Posts Tagged Video game

[Abstract] Effects of Virtual Reality Training using Xbox Kinect on Motor Function in Stroke Survivors: A Preliminary Study

Background

Although the Kinect gaming system (Microsoft Corp, Redmond, WA) has been shown to be of therapeutic benefit in rehabilitation, the applicability of Kinect-based virtual reality (VR) training to improve motor function following a stroke has not been investigated. This study aimed to investigate the effects of VR training, using the Xbox Kinect-based game system, on the motor recovery of patients with chronic hemiplegic stroke.

Methods

This was a randomized controlled trial. Twenty patients with hemiplegic stroke were randomly assigned to either the intervention group or the control group. Participants in the intervention group (n = 10) received 30 minutes of conventional physical therapy plus 30 minutes of VR training using Xbox Kinect-based games, and those in the control group (n = 10) received 30 minutes of conventional physical therapy only. All interventions consisted of daily sessions for a 6-week period. All measurements using Fugl–Meyer Assessment (FMA-LE), the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the 10-meter Walk Test (10mWT) were performed at baseline and at the end of the 6 weeks.

Results

The scores on the FMA-LE, BBS, TUG, and 10mWT improved significantly from baseline to post intervention in both the intervention and the control groups after training. The pre-to-post difference scores on BBS, TUG, and 10mWT for the intervention group were significantly more improved than those for the control group (P <.05).

Conclusions

Evidence from the present study supports the use of additional VR training with the Xbox Kinect gaming system as an effective therapeutic approach for improving motor function during stroke rehabilitation.

Source: Effects of Virtual Reality Training using Xbox Kinect on Motor Function in Stroke Survivors: A Preliminary Study – Journal of Stroke and Cerebrovascular Diseases

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[ARTICLE] Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis – Full Text

 

Abstract

Background

Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined.

Methods

This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL).

Discussion

This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation.

Background

Clinical practice guidelines recommend outpatient rehabilitation for stroke survivors who remain disabled after discharge from inpatient rehabilitation [1]. Although these guidelines recommend that the majority of stroke survivors receive at least some outpatient rehabilitation [2], many cannot access long-term care [3]. Among those individuals who do undergo outpatient rehabilitation, the standard of care for upper extremity rehabilitation is suboptimal.

In an observational study of 312 rehabilitation sessions (83 occupational and physical therapists at 7 rehabilitation sites), Lang and colleagues [4] found that functional rehabilitation (i.e., movement that accomplishes a functional task, such as eating, as opposed to strength training or passive movement) was provided in only 51% of the sessions of upper extremity rehabilitation, with only 45 repetitions per session on average. This is concerning given that empirically-validated interventions incorporate higher doses of active motor practice [5, 6, 7]. Additionally, functional upper extremity movements are most likely to generalize to everyday tasks [8], an aspect of recovery that is critically important to patients and their families [9, 10, 11]. Yet, passive movement and non-goal-directed exercise are more frequently administered [4].

There appear to be at least two critical elements required for successful upper extremity motor rehabilitation: 1) motor practice that is sufficiently intense and 2) techniques to carryover motor improvements to functional activities. Carry-over techniques to increase a person’s use of the more affected upper extremity for daily activities are extremely important for rehabilitation and appear necessary for structural brain change [12, 13, 14, 15]. When rehabilitation incorporates these techniques, there is substantially improved improvement in self-perceived quality of arm use for daily activities [12, 16]. Carry-over techniques enable the patient to overcome the conditioned suppression of movement (learned nonuse) characteristic of chronic hemiparesis [17]. Techniques include structured self-monitoring, a treatment contract, daily home practice of specific functional motor skills, and guided problem-solving to overcome perceived barriers to using the extremity [18].

Constraint-Induced Movement therapy (CI therapy) has strong empirical backing [5, 19] and combines high-repetition functional practice of the more affected arm with behavioral techniques to enhance carry-over [13, 18]. CI therapy produces consistently superior motor performance and retention of gains versus standard upper extremity rehabilitation [20, 21], particularly when it includes the critically important carry-over (transfer package) techniques [12]. When compared to other equally intensive interventions (i.e., equal hours of training on functional tasks), CI therapy with carry-over (transfer package) techniques has also shown enhanced carry-over of clinical gains to daily activities [12, 13, 22, 23, 24] that are retained for at least 2 years [19, 25, 26, 27, 28].

