Monday, January 30, 2012

Voice access video game


Proof of Concept

King SN, Davis L, Lehman JJ, Ruddy BH. A Model for Treating Voice Disorders in School-Age Children within a Video Gaming Environment. J Voice. 2011 Dec 29. [Epub ahead of print]

Link to abstract:
www.ncbi.nlm.nih.gov/pubmed/22209055


Objective: The authors altered a voice-themed video game to make it voice activated, for use at home with school-age children with hyperfunctional voice disorders.

Video games can provide compelling ‘homework’ for children undergoing voice therapy, and may contribute to generalizing the learned behaviours to the home. The authors modified the video game Opera Slinger, an interactive game that requires players to score points by matching sound pitch and volume.

Process: The article is written about three cycles of trying and modifying the video game: firstly to adapt the game to voice activation, then to increase playability for children and adults. The third iteration was a case study of a 9 year old boy with the target condition. He received weekly one hour traditional speech therapy for two weeks before playing the video game at home for two weeks.

Findings: The voice-activated game was found to be functional, playable, and highly engaging. The players produced vocalizations that may be beneficial therapy outcomes, but video play and traditional therapy outcomes were not compared here. “Voice video games may contribute to the success of voice therapy by helping the generalization that needs to occur from the therapy session to home life”.

Friday, January 20, 2012

CP and Video games: Systematic Review


Sandlund M, McDonough S, Häger-Ross C.
Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review.
Dev Med Child Neurol. 2009 Mar;51(3):173-9

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/19191834

This review is notable because of the focus on cerebral palsy. The researchers used the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) levels of evidence guidelines, and many of the articles used the Bruninks-Oseretsky Test for Motor Efficiency (BOTMP) as an outcome measure.

Objective:
A systematic review of evidence using interactive computer play for motor rehabilitation for children. Therapeutic active video gaming is defined here as “play with virtual objects in a computer-generated environment” (including mouse and keyboard interaction) for improved motor control and motor learning as a primary or secondary outcome.

Method:
Eleven databases were searched for literature from 1995 to May 2008.
Some studies used the Gross Motor Functioning Classification System and included children with level IV and V disabilities. AACPDM levels of evidence guidelines were used to assess and categorize each (quantitative) research design and methodology of the 16 included articles. Of them, three were randomized control trials (level II), four were level III (cohort studies), six were level IV (case series) and three were level V (case reports).

Findings:
Two of the three level II and one level III study found no significant improvements. Several of the level IV, cohort studies used the BOTMP (subtest 5:6), the Peabody Developmental Motor Scale, or the Quality of Upper Extremities Skills Test. One study used the Canadian Occupational Performance Model.

In summary, “nine studies investigated movement quality; two showed no significant improvements and seven, mostly low-level studies, reported positive findings”, and a call for “further and more convincing research”.

Selected References

AACPDM levels of evidence

Butler C. AACPDM methodology to develop systematic reviews
of treatment interventions 1999; (Revision 1.1, 2004). Available
from URL: http://www.aacpdm.org/resources/systematicReviews
Methodology.pdf.

Studies using BOTMP assessing motor quality

Eliasson AC, Rosblad B, Hager-Ross C. Control of reaching
movements in 6-year-old prematurely born children with motor
problems - an intervention study. Adv Physiother 2003; 5: 33–48.

Petrofsky JS, Petrofsky D. A simple device to assess and train
motor coordination. J Med Eng Technol 2004; 28: 67–73.

Bartscherer ML, Dole RL. InteractiveMetronome training for a
9-year-old boy with attention and motor coordination difficulties.
Physiother Theory Pract 2005; 21: 257–69.

Krichevets AN, Sirotkina EB, Yevsevicheva IV, Zeldin LM. Computer
games as a means of movement rehabilitation. Disabil Rehabil
1995; 17: 100–5.

