databases, and selected studies were assessed using the Downs and Black Checklist and then analyzed according to specific research questions.

Results

We identified 86 studies and our findings indicate that the number of studies in this field is increasing, with Korea and USA in the lead. We found that Kinect, EyeToy system, and GestureTek IREX are the most commonly used technologies in studying the effects of vision-based serious games and virtual reality systems on rehabilitation. Findings also suggest that cerebral palsy and stroke patients are the main target groups, with a particular interest on the elderly patients in this target population. The findings indicate that most of the studies focused on postural control and upper extremity exercises and used different measurements during assessment.

Conclusions

Although the research community’s interest in this area is growing, many clinical trials lack sufficient clarity in many aspects and are not standardized. Some recommendations have been made throughout the article.

via Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology – ScienceDirect

, , , , , , , , ,

Leave a comment

[ARTICLE] FarMyo: A Serious Game for Hand and Wrist Rehabilitation Using a Low-Cost Electromyography Device – Full Text PDF

Abstract

One of the strategies used in recent years to increase the commitment and motivation of patients undergoing rehabilitation is the use of graphical systems, such as virtual environments and serious games. In addition to contributing to the motivation, these systems can simulate real life activities and provide means to measure and assess user performance. The use of natural interaction devices, originally conceived for the game market, has allowed the development of low cost and minimally invasive rehabilitation systems. With the advent of natural interaction devices based on electromyography, the user’s electromyographic data can also be used to build these systems. This paper shows the development of a serious game focused on aiding the rehabilitation process of patients with hand motor problems, targeting to solve problems related to cost, adaptability and patient motivation in this type of application. The game uses an electromyography device to recognize the gestures being performed by the user. A gesture recognition system was developed to detect new gestures, complementing the device’s own recognition system, which is responsible for interpreting the signals. An initial evaluation of the game was conducted with professional physiotherapists.

Download Full Text PDF

via FarMyo: A Serious Game for Hand and Wrist Rehabilitation Using a Low-Cost Electromyography Device | International Journal of Serious Games

, , , , ,

Leave a comment

[Abstract + References] Serious Game Based on Myo Armband for Upper-Limb Rehabilitation Exercises – Conference paper

Abstract

The purpose of a rehabilitation processes is to restore a person to a state of optimal functioning. A wide variety of rehabilitation processes consist of repetition tasks. Thus, Serious Games (SG) can be used as a technology to assist in this process by motivating patients to perform the exercises during rehabilitation sessions using a variety of devices, with goals or scores to be achieved during sessions. This work addresses the development and usage of SG based on the Myo Armband, an affordable-access device, which is used to build an Assistive Technology for upper-limb rehabilitation. This SG has a circus target shooting as theme, in which the individuals must make the selected upper-limb rehabilitation exercise (the full fist position), in order to shoot with the gun and hit the targets. To test these SG, five healthy volunteers used them during 3 sessions of 10 repetitions each. To evaluate this SG, the volunteers answered a System Usability Scale (SUS) questionnaire and a free questionnaire with questions about the structure of the SG. Results showed that these SG have good potential to be used as a rehabilitation tool, and the suggestions of the free form questionnaire will be useful to make the necessary changes before its usage with impaired patients.