Despite its inclusion in best practice recommendations [29, 30], CI therapy is available to only a very small minority of those who could benefit from it in the US. CI therapy is not typically covered by insurance and the 30+ hours of assessment and physical training cost upwards of $6000. Access barriers for the patient include limited transportation and insurance coverage, whereas therapists may have difficulty accommodating the CI therapy schedule [31, 32]. Access barriers aside, CI therapy has also been plagued by a variety of misconceptions regarding use of restraint and the transfer package. Most iterations of CI therapy employ use of a restraint mitt to promote use of the affected arm, which is viewed by many patients and clinicians as excessively prohibitive [32]. Yet, literature demonstrates that restraint is not specifically required to achieve positive outcomes [33, 34]. Moreover, the transfer package, a component found to be critical [13, 14], is omitted from the majority of research studies on CI therapy [35].

To address transportation barriers, a telerehabilitation model of CI therapy delivery (AutoCITE) has been tested. AutoCITE is a large specialized motor apparatus (not commercially available, cost not established) that was installed in patients’ homes to enable therapeutic manipulation of actual objects with continuous video monitoring via Internet. This telerehabilitation approach demonstrated efficacy approximately equivalent to that of in-clinic CI therapy [36, 37, 38], thus establishing the feasibility of utilizing technology to deliver CI therapy remotely. However, this system involved specialized equipment at a high cost and did not become available outside a research setting.

To more fully address the barriers to accessing CI therapy and to counter the misconceptions surrounding CI therapy, a patient-centered treatment approach was developed that incorporated the high-repetition practice and carry-over strategies from CI therapy, while reforming non-patient-centric elements of the protocol that lack strong empirical support (i.e., the restraint). To deliver engaging high-repetition practice, a Kinect-based video game was created that can accommodate a wide range of motor disability, can be customized to each user, and automatically progresses in difficulty as the individual’s performance improves (termed “shaping” in the CI therapy literature). A player’s body movements drive game play (there is no external controller), which makes the game easy to use for those who may be unfamiliar with technology. To date, such high-repetition practice through motor gaming [39] has shown initial promise compared to traditional clinic-based approaches [40]. To promote increased use of the weaker arm, a smart watch biofeedback application is utilized in lieu of the restraint mitt. This application counts movements made with the weaker arm and provides alerts when a period of inactivity is detected. Previous approaches for providing CI therapy in the home and reducing the amount of therapist effort have been carried out [36, 37, 38, 41]. These approaches automated the delivery of training and permitted remote supervision of the training via an Internet-based audio-visual link, but did not embed the training within the context of a video game, rely on manipulation of virtual objects, or incorporate a patient-centric substitute for the mitt.

Initial evidence from a pilot trial of this system (Borstad A, Crawfis R, Phillips K, Pax Lowes L, Worthen-Chaudhari L, Maung D, et al.: In-home delivery of constraint induced movement therapy via virtual reality gaming is safe and feasible: a pilot study, submitted) suggests that improvements in motor speed, as measured by Wolf Motor Function Test (WMFT) performance time [42], an outcome of prime importance to stroke survivors, are approximately equivalent to those reported in the traditional CI therapy literature [5, 13, 19, 25]. Qualitative data reveal that the technology is accepted irrespective of age, technological expertise, ethnicity, or cultural background. Thus, this technology has the potential to address the main barriers to adoption of CI therapy, while reducing the cost of care. A randomized clinical trial is now required to provide Level 1 evidence of the comparative effectiveness of this novel model of CI therapy delivery. Data from this trial will enable individuals with motor disability to evaluate whether a home-based video game therapy has the potential to help them meet their rehabilitation goals compared to in-clinic CI therapy and traditional approaches. By combining novel gaming elements with the transfer package from CI therapy, this trial will also address a major limitation of rehabilitation gaming interventions that have been tried to date: extremely limited emphasis on carry-over of training to daily activities.

