Game play at home, is it effective?

RCT

Impact of multi-modal web-based rehabilitation on occupational performance and upper limb outcomes: pilot randomized trial in children with cerebral palsy

Sakzewski L, Lewis MJ, McKinley L, Ziviani J & Boyd RN

Developmental Medicine and Child Neurology, 2016 May 27 Epub

DOI: 10.1111/dmcn.13157

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/27230022

Objective: For children with acquired brain injury, is a program of web-based and home-delivered rehabilitation better than the wait list treatment for occupational performance and upper limb measures?

Procedure: 58 9 – 14 year old children were matched using their age, Manual Abilities Classification Scale, full-scale IQ and other demographic and physical characteristics. The intervention group was encouraged to use the Mitii game system 30 minutes daily, 6 days per week for 20 weeks. The control group was wait-listed to receive the intervention. Mitii is based on Microsoft Kinect and comprises visual-perceptual, cognitive, upper limb and gross motor activities, accessed by internet.

Findings: Game play averaged less than an hour per week, substantially less than the recommended 3 hours weekly. “A home-delivered, multi-modal web-based rehabilitation programme did not achieve the anticipated dose of therapy for children with acquired brain injury… Results highlight issues around feasibility and acceptability of a… home-delivered intervention.”

A Survey of Low-cost Virtual Reality Rehab Game Properties

Survey

Usability evaluation of low-cost virtual reality hand and arm rehabilitation games

Seo NJ, Kumar JA, Hur P, Crocher V, Motawar B & Lakshminarayanan K

Journal of Rehabilitation Research and Development, 53(23), 2016

DOI: http://dx.doi.org/10.1682/JRRD.2015.03.0045

Link to content: hurgroup.net/sub/external/data/papers/Seo_2016_jrrd_usability.pdf

Objective: to survey user expectations of low-cost virtual reality rehabilitation games (VRRG), and to determine factors that will enhance usability.

Process: 10 community-dwelling adults with CVA (ages 43 – 73 years; time post-stroke 3 – 13 years) were surveyed before and after exposure to low-cost VRRG. Microsoft Kinect and a P5 glove were used as low-cost interfaces for the virtual games.

Findings: The pre-game survey of the virtual games rated ease of understanding, ease of use and clinical feedback most highly. After exposure to the games, subjects rated motivation as the best aspect of the VRRG, and rated clinical effectiveness and clinical evidence as most in need of improvement, by means of a “House of Quality” matrix. en.wikipedia.org/wiki/House_of_Quality

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.