Friday, June 23, 2017

Balanced Games = More Fun

Pairs study

How Game Balancing Affects Play: Player Adaptation in an Exergame for Children with Cerebral Palsy

Hwang S, Schneider ALJ, Clarke D, MacIntosh A, Switzer L, Fehlings D & Graham TCN

Conference proceedings: ACM DIS 2017, June 10 – 14, 2017, Edinburgh UK

Link to abstract:"

Player balancing changes game mechanics to accommodate differences in players’ manual and cognitive abilities. Addressing the imbalances also involves players’ awareness of a new fairness that may motivate both the advantaged and disadvantaged players.

Objective : When children with CP play knowingly balanced exergames, do the effects (including motivation) persist?

Process : Eight participants 8 – 14 years old with GMFCS scores of II or III experienced 6 hour-long sessions of either balanced or unbalanced game play.

Findings : "Our results showed that motivation was higher in balanced versus non-balanced conditions [and] perceived fun and fairness were higher for both winners and losers in balanced versus non-balanced conditions."

Friday, May 26, 2017

Testing a Therapy Assistant Robot

Proof of Concept

Adapting a General Purpose Robot for Paediatric Rehabilitation: In-situ Design of a Socially Assistive Robot

Carrillo FM, Butchart J, Knight S, Scheinberg A, Wise L, Sterling L & McCarthy C

Link to article:

Objective: Socially Assistive Robots are engaging and motivating. For social robots in pediatric rehabilitation, what are the therapist, carer and patient-centric properties needed for robots to be effective stand-alone therapeutic aids? What are the lessons from ongoing use in a clinical setting?

Process: Development began with weekly visits to clinic with the robot to stimulate brief discussions with parents and therapists; and interactions with children, followed by programmers involving therapists in cycles of programming the NAO robot and reviewing the exercise sequences. Later development shifted the sole operation of the robot to therapists, parents and care-givers. Clinical use of the robot had 5 therapists working with 9 patients over 14 sessions and continued the iterative design process.

Outcomes: The authors state: “this (deployment) approach has led to a system that not only meets minimum operational and therapeutic requirements for clinical deployment, but also has clearly established priorities for further development as we prepare for formal clinical trials of the socially assistive robot for pediatric rehabilitation.”

Monday, May 1, 2017

Distance Rehab for Kids – A Case Report

Case Report

Feasibility of Pediatric Game-Based Neurorehabilitation Using Telehealth Technologies: A Case Report

Reifenberg G, Gabrosek G, Tanner K, Harpster K Proffitt R & Persch A

American Journal of Occupational Therapy, 71 7103190040


Objective: Feasibility of and suitable outcome measures for distance-monitored video game rehabilitation.

Process: A child with hemiparetic spastic cerebral palsy played 7 hours weekly for 8 weeks of computer games monitored at a distance by a therapist via videoconference technology KUBI The setup permitted the remote therapist to move their camera (iPad) to see the child and the child’s position. The distance therapist consulted with child and parents 30 minutes each week for technical issues.

The outcome measures that were expected to detect change before and after the test condition were: Quality of Upper Extremity Skills Test (QUEST), Bruininks-Oseretsky Test of Motor Proficiency 2 Ed.(BOT-2), Assisting Hand Assessment (AHA), Pediatric Evaluation and Disability Inventory-Computer Adapted Test (PEDI-CAT) and Pediatric Motor Activity Log (PMAL). Pre- and post- tests were applied two weeks before and after the game sessions.

Findings: Feasibility – the audio quality was sufficient for the therapist to interact with the child and family, and the video quality allowed the therapist to see the child’s activity without seeing the TV monitor. There were no insurmountable technical issues though this subject and family were familiar with the technologies used and so this case did not represent a truly novel situation.

Measures – All the measures were sensitive to change in the child’s performance before and after the test condition except the QUEST.

“The use of telehealth technologies provides practitioners with a mechanism to supervise treatments for clients in underserved communities. This research provides initial evidence that it is feasible to administer game-based neurorehabilitation and telehealth technologies and monitor relevant outcomes.”

Monday, April 10, 2017

Wearable Tech for Rehabilitation: Interactive Wearable Systems


Interactive Wearable Systems for Upper Body Rehabilitation: a Systematic Review

Wang Q, Markopoulos P, Yu B, Chen W & Timmermans A

Journal of Neuroengineering and Rehabilitation (2017) 14:20

DOI 10.1186/s12984-017-0229-y

Note: this paper performs a survey of the literature; the authors do not report the outcome of the PRISMA protocol.

Interactive wearable systems (IWS) measure range of motion, posture or usage; and provide auditory, visual or tactile feedback. Posture monitoring is traditionally performed by a therapist. When devices can provide accurate and reliable feedback, IWS opens up the possibility of independent training.

Objectives: A) to classify interactive wearable systems used for movement and posture monitoring during upper body rehabilitation, B) to gauge the wear-ability of the systems and C) to perform a literature review.

