ICF-inflenced VR for CP and DCD

Review

Integrating New Technologies into the Treatment of CP and DCD

Wilson P, Green D, Caeyenberghs K, Steenbergen B & Duckworth J

Disorders Of Motor (PH Wilson, Section Editor), Current Developmental Disorders Reports pp 1-14 First online: 11 April 2016

DOI: 10.1007/s40474-016-0083-9

Link to abstract: link.springer.com/article/10.1007%2Fs40474-016-0083-9

Intention: From the perspective of the International Classification of Functioning, Disability and Health (ICF) http://www.who.int/classifications/icf/en/ , how does the current understanding of childhood participation and motor development shape opportunities for developing new rehabilitation technologies?

Process: The authors examine the ICF framework, its holistic perspective on neurodevelopmental disorders, and then the implications that could influence technology-mediated treatments. “…interventions should have a clear focus on enhancement of participation.” Virtual reality and interactive games for both CP and DCD are considered.

Conclusion: “VR technologies have the potential to expand the opportunities available for engaging children in therapeutic activities across physical, social [,] and cognitive domains.”

Un-Robots for Therapy

Review

Robotic Therapies for Children with Cerebral Palsy: A Systematic Review

Bayon C, Raya R, Sergio LL, Ramirez O, Serrano J I & Rocon E

Translational Biomedicine 2016, 7(1):44

Link to full text article: www.transbiomedicine.com/translational-biomedicine/robotic-therapies-for-children-with-cerebral-palsy-a-systematic-review.php?aid=8788

Objective: For children with cerebral palsy, what is the evidence for robot-based rehabilitation?

Process: The authors performed a systematic review using the PRISMA protocol http://www.prisma-statement.org/ They searched 4 terms: robot, children, therapies and cerebral palsy. This resulted in 44 included studies that were broken into 4 groups: lower extremities (gait), upper extremities, virtual reality as an adjunct to the therapy and clinical applications. The authors do not define the term ‘robot’, and although the search results in articles that include the word robot, the articles are not specifically about robots, but assistive machines. Robots possess a degree of autonomy, this key quality separates robots from machines. The upper and lower extremity devices discussed in this review are passive (mechanical) or power-assistive (electro-mechanical) machines: (NF-walker, Innowalk, LOKOMAT, GT-1 RehaStim, Inmotionarm, ARMEO, Yougrabber and REAplan).

Findings: “There is still a lack of randomised clinical trials with a representative number of subjects, which makes it difficult to evaluate the impact of robot-based therapy, especially the long-term effects. The inclusion of cognitive aspects into the therapies and the design of virtual scenarios in combination with robotic devices provide promising results.”

Virtual Reality Inspires Treadmill Gains

Paired Groups

Treadmill training with virtual reality improves gait, balance and muscle strength in children with cerebral palsy

Cho C, Hwang W, Hwang S & Chung Y

Tohoku Journal of Experimental Medicine 238:3, 213-218 (2016)

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/26947315

Objective: For children with cerebral palsy, does virtual reality (VR) as a distraction/motivator while doing treadmill training (compared to no virtual reality) increase performance?

Process: 18 children with GMFCS levels I – III were randomly assigned to VR or non-VR treadmill training treatment groups. All participants received training for 30 minutes, 3 times weekly for 8 weeks. Jogging program from Nintendo Wii was used for the VR group. Pre- and post-tests included GMFM, Pediatric Balance Scale (PBS), Ten Meter Walk Test (10WT) and Two Minute Walk Test (2MWT). Evaluators were blinded to test condition.

Outcomes: the virtual reality group showed significantly different improvements compare to the non VR group in gait, balance, muscle strength and gross motor function in children with cerebral palsy. There is no evidence of enduring, longer term benefits.

What qualities should a rehab robot have?

Pilot study

Robots in Rehab: Towards socially assistive robots for paediatric rehabilitation

McMarthy C, Butchart J, George M, Kerr D, Kingsley H, Scheinberg A M & Sterling L

OzCHI '15 Proceedings of the Annual Meeting of the Australian Special Interest Group for Computer Human Interaction, pp. 39-43

Link to abstract: dx.doi.org/10.1145/2838739.2838791

Objective: What are the possible clinical benefits of social robots in rehabilitation for children? This preliminary study explores the characteristics required of robots which interact with children in a post-surgery inpatient setting.

