Amadeo robot for kids rehab

Hand Robotic Therapy in Children with Hemiparesis

Pilot Study

Bishop L, Gordon AM & Kim H

American Journal of Physical Medicine and Rehabilitation 2016;00,00-00

DOI: 10.1097/PHM.0000000000000537

Objective: In a sample of children with hemiparetic upper extremity cerebral palsy, is the Amadeo Hand Robot System feasible for retraining grasp and release?
Amadeo Hand Robot System

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/27386804

Method: 12 participants, 6 – 17 years old with upper extremity hemiparesis were measured initially, after a 6 week pre-intervention stage and following 6 weeks of three- hour long sessions. The Assisting Hand Assessment was chosen as the primary measure.

Findings: Participants tolerated the Amadeo, and the Assisting Hand Assessment showed significant change pre- to post-test. The Jebson-Taylor Test of Hand Function, the Upper Extremity Fugl-Meyer and the Quality of Upper Skills Test all revealed non-significant positive change; and the Pediatric Evaluation of Disability Inventory showed no change.

Freely motivated game play

Single group

Using Free Internet Videogames in Upper Extremity Motor Training for Children with Cerebral Palsy

Servik M, Eklund E, Mensch A, Forman M, Standeven J & Engsberg J

Behavioral Sciences, 2016 6:10

DOI: 10:3390/bs6020010

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/27338485

Objectives: Motion-based virtual reality rehabilitation can be an engaging and motivating form of therapy. “Tedium and lack of motivation are substantial barriers to performance improvements.” In children with cerebral palsy, is using free internet games feasible and motivating enough to encourage participation in movement therapy and increase function?

Process: Four 8-to-17 year old children with mild to moderate upper extremity limitations played 26 games over 12 weeks. The games were freely accessed internet games adapted for the Kinect controller with free Flexible Action and Articulated Skeleton Toolkit (FAAST) software. “Internet games eliminate the high cost of game development, permit games to be paired with an individual’s interests and allow for changing of games to maintain novelty. Matching the interest of the child makes the therapy increasingly client-centered and motivating.”

Outcomes:All children “progressed through the pre-set 12 week plan”, thus demonstrating feasibility. Children averaged nearly 900 repetitions per training session, and 2 of the participants showed improved range of motion.
The participants demonstrated motivation with an aggregated score of 46 of 49 possible points on the Intrinsic Motivation Inventory (IMI).

Rating game play

Single group

Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play

Levac D, Nawrotek J, Deschenes E, Giguere T, Serafin J, Bilodeau M & Sveistrup H

JMIR Serious Games 2016;4(1):e9
URL: http://games.jmir.org/2016/1/e9/
doi:10.2196/games.5528
PMID:27251029

Objective: to "develop and evaluate the feasibility and reliability" of a measure for separating and quantifying the movements children make during VR therapy. The Movement Rating Instrument for Virtual Reality Video Game Play (MRI-VRGP) was applied to IREX and Kinect game systems.

Process: Movements were parsed into items and after several iterations, the selected items were trialled. Reviewers watched videotapes of subjects to rate upper extremity movements (unilateral or bilateral; close or far) and lower extremity movements within or without the base of support. They rated the activities as movements on a spectrum of easy to difficult and rated their confidence in making the rating.

Outcome: Within-rater reliability was higher (good) than inter-rater reliability (moderate). Finer movements were harder to rate consistently within therapists. Inter-rater reliability varied widely, and upper extremity fine (close) movements were rated less consistently.
More "item definition clarification and further psychometric property evaluation" will allow therapists to sort VR games by the type and frequency of their body movements.

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.”