References

  1. 1.
    Brasil. A Coleção Progestores – Para entender a gestão do SUS. Ciência e Tecnologia em Saúde, 1 ed. Brasília (2007)Google Scholar
  2. 2.
    Brasil. Subsecretaria Nacional de Promoção dos Direitos da Pessoa com Deficiência. Comitê de Ajudas Técnicas. Tecnologia Assistiva. CORDE, 138 pp. Brasília (2009)Google Scholar
  3. 3.
    Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística – IBGE. Censo demográfico 2010: características gerais da população, religião e pessoas com deficiência, pp. 1–215. Rio de Janeiro (2010)Google Scholar
  4. 4.
    Robitaille, S.: The Illustrated Guide to Assistive Technology and Devices: Tools and Gadgets for Living Independently. Demos Medical Publishing, New York (2010)Google Scholar
  5. 5.
    Ritterfeld, U., Cody, M., Vorderer, P.: Serious Games: Mechanisms and Effects. Taylor & Francis, New York (2009)CrossRefGoogle Scholar
  6. 6.
    Bonnechère, B.: Serious Games in Physical Rehabilitation. Springer International Publishing, Brussels (2018)CrossRefGoogle Scholar
  7. 7.
    Delisa, A., Gans, M., Walsh, E.: Physical Medicine and Rehabilitation: Principles and Practice, 15th edn. Lippincott Williams & Wilkins, Philadelphia (2005)Google Scholar
  8. 8.
    Monteiro, C.B.D.M.: Realidade virtual e jogos eletrônicos: uma proposta para deficientes. Realidade virtual na paralisia cerebral, pp. 68–87. São Paulo (2011)Google Scholar
  9. 9.
    Masson, S., Fortuna, F., Moura, F., Soriano, D.: Integrating Myo Armband for the control of myoelectric upper limb prosthesis. In: Proceedings of the XXV Congresso Brasileiro de Engenharia Biomédica. Foz do Iguaçu (2016)Google Scholar
  10. 10.
    Kisner, C., Colby, L.A.: Therapeutic Exercise: Foundations and Techniques, 6th edn. Fa Davis, Philadelphia (2012)Google Scholar
  11. 11.
    Levin, F., Weiss, L., Keshner, A.: Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles. Phys. Ther. 95(3), 415–425 (2015)CrossRefGoogle Scholar
  12. 12.
    Silva, R., Silva, A.: Tecnologias para Construção de Mundos Virtuais: Um Comparativo Entre as Opções Existentes no Mercado, FAZU em Revista, pp. 211–215 (2012)Google Scholar
  13. 13.
    Hjorungdal, R.M., Sanfilippo, F., Osen, O.L., Rutle, A., Bye, R.T.: A. game-based learning framework for controlling brain-actuated wheelchairs. In: ECMS, pp. 554–563 (2016)Google Scholar
  14. 14.
    Unity Technologies: Unity. http://unity3d.com/ (2018). Accessed 18 Feb 2018
  15. 15.
    Blender Foundation: Blender. https://www.blender.org/ (2018). Accessed 18 Feb 2018
  16. 16.
    Gimp: Gimp. https://www.gimp.org/ (2018). Accessed 18 Feb 2018
  17. 17.
    Finstad, K.: The system usability scale and non-native english speakers. J. Usability Stud. 1(4), 185–188 (2006)Google Scholar
  18. 18.
    Bangor, A., Kortum, P., Miller, J.: Determining what individual SUS scores mean: adding an adjective rating scale. J. Usability Stud. 4(3), 114–123 (2009)Google Scholar

via Serious Game Based on Myo Armband for Upper-Limb Rehabilitation Exercises | SpringerLink

, , , , , ,

Leave a comment

[Abstract + References] Virtual Reality Game Development Using Accelerometers for Post-stroke Rehabilitation – Conference paper

Abstract

Stroke can generate several types of sequelae, including motor difficulties in both upper and lower limbs. One way to eliminate or reduce these difficulties is through physical therapy, but this type of treatment can often become tiresome and monotonous, decreasing the patient’s interest. Thus, aiming to assist in the rehabilitation of patients, this work seeks to use immersive virtual reality games with the purpose of interacting with physiotherapy exercises. In this type of game the individual must use special equipment (glasses) to feel in an environment where they can interact in different ways with the scenery. Among the possible equipment used for immersive virtual reality was chosen to use a smartphone in conjunction with a virtual reality glasses. In this way an environment was developed that allows the individual to move through the scenario by the control of the upper virtual members by accelerometry sensors, which will be positioned properly to identify the actual movement of the limbs. Thus, an equipment was developed capable of reading the movements and sending this information to a smartphone that executes the developed game.