Process: In this setting, NAO robot was used to mimic exercises and motivate children when the therapist was not present. Children had two sessions weekly with a therapist, followed by a third session with NAO, over a period of five months. NAO speaks and demonstrates each exercise, provides a focus during the exercises to minimize boredom, provides encouraging and rewarding vocalizations and records the child’s activity for later review.

Findings: Outcomes of interest are specific to the characteristics of the device. Issues that detracted from NAO’s functionality were movement and speech slowness, physical stability and limited balance, voice clarity and battery life.

Therapy Robots: What Therapists Think

Survey

Views of Physiatrists and Physical Therapists on the use of Gait-training Robots for Stroke Patients

Journal of Physical Therapy Science 28: pp. 202 – 206, 2016

Kang, CG, Chun, MH, Jang, MC, Kim, W & Do, KH

Link to full text: www.jstage.jst.go.jp/article/jpts/28/1/28_jpra-2015-652/_article

Objective: to survey therapists on the desired characteristics of gait-training robots.

Process: 100 physiatrists and 100 physical therapists from 38 hospitals were given questionnaires. One-third of the respondents had worked with a gait-training robot before, and a third had more than 5 years experience with stroke rehabilitation.

Results: therapists thought that treadmill type gait-training robots should be used with non-independent ambulators to "improve treatment effects" one to three months after stroke. Sensors should detect electromyography, foot pressure, joint torque, tilt sensor. Qualities of design and production should include: stability, comfort, easiness on-and-off, "fitting sense" and light weight.

Therapists Report on Virtual Reality Adoption Barriers

Single group

Evaluating change in virtual reality adoption for brain injury rehabilitation following knowledge translation

Glegg, SMN, Holsti, L, Stanton, S, Hanna, S, Velikonja, D, Ansley, B, Sartor, D & Brum, C

Disability and Rehabilitation: Assistive Technology, 2016

Link to abstract: dx.doi.org/10.3109/17483107.2015.1111944

Objective: to explore the barriers to adoption of VR technology by clinicians before and after training and support.

Method: 42 therapists at 2 rehabilitation centres were surveyed using the “Assessing Determinants of Prospective Uptake of Virtual Reality (ADOPT-VR) Instrument”. They completed the assessment before and following training, including receiving a manual and support.

Findings: The most often reported pre-test barrier of limited knowledge in how to use the system is absent in post-test reporting. The most significant barriers at post-test included “lack of time, appropriate clients, poor client motivation, technical issues, difficulty explaining the system to clients, and compatibility issues with wheelchair users”.

Article contact: Stephanie Glegg sglegg@cw.bc.ca

Studying Themes in Therapeutic Gameplay

Qualitative Study

Understanding Engagement in Home-Based Interactive Computer Play: Perspectives of Children with Unilateral Cerebral Palsy and Their Caregivers

James, S., Ziviani, J., King, G. & &. Boyd, R. N.

Physical & Occupational Therapy In Pediatrics (2015), DOI: 10.3109/01942638.2015.1076560

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/26606419

Purpose: using qualitative methodology, therapy researchers studied themes arising from children with CP and their caregivers on therapeutic computer game play. The software " (Mitii™) is intended to improve physical and mental skills and to be used in the home setting.

Method: Ten 8 - 18 year old children with one-sided cerebral palsy and their caregivers participated in semi-structured interviews following use of the Mitii game in a 20 week trial reported elsewhere (Boyd et al., 2013) Inclusion for the study required children to be of GMFCS level 1 or 2, and MACS study level 1 to 3. The theoretical positioning of the authors and their perspective as therapists is made explicit.

Findings: The inductive methodology identified three key themes: child and caregiver, themes relating to the intervention and themes that related to therapists’ involvement.
"Child/family characteristics: children's interest captured through novelty and technology, motivation declines as novelty wears off, children require "finely tuned" programs, strong family support facilitates engagement, and children develop confidence and ownership."
"Intervention characteristics: increased therapy frequency with reduced caregiver involvement, Mitii™ "becomes therapy" and competes with other interests; convenience within family routine, lack of real-time feedback and technical issues, and therapist guidance is essential."
"Service provider characteristics: initial and ongoing therapist input, family-friendly therapy approach, and tailored strategies to sustain engagement."

Reference
Boyd, R.N., Mitchell, L.Ee, James, S.T., Ziviani, J., Sakzewski, L., Smith, A. et al. (2013). Move it to improve it (Mitii): Study protocol of a randomised controlled trial of a novel web-based multimodal training program for children and adolescents with cerebral palsy.
Link to full text: bmjopen.bmj.com/content/3/4/e002853.full