Test of Playfulness with CP Kids

Single group

Playfulness in Children with Limited Motor Abilities when using a Robot

Rios AM, Adams K, Magill-Evans J, & Cook A

Physical & Occupational Therapy in Pediatrics (IPOP)

DOI: 10.3109/01942638.2015.1076559

Link to full text:https://era.library.ualberta.ca/files/8g84mq002/Rios%202016%20IPOP.pdf

Objective: For children with limited motor skills, how does robot play change playfulness?

Process: Four children with GMFCS levels IV or V played with Lego robot for 15 minutes twice a week for 14 weeks. The Test of Playfulness was applied at baseline, during intervention and at follow-up.

Findings: "Test of Playfulness scores of the four children with cerebral palsy significantly increased during the intervention compared with baseline."

Sensorimotor Robot Therapy: the Anklebot

Pilot study

Pediatric robotic rehabilitation: Current knowledge and future trends in treating children with sensorimotor impairments

Michmizos KP & Krebs HI

Neurorehabilitation (pre-press) DOI: 10.3233/NRE-171458

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/28505989

Objective: "As long as motor learning remains the major working hypothesis for sensorimotor rehabilitation, a well-designed robotic therapy… should follow the principles of motor learning, namely massed practice, cognitive engagement and functional relevance." Sensorimotor therapy is identified as three elements: discrete and rhythmic movements, and interaction with the environment.

Process: The application of the Pedi-Anklebot 'robot' is to target ankle movements and functional walking for children with motor disabilities. The authors use the games designed to treat reduced speed, strength, accuracy, co-ordination; and cognitive or perceptual difficulties. To provide comprehensive sensorimotor therapy, practice included discrete sub movements, rhythmic oscillations and practice with ground contact.

Conclusion: "To fully harness the therapeutic power of adaptation, we need to continue our research on the special characteristics of [the] sensorimotor control… on the differences between rhythmic and discrete movements, as well as mechanical impedance training."

Robots Learn to Play

Review

Robots Learn to Play: Robots Emerging Role in Pediatric Therapy

Howard AM

Proceedings of the 26th International Florida Artificial Intelligence Research Society Conference, 2013

Link to full text: www.aaai.org/ocs/index.php/FLAIRS/FLAIRS13/paper/view/5838/6033

Objective: Therapy for children includes play; at best, robots will express this quality as they are brought into the pediatric setting. Three types of robots are discussed in this article: robots (smart toys) that are operated by alternative inputs such as the smart phone, robotic orthoses that include an element of play, and autonomous robots that interact through play. In each case, examples are given.

Discussion:

1. ‘Robot’ or smart toys are considered here as toys which children can play with using an alternative means of manipulation. True smart toys possess some awareness of their surroundings and additionally require some degree of autonomy to meet the definition of robot.
2. Robotic orthoses or exoskeletons guide, limit and assist in motor movements of upper and lower extremities. Play can be incorporated into this therapy.
3. Autonomous robot toys which engage children with intentional, purposeful imitation play. "While typically developing children possess the ability to imitate others from birth, children with pervasive developmental disorders, such as autism, demonstrate significant difficulty in object and motor imitation. Imitation skills are thought to be closely related to early language and social abilities."

Conclusion:"It seems natural then that this research thread (autonomous robotic playmates capable of engaging children in shared manipulation-based play), along with … quantitative results… emerges as the next step in the domain of robots for pediatric therapy."

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: dx.doi.org/10.1145/3064663.3064664"

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."

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:https://arxiv.org/abs/1705.05142

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.”

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

DOI: doi.org/10.5014/ajot.2017.024976

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.”

Wearable Tech for Rehabilitation: Interactive Wearable Systems

Survey

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.