Reid DT. The use of virtual reality to improve upper-extremity
efficiency skills in children with cerebral palsy: a pilot study.
Technol Disabil 2002; 14: 53–61.

Reid D, Campbell K. The use of virtual reality with children with
cerebral palsy: a pilot randomized trial. Ther Recreation J 2006;
40: 255–68.

Chen YP, Kang LJ, Chuang TY, et al. Use of virtual reality to
improve upper-extremity control in children with cerebral palsy:
a single-subject design. Phys Ther 2007; 87: 1441–57.

Shaffer RJ, Jacokes LE, Cassily JF, Greenspan SI, Tuchman RF,
Stemmer PJ Jr. Effect of interactive metronome training on
children with ADHD. Am J Occup Ther 2001; 55: 155–62.

You SH, Jang SH, Kim YH, Kwon YH, Barrow I, Hallett M.
Cortical reorganization induced by virtual reality therapy in a
child with hemiparetic cerebral palsy. Dev Med Child Neurol 2005;
47: 628–35.

Study using Peabody Developmental Motor Scale

Chen YP, Kang LJ, Chuang TY, et al. Use of virtual reality to
improve upper-extremity control in children with cerebral palsy:
a single-subject design. Phys Ther 2007; 87: 1441–57.

Study using Quality of Upper Extremities Skills Test

Reid DT. The use of virtual reality to improve upper-extremity
efficiency skills in children with cerebral palsy: a pilot study.
Technol Disabil 2002; 14: 53–61.

Friday, January 13, 2012

Realistic and adapted movements in play


Research article
Berry T, Howcroft J, Klejman S, Fehlings D, Wright V, Biddiss, E. (2011)
Variations in Movement Patterns during Active Video Game Play in Children with Cerebral Palsy. J Bioengineer & Biomedical Sci S1:001. doi:10.4172/2155-9538. S1-001

Link to article: www.omicsonline.org/2155-9538/2155-9538-S1-001.php

Objective:
Low-cost active video games (AVG) such as Ninteno Wii® are popular physical therapy tools for children with cerebral palsy. While not specifically designed to match rehabilitation goals, various studies have found clinically-relevant improvements in functional motor ability. The games reward realistic movements involving more proximal joints and bilateral upper extremity use but play can also proceed with adapted, more conservative movements of distal joints.

This study investigates play styles of three Nintendo Wii® games; boxing, bowling and tennis for realistic movement patterns related to the real-world activity and variations of adapted movement patterns.

Method:
A purposive sample of 16 children with GMFCS level I hemi- or diplegic cerebral palsy played each of three Wii® games. One minute of play was captured and analyzed as realistic or adapted movement.

Findings:
Game play was either realistic or adapted depending on the game and the child. Wii® bowling was performed more realistically, tennis and boxing less so. Children adapted their play style to succeed at the games, favouring their dominant arm in bilateral activities. Therapists need to encourage children to play realistically to derive the most therapeutic benefits from video game playing.

Friday, January 6, 2012

Virtual Reality: Cochrane Review



Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database of
Systematic Reviews
2011, Issue 9. Art. No.: CD008349. DOI: 10.1002/14651858.CD008349.pub2.

Link to abstract: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008349.pub2/abstract

Objective:
To evaluate the effects of virtual reality (VR) and interactive video gaming on upper limb, lower limb and global motor function after stroke.

Method: The authors searched for randomized trials (RT) and quasi-randomized trials for a population of adults that had had strokes, and that met their definition: “an advanced form of human-computer interface that allows the user to "interact’ with and become ’immersed’ in a computer-generated environment in a naturalistic fashion". 19 trials that involved 565 participants met the criteria. These studies largely do not evaluate commercial gaming consoles such as Wii.

Findings:
Significant results imply limited evidence for the benefits of virtual reality over conventional therapies specifically for arm function (7 studies) and for activities of daily living (3 studies). The properties of VR which are effective and how long the results last are not yet conclusively known.