Towards a core set of gaming outcomes

Gaming supports youth with acquired brain injury? A pilot study

de Kloet, A. J., Berger, M. A., Verhoeven, I. M., van Stein Callenfels, K., & Vliet Vleiland, T. P. Brain Injury, 2012, May 25, 1 – 9, Early Online

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/22632604

Objective: Do children and young adults with brain injury benefit from Nintendo Wii sessions?

Method: Fifty 6 – 29 year olds with acquired brain injury were required to independently play at least two hours of Wii games weekly for 12 weeks. Participants were interviewed to help self-identify three limitations to activities of daily living; three Nintendo games were matched to individual’s interests and limitations via a protocol called “TherapyWii”, available at www.TherapyWii.nl

Participants were assessed before and after the intervention. The Children’s Assessment of Participation and Enjoyment (CAPE), the Amsterdam Neurological Tasks (ANT), Goal Attainment Scaling (GAS), Pediatric Quality-of-Life Inventory (PedsQL) were used.

Findings: Two thirds of the participants reported improvement towards their self-identified goals, mostly in gross motor performance and information processing. Significant changes were seen in the level of physical activity (CAPE), speed of processing information, attention, response inhibition, and visual-motor coordination (ANT). No difference was seen for PedsQL.

The authors make a call for a core set of outcomes for studies of virtual reality and interactive video gaming in patients with brain injury. This study “substantiates the potential benefits of gaming in patients with ABI”.

Review: Remote sensing and rehabilitation

Patel, S., Park, H., Bonato, P., Chan, L. & Rodgers, M.
A review of wearable sensors and systems with application in rehabilitation' Journal of NeuroEngineering and Rehabilitation 2012,9:21 doi:10.1186/1743-0003-9-21

Article available at www.jneuroengrehab.com/content/pdf/1743-0003-9-21.pdf

"...there exist technologies that hold great promise to expand the capabilities of the health care system, extending its range into the community, improving diagnostics and monitoring, and maximizing the independence and participation of individuals."

Three systems work together to permit this: sensors, wireless transmission of information and data analysis. Easily wearable devices (similar in size to a wristwatch) perform the functions of sensing some property (movement, pulse, respirations, temperature) and sending this information wirelessly to a networked device such as a smart phone. Once networked, the information is assessed by data analysing software. Short messages can be created to let the healthcare professional know of normal or abnormal activity. If necessary, alerts are sent out to family members or healthcare professionals.

This article discusses these technologies in detail and develops examples highlighting different applications of the key ‘enabling’ technologies, including home-based rehabilitation programs, an application that extends the reach and participation of healthcare recipients.

Reaching in games: Does it help in reality?

Research Study Low-cost motion interactive video games in home training for children with cerebral palsy: a kinematic evaluation

Sandlund, M., Grip, H., Häger, C., Domellöf, E. & Rönnqvist, L. Proceedings of International Conference on Virtual Rehabilitation 2011, June 27 – 29, 2011

Link to the abstract ieeexplore.ieee.org/xpl/articleDetails.jsp?reload=true&arnumber=5971854&contentType=Conference+Publications

Objective: In children with cerebral palsy, does active video game play result in a pre- vs. post- intervention change in arm movement quality?

Method: 15 children (6 to16 years) with cerebral palsy and limitations in upper extremity movement were assessed before and after 4 weeks of daily, (20 minutes or more) game playing at home on Sony’s PlayStation2 EyeToy©. Motion analysis pre- and post-intervention measured spatiotemporal parameters, smoothness and precision while the children were engaging in game play and in real reaching activities.

Findings: Overall, arm movement velocities were lower post-intervention. However the game play demanded rhythmic movements where quickness was not required. Children showed post-intervention “reduced variability in shoulder angles and shorter center of pressure excursions which indicate increased economic reaching strategies”. Smoothness of movements was significantly increased post-intervention when reaching in the higher-accuracy condition of real targets, but not for virtual ones. Precision in reaching for targets improved in the virtual condition but not when reaching for real targets at post-intervention. There is some evidence for increased motor performance after video game play.

“According to earlier kinematic studies of reaching movements in children with cerebral palsy, fast and straight movements are often associated with improved movement control. It is important to consider the nature of the task and the context in which movements are performed when selecting kinematic and interpreting parameters.”