References

  1. 1.
    Monteiro, A.: Qualidade de vida (QV) em Indivíduos com Sequelas de Acidente Vascular Cerebral (AVC). Vila Nova de Gaia: Escola Superior de Tecnologias da Saúde do Porto. Vila Nova de Gaia (2011)Google Scholar
  2. 2.
    Lennon, S., Hastings, M.: Key physiotherapy indicators for quality of stroke care. Physiotherapy 82(12):655–664 (1996)CrossRefGoogle Scholar
  3. 3.
    Deutsch, J.E., Mirelman, A.: Virtual Reality-based approaches to enable walking for people poststroke. Topics Stroke Rehabil. 14(6):45–53 (2007)CrossRefGoogle Scholar
  4. 4.
    Dores, A.R., et al.: Realidade Virtual na Reabilitação: Por Que Sim e Por Que Não? Uma Revisão Sistemática. Acta Médica Portuguesa, v. 25(6) (2012)Google Scholar
  5. 5.
    Tori, R., Kirner, C., Siscoutto, R.A.: Fundamentos e tecnologia de realidade virtual e aumentada. Editora SBC (2006)Google Scholar
  6. 6.
    Pompeu, J.E., Alonso, T.H., Masson, I.B., et al.: Os efeitos da realidade virtual na reabilitação do acidente vascular encefálico: Uma revisão sistemática. Motricidade 10(4) (2014)Google Scholar
  7. 7.
    Sha, M.A., et al.: EMG biofeedback based VR system for hand rotation and grasping rehabilitation. In: 14th International Conference on Information Visualisation (IV). IEEE, pp. 479–484 (2010)Google Scholar
  8. 8.
    Kang, Y., Park, H., Kim, H. et al.: Upper extremity rehabilitation of stroke: facilitation of corticospinal excitability using virtual mirror paradigm. J. NeuroEng. Rehabil. 9(1):71 (2012)CrossRefGoogle Scholar
  9. 9.
    Yasuda, K., Muroi, D., Ohira, M., et al.: Validation of an immersive virtual reality system for training near and far space neglect in individuals with stroke: a pilot study. Topics Stroke Rehabil. 24(7):533–538 (2017)CrossRefGoogle Scholar
  10. 10.
    Kang, H.K., Kim, Y., Chung, Y., Hwang, S.: Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials. Clinic. Rehabil. 26(3):246–255 (2012)CrossRefGoogle Scholar
  11. 11.
    Brahler, S.: Analysis of the Android Archtecture. Karlsruher Institut fur Technologie. [S.l.], p. 43 (2010)Google Scholar

via Virtual Reality Game Development Using Accelerometers for Post-stroke Rehabilitation | SpringerLink

, , , ,

Leave a comment

[Abstract] Towards Bilateral Upper-Limb Rehabilitation after Stroke using Kinect Game – IEEE Conference Publication

Abstract:

This paper presented a game-based rehabilitation of the upper limb after stroke. We designed and developed a game for supporting stroke patients to have an exercise their arms, and the game had functions for recording their playing and showing a performance report. The performance report can infer the progress of bilateral uppper-limb rehabilitation and use for comparing among patient cases. This is because the game used a Kinect device to detect the arm movements in aspect of precision and speed.

 

1. L. Anderson, G. A. Sharp, R. J. Norton, H. Dalal, S. G. Dean, K. Jolly, A. Cowie, A. Zawada, R. S. Taylor, “Home-based versus centre-based cardiac rehabilitation”, The Cochrane Library, 2017.

2. K. Thomson, A. Pollock, C. Bugge, M. C. Brady, “Commercial gaming devices for stroke upper limb rehabilitation: a survey of current practice”, Disability and Rehabilitation: Assistive Technology, vol. 11, no. 6, pp. 454-461, 2016.

3. L. Y. Joo, T. S. Yin, D. Xu, E. Thia, P. F. Chia, C. W. K. Kuah, K. K. He, “A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke”, Journal of rehabilitation medicine, vol. 42, no. 5, pp. 437-441, 2010.

4. K. Price, “Health promotion and some implications of consumer choice”, Journal of nursing management, vol. 14, no. 6, pp. 494-501, 2006.

5. J. A. M. Bravo, P. Paliyawan, T. Harada, R. Thawonmas, “Intelligent assistant for providing instructions and recommending motions during full-body motion gaming”, Consumer Electronics (GCCE) 2017 IEEE 6th Global Conference on. IEEE, pp. 1-2, 2017.