The primary objective of this trial is to compare the effectiveness of two video game-based models of CI therapy versus traditional clinic-based CI therapy versus standard upper extremity rehabilitation for improving upper extremity motor function. One video gaming group will match the number of total hours spent on the CI therapy transfer package, but will involve fewer days of therapist-client interaction (4 versus 10); the other will match the number of interactions with a therapist to that of clinic-based CI therapy using video consultation between in-person sessions and, as such, will involve more therapist contact hours spent focusing on the transfer package. The secondary objective of this project is to promote personalized medicine by examining individual factors that may differentially influence response to one treatment versus another.

Continue —>  Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis | BMC Neurology | Full Text

Fig. 1 Screen capture of the Recovery Rapids gaming environment

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[WEB SITE] Stroke Rehab Gamification: Hangout with Ohio State Wexner Medical Center’s Researchers.

Stroke rehabilitation can be a monotonous and uninspiring experience, resulting in many patients recovering not as well as they could. We hosted a hangout with researchers from Ohio State Wexner Medical Center who have developed a couple tools that make stroke rehab considerably more exciting while improving the effectiveness of the therapy. Here’s our conversation with Lynne Gauthier and Lise Worthen-Chaudhari about the technologies they’ve been working on:

 

 

Lynne Gauthier, a neuroscientist at Ohio State Wexner Medical Center, developed a video game that forces patients to use the side of their body affected by stroke. Patients wear a glove with sensors that they use to control the game, while a mit restricts their “good hand” from doing the work instead.

 

Lise Worthen-Chaudhari, associate director of the Motion Analysis and Recovery Laboratory at Ohio State Wexner Medical Center, developed Embedded Arts. The digital program is used to help patients with limited mobility. Motion detectors are worn on the part of the body that needs to be exercised, and the patient moves that body part to make artwork that appears on a screen as they move.

Source: Stroke Rehab Gamification: Hangout with Ohio State Wexner Medical Center’s Researchers | Medgadget

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[Abstract] A pilot randomized, controlled trial of an active video game physical activity intervention. – PsycNET

Abstract
Objective: Active video games (AVGs) transform the sedentary screen time of video gaming into active screen time and have great potential to serve as a “gateway” tool to a more active lifestyle for the least active individuals. This pilot randomized trial was conducted to explore the potential of theory-guided active video games in increasing moderate-to-vigorous physical activity (MVPA) among young adults.
Method: In this pilot 4-week intervention, participants were randomly assigned to 1 of the following groups: an AVG group with all the self determination theory (SDT)–based game features turned off, an AVG group with all the SDT-based game features turned on, a passive gameplay group with all the SDT-based game features turned on, and a control group. Physical activity was measured using ActiGraph GT3X accelerometers. Other outcomes included attendance and perceived need satisfaction of autonomy, competence and relatedness.
Results: It was found that playing the self-determination theory supported AVG resulted in greater MVPA compared with the control group immediately postintervention. The AVG with the theory-supported features also resulted in greater attendance and psychological need satisfaction than the non–theory-supported one.
Conclusion: An AVG designed with motivation theory informed features positively impacted attendance and MVPA immediately postintervention, suggesting that including AVG features guided with motivation theory may be a method of addressing common problems with adherence and increasing effectiveness of active gaming. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Source: PsycNET – Option to Buy

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[ARTICLE] Effectiveness of Virtual Reality Game on Functional Movement and Activities of Daily Living in Hemiparetic Stroke Patients.

Abstract:

Independent activities of daily living (ADLs) performance are recognized as a major goal of stroke rehabilitation. Recently, virtual reality training using a video game is considered as an effective approach to improve functional activity of stroke patients.

The purpose of this study is to investigate the effects of virtual reality game using a wii fit balance board on functional movement and ADLs of hemiparetic stroke patients.

20 subjects were randomly allocated into two groups: the virtual reality game training (n = 10) and control groups (n = 10). Both groups participated in standard rehabilitation program for 6 weeks. In addition, virtual reality game training group participated in virtual reality game training for 30 minutes per day, 3 times a week, for 6 weeks.