American Speech-Language-Hearing Association blog

ASHAsphere is the official blog of the American Speech-Language-Hearing Association. ASHAsphere provides “the latest opinion and information related to audiology and speech-language pathology”. It is intended to feature posts including those written by communication sciences and disorders professionals and ASHA staff to encourage discussion. One offering is a list of ‘best’ SLP blogs.
blog.asha.org/2012/03/15/the-best-speech-language-pathologist-blogs-from-a-to-z/

The blogs needed to meet the following criteria: written by a speech-language pathologist or current graduate student, currently active and frequent, written about or sharing resources on speech language topics, directed to clinicians, parents and caregivers. Additionally, the blogs needed to appear professional and well edited with limited self-promotion.

Neither Sunny Hill nor ASHAsphere endorses any of these bloggers or the quality of the content, so your judgement is important in deciding how relevant and useful the blogs are.

Intensive Virtual Reality Program for Cerebral Palsy

Single subject research: An Intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy.
Brien, M. & Sveistrup, H. Pediatric Physical Therapy, Fall 2011 23(3) pp. 258–266 doi:10.1097/PEP.0b013e318227ca0f
Link to abstract: ncbi.nlm.nih.gov/pubmed/21829120

Link to Clinical Bottom Line: ncbi.nlm.nih.gov/pubmed/21829121

Objective: When adolescents with cerebral palsy receive short duration virtual reality therapy, does functional balance and mobility improve?

Method: A convenience sample of four male adolescents, classified as Gross Motor Function Classification System 1, were tested before, during and (one week and one month) after five days of 90 minute virtual reality, delivered in two sessions. The research method follows the American Academy for Cerebral Palsy and Developmental Medicine study design for single subjects, and meets the criteria for Level III evidence. Tests included the Community Balance and Mobility Scale, the 6-Minute Walk Test, the Timed Up and Down Stairs, and the GMFM Dimensions E.

Findings: Statistically significant improvements were maintained as measured on the Community Balance and Mobility Scale and the 6-Minute Walk Test. Timed Up and Down Stairs, and the GMFM Dimensions E showed no significant change.

Games for Health Journal

Games for Health Journal is the first peer-reviewed publication organized around healthcare games. It’s scope intends to include:

• Nutrition, weight management, and obesity
• Disease prevention, self-management, and adherence
• Cognitive behavior and mental and emotional health
• Clinical training, simulation, diagnosis, and treatment
• Rehabilitation and therapy
• The psychology of game design
• Social influence and peer groups in health games
• Health game sensors
• Mobile health games

Home page: online.liebertpub.com/toc/g4h/1/1
The journal is published by Mary Ann Liebert and their first issue is now available. It contains editorials, interviews, a roundtable discussion, a program profile, and original articles. All of the initial issue’s articles are open access. The table of contents can be accessed by email subscription or pushed to you by RSS. We anticipate this timely journal will help integrate research into clinical practice.

Measured family-supported Wii use

Case report
Berg, P., Becker, T., Martian, A., Primrose, K. D. & Wingen, J.
Motor control outcomes following Nintendo wii use by a child with down syndrome. Pediatric Physical Therapy 2012 Spring;42(1):78-84

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/22207475

The benefit of this study is that it is well documented and easily reproduced.

Objective: A child with Down Syndrome plays family-supported Wii for eight weeks, tested before and after to compare motor and self-efficacy outcomes.

Process: An 11-year-old boy, eldest of three siblings had minimal prior exposure to the Wii. Family members were encouraged to participate in the suite of four games the boy chose. He was encouraged to play for at least 20 minutes at a time, four times a week for eight weeks. Outcome measures assessed change in activity and body structure and function, and included measures of strength, agility, coordination, balance, visual perceptual skills and body composition. The tests administered were the Test of Visual Perceptual Skills (TVPS), Self-Perception Profile for Children (SPPC), Perceived Physical Ability Scale (PPSA), Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), Biodex BioSway Balance System, and the BodyStat Quadscan 4000.

Findings: The results show positive significant changes in BOT-2 scores for balance, manual dexterity, and running speed and dexterity across the 4 games. Postural stability and limits of stability were improved (undeclared significance) according to balance system data.