 

via Towards Bilateral Upper-Limb Rehabilitation after Stroke using Kinect Game – IEEE Conference Publication

 

, , , , , , , , , , ,

Leave a comment

[ARTICLE] Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke – Full Text

Abstract

Background

Impairment of upper extremity function is a common outcome following stroke, to the detriment of lifestyle and employment opportunities. Yet, access to treatment may be limited due to geographical and transportation constraints, especially for those living in rural areas. While stroke rates are higher in these areas, stroke survivors in these regions of the country have substantially less access to clinical therapy. Home therapy could offer an important alternative to clinical treatment, but the inherent isolation and the monotony of self-directed training can greatly reduce compliance.

Methods

We developed a 3D, networked multi-user Virtual Environment for Rehabilitative Gaming Exercises (VERGE) system for home therapy. Within this environment, stroke survivors can interact with therapists and/or fellow stroke survivors in the same virtual space even though they may be physically remote. Each user’s own movement controls an avatar through kinematic measurements made with a low-cost, Kinect™ device. The system was explicitly designed to train movements important to rehabilitation and to provide real-time feedback of performance to users and clinicians. To obtain user feedback about the system, 15 stroke survivors with chronic upper extremity hemiparesis participated in a multisession pilot evaluation study, consisting of a three-week intervention in a laboratory setting. For each week, the participant performed three one-hour training sessions with one of three modalities: 1) VERGE system, 2) an existing virtual reality environment based on Alice in Wonderland (AWVR), or 3) a home exercise program (HEP).

Results

Over 85% of the subjects found the VERGE system to be an effective means of promoting repetitive practice of arm movement. Arm displacement averaged 350 m for each VERGE training session. Arm displacement was not significantly less when using VERGE than when using AWVR or HEP. Participants were split on preference for VERGE, AWVR or HEP. Importantly, almost all subjects indicated a willingness to perform the training for at least 2–3 days per week at home.

Conclusions

Multi-user VR environments hold promise for home therapy, although the importance of reducing complexity of operation for the user in the VR system must be emphasized. A modified version of the VERGE system is currently being used in a home therapy study.

Background

Chronic upper extremity impairment is all too common among the more than 7 million stroke survivors in the U.S. [1]. These impairments have disabling effects on all facets of life, including self-care, employment, and leisure activities. Repetitive practice of movement, such as arm movement, is thought to improve outcomes for stroke survivors [234], but access to the clinic for therapy is often limited by geography or lack of transportation. While almost 50 million Americans live in rural areas, 90% of physical and occupational therapists live in major urban areas [5]. Per capita ratios of therapists to overall population are 50% larger in urban as compared to rural regions of the country [6]. Rates of stroke in these rural areas, however, exceed those of major urban areas [789]. Thus, a large number of stroke survivors have limited access to skilled treatment. Data from 21 states found that only 30% of stroke survivors received outpatient rehabilitation, a much lower percentage than that recommended by clinical practice guidelines [10]. Declines seen following discharge from inpatient rehabilitation are undoubtedly exacerbated by limited access to clinical therapy [11].

Disparity in quality of care has been recognized in the acute treatment of stroke for a number of years. This situation has led to the development of telemedicine to extend expert care to individuals during the initial hours and days following the stroke, advance site-independent treatment, and create models of care in rural areas [121314]. Therapy options after this acute period, however, generally remain limited for stroke survivors in rural areas. Akin to the telemedicine efforts, telerehabilitation treatments have been proposed. However, telerehabilitation interactions are typically limited to off-line monitoring by the therapist [8915], phone calls between a therapist and client [1617], or videoconferencing [181920]. While systems allowing more direct interaction have been proposed, the hardware cost and complexity limit applicability for home-based therapy [212223]. Hence, the therapist is relegated to the role of observer and the intimacy of a clinical therapy session is lost. Therapy options are substantially restricted, as is the available feedback.

Recently, multiple investigators have been exploring means of improving home-based therapy through the development of systems or serious games which permit multiple, simultaneous users [24252627282930]. These efforts have proposed the inclusion of multiple users as a means to overcome resistance to home-based therapy that may result due to isolation or lack of engagement. Indeed, studies have observed a preference for multi-user vs, single-user therapy when utilizing these systems [2629]. However, these systems have largely been limited to control of a one-dimensional or two-dimensional space and both users remain in the same physical location (e.g., side by side). One team of researchers did develop a framework for supporting distant users (such as a therapist in the hospital and a stroke survivor in their home), but game control was limited to one or two dimensions [3132].