Virtual reality game training program consisted of balance bubble, ski slalom, ski jump, soccer heading, table tiling, and the penguin slide was conducted with the Wii-Fit balance board. After 6 weeks virtual reality game training, significant improvement observed in functional movement and ADL performance in the virtual reality game training group compared to the control group.

Findings of this study demonstrated that the virtual reality game training has an effective on functional movement and ADL performance in hemiparetic stroke patients when added to standard rehabilitation.

Source: Effectiveness of Virtual Reality Game on Functional Movement and …: ingentaconnect

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[WEB SITE] Here’s an idea: Play your way to recovery – ideas.ted.com

As anyone who’s ever recovered from an injury knows, physical therapy can be painful, boring and slow. TED Fellow Cosmin Mihaiu is out to change that with MIRA, software that disguises physical therapy exercises as fun-to-play videogames. Here’s how it works.

Unlikely — fun! — physical therapy. “Traditionally, a patient doing physical therapy at home is, at most, looking in the mirror. There’s no other feedback or encouragement,” says Mihaiu. MIRA, built by his team in Romania and the United Kingdom, changes that. It’s a set of simple, fun-to-play videogames that encourage precise movement while offering audio and visual stimulus and a sense of achievement. By reaching their onscreen goals, patients also do their physical therapy exercises. So a patient recovering from a broken arm might fly a bee to gather pollen — while flexing and extending the arm. Someone recovering from a stroke might navigate a submarine through water to improve the precision of movement in the shoulder.

Off-the-shelf hardware and tailored exercises produce a personal experience. Each of the ten games offers a range of exercises that can be tailored to each patient’s needs; it’s up to the therapist to prescribe which ones to play, and for how long. Mihaiu and his team built software that can be played via a Kinect motion-sensing input device and a PC. Using readily available and relatively cheap hardware is one way they hope to promote adoption by clinics and hospitals — and eventually by patients at home.

BECAUSE PATIENTS KNOW THAT THEIR CLINICIANS CAN SEE WHETHER AND HOW THEY ARE DOING THE PRESCRIBED EXERCISES, THEY’RE MORE LIKELY TO COMPLY.

The inspiration for MIRA: a fall from a tree. When he was seven, Mihaiu fell out of a tree he’d used as a (poor) hiding place. “The doctors encased my arm and torso in a cast, and because I was stuck in that position for six weeks, I could no longer extend my elbow when the cast came off,” he says. A physical therapist prescribed exercises that called for him to flex and extend his elbow 100 times a day. Unsurprisingly, little Cosmin balked at such tedium. But that meant his recovery took far longer than it should have done. Years later, as a computer engineering student at the University of Babeș-Bolyai in Romania, Mihaiu remembered this childhood experience during a brainstorming session for the Microsoft Imagine Cup innovation competition. “We thought, what if we could get people to play their way to recovery?” he recalls. They didn’t win, but the idea stuck, and MIRA — which stands for Medical Interactive Recovery Assistant — was born.

VIDEO —> Cosmin Mihaiu: Physical therapy is boring — play a game instead

Continue —>  Here’s an idea: Play your way to recovery | ideas.ted.com.

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[WEB SITE] FDA Approves Mobile App for Evaluating Traumatic Brain Injury

FDA Approves Mobile App for Evaluating Traumatic Brain Injury

A new app will soon be available to help clinicians diagnose traumatic brain injury in as little as five minutes in almost any setting, including environments of combat.

The app, called the Defense Automated Neurobehavioral Assessment (DANA), runs on multiple mobile platforms and was recently granted U.S. Food and Drug Administration (FDA) approval. “It’s like a brain thermometer,” stated Lt. Col. Chessley Atchison, a program manager for the Combat Casualty Care Research Program of the U.S. Army Medical Research and Materiel Command (USAMRMC). “And once we get it right, we’re going to put it fairly far forward in the field.”

According to the USAMRMC, DANA operates much like a video game. Service members will undergo a baseline series of on-screen exercises during which both their speed and accuracy are recorded. Those who may have had a serious head injury will then participate in a series of both cognitive efficiency tests and self-administered questionnaires. Afterward, a clinician will review the results, comparing them with the results of the baseline exercises. The combination of the app’s cognitive and psychological components allows for insight into the prevalence of symptoms related to both traumatic brain injury and posttraumatic stress disorder, USAMRMC said in a press statement.