Process: A) The authors created a matrix of three axes to classify IWS technology.The axes reflect

  • sensor technology – how it measures: (accelerometers or inertial measurement units, angular sensors or other);
  • measurement - what is measured: (body posture, range of movement or amount of use); and
  • the way feedback is delivered: (auditory, visual, tactile or multi-modal).

B) Wear-ability is classified by the following criteria: the sensor system should remain in place on the body, be comfortable, flexible enough not to limit movement, easy to use and fit different body shapes.

C) The authors included 45 papers, classified by the literature by the level of involvement with patients and the level of evaluation as technical, regarding usability, or clinical. The largest group of papers report on usability evaluation on normal subjects or with ‘real patients’ in stroke rehabilitation. Three papers report clinical evaluation with clinical patients, and one randomized controlled trial was found in the literature. Since a similar review in 2008, there have been only small improvements in the strength of clinical evidence for interactive wearable systems.

Findings: The strength of this paper is in the creation of a matrix for classifying interactive wearable devices. The authors also propose (but do not employ) a list for evaluating the wear-ability of such systems. This report provides a systematic way of regarding interactive wearable systems.

Monday, March 20, 2017

Exergame for CP Kids: GMFCS III Shuttle Run Test

Pilot study

An innovative cycling exergame to promote cardiovascular fitness in youth with cerebral palsy

Knights S, Graham N, Switzer L, Hernandez H, Ye Z, Findlay B, Xie W Y, Wright V & Fehlings D

Developmental Neurorehabilitation 2016 19(2): 135-140
DOI: 10.3109/17518423.2014.923056

Link to abstract

Objective: For youth with cerebral palsy, will playing an exergame increase cardiovascular fitness?

Procedure: The participants were 8 children with spastic bilateral cerebral palsy (GMFCS level III), able to use a hand-held video controller to play an internet-based multi-player game over a six week trial. They exercised at home at least three days a week for 30 minutes a day and tasked to achieve their individually calculated target heart rate for at least 30 minutes a week.

Findings: The primary measure was the GMFCS level III-specific shuttle run test; where higher levels indicate higher cardiovascular fitness. Participants walk or run a distance of 7.5 meters with increasingly less time until they fail to make the distance in the time given, twice. The children were tested before and two days after the six week intervention. The results showed a significant improvement of an average of 1.7 levels on the shuttle run test. Other outcome measures did not show changes that were significant.

Reference: Reliability of a shuttle run test for children with cerebral palsy who are classified at Gross Motor Function Classification System level III

Monday, March 13, 2017

Social Robots: NAOTherapist

Proof of Concept

NAOTherapist: Autonomous Assistance of Physical Rehabilitation Therapies with a Social Humanoid Robot

Pulido J C, Gonzalez J C & Fernandez F

Proceedings of IWART 2016: International Workshop on Assistive and Rehabilitation Technologies, Elche, Spain, December 14 – 16, 2016

Link to paper

Link to video

Objective: The goal of this work is to identify the architecture needed for NAO to provide therapy without human supervision.

Discussion: Social robots may act to relieve the workload of the therapist, fulfilling the clinical objectives autonomously over many treatment sessions. In this study, early requirements of a robotic therapist have been previously identified: the children had no problem following the instructions; they enjoyed the activity and adhered to the regimen.

For autonomous therapy, the robot must possess social awareness in addition to offering exercises that it models, monitors, encourages and corrects. It should be able to report back results to the therapist. In this case, NAO is doing successive arm poses with the child. The robot greets the child. It then models each arm pose, checks on the position achieved by the child, encourages and corrects the pose by using a variety of strategies to model the pose and to show how move into that pose. NAO times the correct achievement of the pose. Here, Kinect is being used separately to capture the poses for feedback to the therapist. NAO indicates the completion of each pose and the exercise routine and offers a wish to "play again tomorrow".

Friday, March 10, 2017

Robot assists with kids mobility


Interactive robot to promote rehabilitation for children with special needs

Kukich D. Published in UDaily, Communications and Public Affairs, University of Delaware, Jan 11, 2016

Link to story

At the University of Delaware in Newark, a research team including mobility researcher Cole Galloway are using "NAO", an interactive human-like robot in a new approach to pediatric rehabilitation. Dr. Galloway, who is known for his Pediatric Mobility Studio and GoBabyGo program, is incorporating the robot into his lab research. His research is directed by the concern that children with motor disabilities have needs that are not met by the training and equipment available today. "Young children’s overall knowledge depends on their ability to be mobile with peers — once they start moving, they begin to learn about the world in fundamentally different ways." The intention of including NAO in the mobility environment is to have the children engage with the robot, and for the robot to facilitate training.


Update on Dr. Galloway's activities

Pediatric Mobility Lab and Design Studio

GoBabyGo "All people exploring their world via independent mobility!"

NAO robot - Softbank