Here, we describe the development of a fully three-dimensional (3D) virtual reality environment (VRE) for home-based therapy in which multiple, remote users can interact in real time. In this Virtual Environment for Rehabilitative Gaming Exercises (VERGE) system [33], movement of the user is mapped to corresponding movement of an avatar to foster a sense of presence in and engagement with the VRE. The 3D environment encompasses aspects of clinical therapy, such as transport of objects or movement of the hand into specified regions of the upper extremity workspace. Although the importance of 3D movements in VR environments is a topic of debate [3435], movements tested in environments with lesser degrees-of-freedom (DOF) are often very limited and dictated by a one DOF robot. These movements differ substantially from the types of movements normally seen in 3D reaching movements [436]. The network architecture of the system allows users to be located remotely from each other, such as a stroke survivor in their home, a therapist in a clinic, or a stroke survivor’s friend or relative living in another city or state. The virtual nature of the environment allows even very limited movements in the physical world to have successful functional outcomes in the virtual world, thereby offering a sense of accomplishment and motivation for successive attempts. Additionally, task difficulty can easily be modified in order to maintain the proper level of challenge, which is important for motor learning in general [37] and rehabilitation in particular [38].

We developed and performed preliminary testing of the VERGE system to gauge user response in comparison to two other therapy modalities that could be used for home therapy: an existing virtual reality system based on the Alice in Wonderland story (AWVR) [39] and a home exercise program (HEP). Fifteen stroke survivors completed three, one-hour therapy sessions per week with each of the three therapy modalities (9 sessions total). We hypothesized that the use of the VERGE system would not decrease the amount of arm movement promoted, in comparison with the AWVR and HEP modalities. We further expected that users’ self-described engagement would be greatest for the VERGE system due to the presence of a partner.

Methods

VERGE System

Architecture

At its core, VERGE consists of a 3D VRE in which avatars interact with virtual objects. To date, we have created two such VREs, one depicting a dining room and the other a kitchen. The scenes were created in Maya (Autodesk Inc., San Rafael, CA) and imported into Unity 3D (Unity 4.5, Unity Technologies, San Francisco, CA), the software platform controlling VERGE. The VREs are rich in detail in order to provide depth cues [40]. Thus, depth can be conveyed without the need for stereovision, such as that provided by head mounted displays (HMDs). We have found that HMDs can be difficult for stroke survivors to use due to the limited field-of-view and, especially, involuntary coupling between neck and arm motion [4142]. The latter may lead to complications with moving the arm while keeping the head steady.

The avatars were created from a custom skeleton in Maya (Autodesk Inc., San Rafael, CA), which was rigged to an existing mesh of the “casual young man” 3D model, purchased and modified for our project (Fig. 1). We created the custom skeleton to match the topology of the existing character while corresponding to the skeletal joint naming convention in Unity 3D. The skeleton (and thus avatar) is animated according to joint angle data captured with a Kinect™ I optical tracker (Microsoft Corp., Redmont, WA). The 3D motion data from the Kinect™ are transmitted to the Unity code through UDP to drive the movement of the avatar in the virtual environment.

[…]

Continue —> Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

, , , , , , , , , , , , , , ,

Leave a comment

[ARTICLE] Music meets robotics: a prospective randomized study on motivation during robot aided therapy – Full Text

Abstract

Background

Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C–), each in a condition with (V+) and without (V–) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation.

Methods

In a prospective randomized single-center study, healthy participants were randomly assigned to play two of the four training conditions, either with (V+) or without visual display (V–). In the third round, the participants played a repetition of the preferred condition of the two first rounds, this time with a new V condition (i.e., with or without visual display). For each of the three rounds, motivation was measured with the Intrinsic Motivation Inventory (IMI) in the subscales interest/enjoyment, perceived choice, value/usefulness, and man-machine-relation. We recorded the actual training time, the time of free movement, and the velocity profile and administered a questionnaire to measure perceived training time and perceived effort. All measures were analysed using linear mixed models. Furthermore, we asked if the participants would like to receive the created music piece.