USAMRMC stated that once DANA is fully validated for battlefield use, it may be used to help assess fitness for duty. The app is currently being tested on tablet devices.

For more information on diagnosing traumatic brain injury, see the Psychiatric News article “I Can’t Think Clearly: Diagnosing Traumatic Brain Injury with DSM-5.”

via Psych News Alert: FDA Approves Mobile App for Evaluating Traumatic Brain Injury.

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[WEB SITE] Virtual reality speeds up rehabilitation: Integrating force feedback into therapies for impaired hands — ScienceDaily

…In response to therapeutic needs, a computerized training programme against impaired hands has been developed at the School of Nursing of The Hong Kong Polytechnic University. Patients being trained are supposed to exercise their hands through playing a series of well-designed computer games that simulate everyday tasks, such as opening a locked door with a key or pouring tea into a cup. While playing, their hand movements are monitored and recorded by a haptic device, which is connected to the control unit held by the patient at one end, and a computer at the other. The haptic device then feeds the data into the computer, resulting in the instant reflection of the patient’s actions in the animation on screen.

In addition, the haptic technology which the programme employs is more true-to-life than similar programmes, as feedback is provided through the force created by the control unit to players. For example, they can literally feel the weight of a simulated bottle diminishing as the water is being poured out. Such kind of precision will greatly enhance training effectiveness and improve the patient’s coordination.

Game-based therapies are highly motivating. Firstly, playing 3D games in colourful animation is more interesting than monotonous physical exercises. Secondly, a reward system incorporated in the programme is sure to fuel a sense of competition and accomplishment. “Our games are designed to be engaging. When players make successful attempts, they get bonus points. And as they win, they move on to the next level, where more attractive rewards are waiting,” said Dr Kup-sze Choi, the leader of the research team. It is satisfying for players to work their way up and keep going with the therapy, thereby improving their hand functions…

more –>Virtual reality speeds up rehabilitation: Integrating force feedback into therapies for impaired hands — ScienceDaily.

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[WEB SITE] Brain-Training Device May Ease Stroke Paralysis – WebMD

MONDAY, Dec. 2, 2013 (HealthDay News)

Scientists are testing a new thought-controlled device that may one day help people move limbs again after they’ve been paralyzed by a stroke.

The device combines a high-tech brain-computer interface with electrical stimulation of the damaged muscles to help patients relearn how to move frozen limbs.

So far, eight patients who had lost movement in one hand have been through six weeks of therapy with the device. They reported improvements in their ability to complete daily tasks.

“Things like combing their hair and buttoning their shirt,” explained study author Dr. Vivek Prabhakaran, director of functional neuroimaging in radiology at the University of Wisconsin-Madison.

“These are patients who are months and years out from their strokes,” Prabhakaran said. “Early studies suggested that there was no real room for change for these patients, that they had plateaued in the recovery. We’re showing there is still room for change. There is plasticity we can harness.”

To use the new tool, patients wear a cap of electrodes that picks up brain signals. Those signals are decoded by a computer. The computer, in turn, sends tiny jolts of electricity through wires to sticky pads placed on the muscles of a patient’s paralyzed arm. The jolts act like nerve impulses, telling the muscles to move.

A simple video game on the computer screen prompts patients to try to hit a target by moving a ball with their affected arm. Patients practice with the game for about two hours at a time, every other day.

Researchers also scanned the patients’ brains before, during and a month after they finished 15 sessions with the device.

The more patients practiced, the more they were able to train their brains, the researchers found.

The findings were scheduled for presentation Monday at the annual meeting of the Radiological Society of North America, in Chicago.

Strokes occur when blood flow to the brain stops. This happens because a blood clot blocks a blood vessel in the brain or a blood vessel breaks in the brain. Strokes often cause problems with movement and language.

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via Brain-Training Device May Ease Stroke Paralysis – WebMD.

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[VIDEO] Report about YouGrabber, shown on Swiss television SF1 (Puls) – YouTube

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