Results

Sixteen healthy subjects (ten males, six females, mean age: 27.2 years, standard deviation: 4.1 years) with no known motor or cognitive deficit participated. Promotion of creativity (i.e., C+ instead of C–) significantly increased the IMI-item interest/enjoyment (p=0.001) and the IMI-item perceived choice (p=0.010). We found no significant effects in the IMI-items man-machine relation and value/usefulness. Conditions promoting creativity (with or without visual display) were preferred compared to the ones not promoting creativity. An interaction effect of promotion of creativity and omission of visual display was present for training time (p=0.013) and training intensity (p<0.001). No differences in relative perceived training time, perceived effort, and perceived value among the four training conditions were found.

Conclusions

Promoting creativity in a visuo-audio-haptic or audio-haptic environment increases motivation in robot-assisted therapy. We demonstrated the feasibility of performing an audio-haptic music creation task and recommend to try the system on patients with neuromuscular disorders.

 

Background

Following a stroke, 80-90% of patients suffer from arm paresis, which remains chronic in about 30-40% of all cases [123]. Task-oriented, intensive, and motivational training is important to increase arm function post-stroke [245678].

Intensity is recognized as a key feature of successful rehabilitation therapy [9]. Robots in neurorehabilitation allow for highly-intensive, task-oriented training and have the potential to be superior to conventional therapies (i.e., physical or occupational therapy) in improving motor function post-stroke [10]. Robotic therapy may embed functional training tasks into computer games to facilitate motor learning and to stimulate motivation [11].

Autonomy, competence, and relatedness can be regarded as the main components of intrinsic motivation [1213]. While extrinsic motivation can be described as a goal-directed drive towards an externally provided reward (e.g., a score in a game), intrinsic motivation is a process oriented and internally provided reward due to a satisfying, interesting, meaningful or enjoyable activity [1415]. The knowledge regarding the meaningfulness of an activity is a positive determinant of patient motivation [7]. Thus, for patients, an activity should not only be enjoyable, but also lead to a rehabilitation progress. Furthermore, patient engagement is related to the expected reduction of impairment during game-based therapy in stroke [16].

Activities with a close relation to intrinsic motivation are frequently associated with activities promoting creativity [171819]. This might be because activities promoting creativity involve one’s own accord, active decision making, and a resulting product, thus satisfying the need of autonomy, competence, and relatedness [12202122].

In addition to encouraging creativity, music is a promising stimulator for intrinsic motivation in the context of rehabilitation [2324]. Music effectively promotes post-stroke recovery in motor and cognitive functions, and furthermore in emotional and social domains [25262728293031]. Studies that compared conventional therapy forms to therapy tasks embedded in active music making revealed that music-associated training increases the level of motivation significantly [2432].

Auditory displays have already been determined to be effective for navigation within complex systems [33]. Accordingly, sound is an audible source for navigation through the execution of a task in virtual scenarios without the need for a visual display unit, the advantage being that the visual focus can be on the trained limb rather than a graphical display, thus promoting visuo-motor control [3435].

We developed tasks for robot-assisted training of the arm that aim to increase intrinsic motivation with a focussed stimulation of the two aspects: creativity and music. To investigate whether a music condition promoting creativity influences motivation differently than a music condition not promoting creativity, we compared motivational effects of both versions. We investigated the effect of the presence or absence of a visual display for both conditions regarding promotion of creativity. As the training goal of the presented gamified task is to induce high intensity during exercise, the game is operated by repetitive horizontal movements.

For this current study, we designed audio-haptic tasks in a way that they can be performed either with visual display (i.e., a monitor presenting the game workspace) as an audio-visuo-haptic environment or without a visual display as an audio-haptic environment only. To reduce the cognitive load of the participants and have more cognitive resources for creation and decision making processes, we designed the visual display and the haptic environment such that they both presented the same game workspace [36]. Accordingly, the visuals were not essential to complete the audio-haptic task.

Given these related works, the primary hypothesis was that a gamified task promoting creativity embedded in a task for motor therapy increases intrinsic motivation more than a gamified task not promoting creativity. Our second hypothesis was that a gamified task in motor therapy without visual display increases intrinsic motivation more than a gamified task with visual display. Moreover, we hypothesized that promoting creativity and omitting a visual display would increase total training time, free movement time and perceived product value. We further hypothesized that promoting creativity and omitting a visual display would reduce energy expenditure, relative perceived training time and perceived effort.[…]

 

Fig. 1

Fig. 1ARMin arm rehabilitation robot. Additionally for this study, a keyboard was placed close to the participant’s left hand so that the space bar could be used as input device

Continue —>  Music meets robotics: a prospective randomized study on motivation during robot aided therapy | Journal of NeuroEngineering and Rehabilitation | Full Text

, , , , , , , , ,

Leave a comment

[Review] Gamified In-Home Rehabilitation for Stroke Survivors: Analytical Review – Full Text DOC file

Abstract

A stroke is a life-changing event that may end up as a disability, with repercussions on the patient’s quality of life. Stroke rehabilitation therapies are helpful to regain some of the patient’s lost functionality. However, in practice stroke patients may suffer from a gradual loss of motivation. Gamified systems are used to increase user motivation, hence, gamified elements have been implemented into stroke rehabilitation therapies in order to improve patients’ engagement and adherence. This review work focuses on selecting and analyzing developed and validated gamified stroke rehabilitation systems published between 2009 and 2017 to identify the most important features of these systems. After extensive research, 32 articles have met the selection criteria, resulting in a total of 28 unique works. The works were analyzed and a total of 20 features were identified. The features are explained, making emphasis on the works that implement them extensively. Finally, a classification of features based on objectives is proposed, which was used to identify the relationships between features and implementation gaps. It was found that there is a tendency to develop low-cost solutions as in-home therapy systems; to include automated features; provide a diversity of games and use of simple interaction devices. This review allowed the definition of the opportunities for future research direction such as systems addressing the three rehabilitation areas; data analytics to make decisions; motivational content identification based on automatic engagement detection and emotion recognition; and alert systems for patient´s safety.

  1. Introduction

Brain stroke is a life-changing disease that can have fatal consequences. Stroke survivors may end up with long-term disabilities. These disabilities will depend on the damaged part of the brain and the body functions related to it. Older adults are the population with the highest risk of suffering a stroke and ending up with a disability. This makes of stroke the leading cause of adult disability worldwide [1-4].

Stroke rehabilitation therapy has proven to be useful in helping the patient to regain some of his lost functionality [5-8]. In traditional rehabilitation programs, when the rehabilitation in the hospital is completed, the patients return to their homes, where they should continue with more rehabilitation activities. However, the patient’s adherence is reduced at home. The two main causes for this are: the lack of available resources and tools to sustain training for longer periods; and, a diminishing motivation as repetitive exercises are perceived as tedious and boring [9-12]. Gamified rehabilitation systems have proven to be useful to improve motor and cognitive function and additionally as a tool to motivate patients to adhere to the therapy programme [13-22].

This study focuses on gamified systems dedicated for stroke patients’ upper limb rehabilitation for in-home use. The objectives of this study are: 1) provide a literature review of the developed and tested gamified systems for in-home stroke rehabilitation, between 2009 and 2017; 2) identify and explain the most used features of these systems; 3) provide a simple way to classify the features, in order to identify the relationships between them and the gaps of their implementations. A total of 32 articles have met the selection criteria, which resulted in a total of 28 unique works. From analysis of these studies, a total of 20 features were identified. The remaining of this paper is structured as follows. Section 2 describes the methodology used to find the reviewed works and the database to be used, as well as the selection criteria applied to select research works. Section 3 presents the results of the analysis, with the emphasis on the importance of each feature and the works that implemented them to higher extents. An analytical point of view is discussed in Section 4, where an objective-based classification is proposed, the relationships between the features are presented and additionally, the gaps in the current systems are identified. Finally, Section 5 is dedicated for the conclusion and the future research perspectives.[…]

 Download Full Text DOC file

, , , , , ,

Leave a comment

[Abstract] Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned

Objective: To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy.

Materials and Methods: This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists’ weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators.

Results: Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology’s use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed.

Conclusion: Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.

 

via Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned | Games for Health Journal

, , , , , , , , ,

Leave a comment

%d bloggers like this: