Tuesday, December 14, 2010

Gaming for Therapists


Exergaming on the Lightspace Playwall
Image from: http://www.exergamefitness.com/


As the realm of virtual reality and its application to rehabilitation develops, new language evolves, too.
Exergaming applies to videogames that require movement and may provide exercise. The means of interaction is not a mouse, keyboard or joystick, but some thing that needs greater weight shifting, body or limb movement.
en.wikipedia.org/wiki/Exergaming

Here’s an article that reviews current applications of virtual reality for rehabilitation, and explores ‘exergaming’ as a way to increase energy expenditure.

http://www.google.ca/url?sa=t&source=web&cd=9&ved=0CGAQFjAI&url=http%3A%2F%2Fplattsburghcas1.com%2FSpectrum%2FJournal%2520of%2520Diabetes%2520Science%2520and%2520Technology%2520-%2520Dr.%2520Rizzo%2C%2520in%2520press.pdf&ei=6tkITdvINIb0tgPc6a2ZDg&usg=AFQjCNE5gnEkDsJhcBNWpaVQcSyJoxTiug

Monday, November 29, 2010

In Cybertherapy, Avatars Assist With Healing

This readable New York Times article discusses the uses of virtual humans in healthcare.
www.nytimes.com/2010/11/23/science/23avatar.html?_r=2&ref=science


Not Quite Reality: Stéphane Bouchard, of University of Quebec in Outaouais, reacting with his very similar avatar
Image by: Dave Chan for the New York Times.

Friday, November 26, 2010

Virtual reality research synthesis




Virtual Reality in Pediatric Neurorehabilitation: Attention Deficit Hyperactivity Disorder, Autism and Cerebral Palsy
Michelle Wang and Denise Reid  Virtual Reality and Neurorehabilitation Laboratory, Department of Rehabilitation Science,
University of Toronto, Toronto, Ont., Canada
Neuroepidemiology 2011;36:2–18

The objective of this review is to provide a synthesis on research for key impairments in three populations. The review is organized by three types of VR, not by the populations receiving treatment, and hopes, in the end, to prompt interest in discussion and further research.  This paper is very useful in that it explores the available literature on this area.

Virtual reality (VR), broadly defined by Wang and Reid, is the action-based response to an event in an artificial environment. This describes almost any computer interface except voice-activation. This definition includes computer mousing, touch screen phones and excludes biofeedback. Popularly accepted as VR activities are gesture-based interactive games like Wii and  Eyetoy. Touch-based interactions include computer mousing and using touchscreens, but at best, haptic VR involves wearing a glove that provides pressure feedback or resistance to movement in certain directions.
 
The authors further explain VR as interaction with an artificial environment in a way that hopes to maximize immersion into the experience. In therapeutic settings, control over the parameters of the VR system permit the therapist to shape the program to create an achievable, challenging activity that is safe and, at best, generalizable to the real world.

This descriptive review is based on 20 peer-reviewed articles published since 2000 where VR is used as a treatment for the primary deficit of ADHD, autism or cerebral palsy. The authors discuss the division of VR into different modalities: ‘focused’ or biofeedback, gesture- and touch-based feedback.

Biofeedback or ‘focused’ feedback is discussed extensively in this article, identified as a kind of VR. Three of the four ADHD articles fall into this category. VR serves as a means of feedback, but it is not action-based or immersive.

Gestures or motion as the controller of activities in an artificial world we can see is a compelling VR application, reviewed through seven studies using IREX, Wii or Eyetoy in the cerebral palsy population. Measures used as performance indicators for upper extremity movement include: Melbourne assessment of unilateral upper extremity function, Quality of upper extremities skills test, one item on one subtest of the Bruninks-Osertesky test of motor proficiency, Modified pediatric motor activity log. Measures used for lower extremities are: Sitting assessment for children with neuoromoter disfunction, Gross motor function measure, SWOC, Postural Scale Analyzer, Test of Visual Perceptual Skills, Fugl-Meyer assessment, and functional MRI, and the Standardized walking obstacle course.

Touch-mediated activity, or hand action controllers, can vary from computer mouse use, through touchscreens to haptic gloves that give sensory feedback. Two studies use touchscreens (slightly more interactive than a computer mouse) with autistic children, and three use sensor gloves (without feedback) looking at the upper extremity in the cerebral palsy population.

Cumulatively, no articles stand out with strong evidence for the use of VR over traditional therapies. The authors hope to encourage further use and study of VR in clinical settings.  

Friday, November 12, 2010

Wireless sensors for physical therapy

Michigan researchers develop rfid-based sensors to measure physical activity
www.rfidjournal.com/article/print/7884 See image on right.
Therapy uses of radio-frequency identification (rfid) or wireless sensors include detecting information such as body movements like sitting activities or movement around a room. The sensors can store this information or relay it to some other equipment. Think of the handheld component of the Nintendo Wii as a wireless sensor.
Therapy applications could include tracking location and distance of walkers, monitoring range and frequency of upper extremity exercises, and providing feedback to the patients, as the interactive computer games do now. Sensors can be specific to therapy uses, and have been created to provide a quantitative way to measure physical therapy activity and activities of daily living.
Search for emerging evidence for therapy and acceleration and adl

scholar.google.ca/scholar?hl=en&q=rfid+adl+acceleration
Search for emerging evidence for rfid and adl

scholar.google.ca/scholar?hl=en&q=rfid+adl

Friday, November 5, 2010

Able-X augmented reality rehabilitation system



Researchers in New Zealand have developed an augmented reality device specifically for rehabilitation. The Able-X is a bilateral handlebar game controller and custom video games. When tested by therapists and researchers at the Otago School of Medicine, the Able-X shows significantly increased upper extremity functioning (fine movement and mobility) using the Fugl-Meyer Assessment. The software allows therapists to monitor progress by showing a "heat map" of the areas of most activity.

The video clip www.im-able.com/information demonstrates some of the capabilities of Able-X.


Newspaper article www.nzherald.co.nz/science/news/article.cfm?c_id=82&objectid=10684426

Able – x product home page
www.im-able.com/

TVnews video
tvnz.co.nz/technology-news/nz-made-console-helps-stroke-victims-3800973/video

Able-X Brochure www.im-able.com/sites/www.im-able.com/files/docs/Able-X%20brochure%204.pdf

Monday, November 1, 2010

Multi-touch screens for rehabilitation

The use of touch screens is advancing into rehabilitation. The touch screen surface provides a way to interact with a computer and that makes it possible to play with virtual objects. A particular benefit for rehabilitation therapists is that they can grade the activity.

An Edmonton, Alberta team of Glenrose Rehabilitation Hospital researchers, technologists and occupational therapists pooled their talents with University of Alberta computing science academic staff and students over the past year to create a touch screen table top specifically for upper extremity rehabilitation.

Read more: www.albertahealthservices.ca/2957.asp

Search for emerging evidence: www.hubmed.org/search.cgi?q=multi-touch+rehabilitation

Search Google: www.google.ca/search?hl=en&q=multi+touch+rehabilitation

Other examples:Multi-Touch Interaction Research at New York University cs.nyu.edu/~jhan/ftirtouch/

Perceptive pixel.com www.perceptivepixel.com/

Research evidence abstracts:Using a multi-touch tabletop for upper extremity motor rehabilitation
portal.acm.org/citation.cfm?id=1738869&dl=GUIDE&coll=GUIDE&CFID=111201097&CFTOKEN=35687580#abstract

Analysis of Multitouch Technology for Neurorehabilitation
iactor.eu/downloads/JCR_2(3).pdf

Friday, October 8, 2010

Capstone student virtual rehabilitation presentations

The annual Capstone conference showcases research by graduating occupational therapy students of the University of British Columbia’s Department of Occupational Science and Occupational Therapy. Research is conducted in the year leading up to the conference and is as diverse as the occupational therapy itself. Two student groups researched virtual rehabilitation topics in the 2009 – 10 year.

Is Nintendo Wii Feasible and Usable for Pediatric ABI Rehabilitation?

Students: Shannon Rolph, Tristan Thomas
Supervisor: Dr. Tal Jarus, S. Jagday, Dr. Debbie Rand


www.capstoneconference.ca/index.php?option=com_projects&view=project&id=10&Itemid=5



Rationale: The functional ability of children with acquired brain injury (ABI) is often limited, and as such clinicians are always exploring new tools for rehabilitation with this population. The Nintendo Wii (Wii) is an inexpensive, accessible and fun gaming system that is emerging as a popular tool in rehabilitation. To this point, some research has examined outcomes using the Wii as a rehabilitation tool, however at this point the fundamental feasibility and usability of the Wii for this population has not been determined.

Objectives: 1) To determine the feasibility and usability of the Wii for children with ABI; 2) to characterize the children’s experience while using the Wii; 3) To compare the experience of children with ABI to the experience of healthy children.

Methods: Fifteen children with ABI and fifteen healthy children, ages six to nineteen, will be recruited from a rehabilitation centre and the community, respectively. Participants will experience three Wii games. Feasibility will be determined based on participants’ game performance. For children with ABI, their motor and cognitive abilities will be measured using a battery of reliable and valid assessments. This information will be correlated with game performance to determine feasibility based on motor and cognitive abilities for children with ABI. Usability will be determined based on the System Usability Scale, administered after participants operate the Wii. The Short Feedback Questionnaire-CHILD and the Borg Scale of Perceived Exertion will obtain participants’ feedback regarding their Wii experiences. Accelerometres will measure the movement elicited while playing the Wii. This data will be compared between healthy and ABI groups.

Clinical Implications: The study’s findings will allow clinicians to determine if the Wii is a feasible and usable rehabilitation tool for children with ABI, based on their client’s cognitive and motor abilities.

EyeToy vs. Wii

Students: Shereen Ens, Ashea Neil, Bobbi Pelletier

Supervisors: Dr. Tal Jarus, Dr. Debbie Rand

www.capstoneconference.ca/index.php?option=com_projects&view=project&id=7&Itemid=5

Introduction: Virtual reality (VR) is an emerging trend in stroke rehabilitation. Research shows virtual reality gaming consoles in stroke intervention can increase motivation, enjoyment and movement during exercise, while giving a heightened sense of presence. To date, there is little research on the amount and intensity of movement elicited using these systems during rehabilitation.

Objectives: Within healthy and stroke populations 1) Compare amount and intensity of movement elicited from both hands while playing Nintendo Wii versus Sony Playstation 2 EyeToy; 2) compare experiences of both groups using both systems; and 3) compare usability of both systems.

Methods: A cross-sectional design was taken. Participants included ten adults who had experienced stroke at least six weeks prior to study and were medically stable, and a convenience sample of ten healthy adults. Participants experienced two games from each console. Amount and intensity of movement was measured using accelerometers on both wrists, while the virtual experience and usability was determined with questionnaires.

Results: No significant differences were found between the systems usability and experience; however stroke participants rated EyeToy easier to use (44.40±5.06 vs. 39.30±6.93). EyeToy elicited significantly greater activity count than Wii among the healthy participants (p=0.028) and significantly greater movement intensity in both the stroke (p=0.005) and healthy (p =0.005) groups.

Conclusion: Both VR systems rated high for usability, enjoyment and satisfaction highlighting their suitability for a range of abilities in stroke rehabilitation. EyeToy as a rehabilitation tool provides increased movement and movement intensity.

Tuesday, September 14, 2010

Wii are not alone: games with motion control interfaces

Although Wii has captured the early market for low cost interactive games, other game systems are coming. Microsoft’s Xbox Kinect allows full body controller-free gaming, due to launch in November. Sony PS3 Move is played with a handheld motion controller and is due to launch on September 17.

Pc world: Playstation Move vs. Kinect
www.pcworld.com/article/199305/kinect_for_xbox_360_vs_playstation_move.html

Msnbc: Xbox (Kinect) vs. Wii vs. PS3 (Move)
www.msnbc.msn.com/id/37911691/ns/technology_and_science-games/

Pc mag: Kinect vs. Move vs. Wii
www.pcworld.idg.com.au/article/356395/kinect_vs_move_vs_wii_/

XBox Kinect official site
www.xbox.com/en-CA/kinect

Wikipedia: Kinect
en.wikipedia.org/wiki/Kinect

CBC article: Kinect
www.cbc.ca/technology/story/2010/06/14/microsoft-xbox-kinect-video-games.html

Engadget: Kinect game descriptions
www.engadget.com/2010/06/13/microsoft-kinect-gets-official/

Cnet: Kinect review
reviews.cnet.com/8301-21539_7-20007681-10391702.html

Sony PS3 Move official site
us.playstation.com/ps3/playstation-move/

Wikipedia: Move
en.wikipedia.org/wiki/PlayStation_Move

Cnet: Move
news.cnet.com/8301-13772_3-10467340-52.html

Medgadget: Dr. Richard Marks, inventor of Sony Eyetoy, talks about Move
medgadget.com/archives/2010/06/games_for_health_2010_interview_with_ps3_move_creator_dr_richard_marks.html

Pc world: Move
www.pcworld.com/article/203652/sonys_ps3_move_bundle_costs_more_and_less_than_you_think.html

Search Youtube for videos
www.youtube.com/

Sony PS3 Move
www.youtube.com/results?search_query=sony+move&aq=f

Xbox Kinect
www.youtube.com/results?search_query=kinect&aq=f

Wii
www.youtube.com/results?search_query=wii&aq=f

Thursday, September 9, 2010

Tele-occupational therapy

Some information categorized under the moniker tele-occupational therapy. Perhaps it is a Canadian term as all the following links are from the Canadian Association of Occupational Therapists (CAOT).
The periodical "OT Now" has a regular section on tele-occupational therapy. New issues are not open to the public, but older articles can be viewed. Here's a 2008 article by Jonathan Halton "Virtual rehabilitation with video games: A new frontier for occupational therapy".
www.caot.ca/otnow/jan%2008/virtual.pdf
OT Now current issue (requires subscription)
www.caot.ca/default.asp?pageid=2388
OT works.ca "Canada's OT resource site" What is tele-occupational therapy?
www.otworks.ca/otworks_page.asp?pageID=749
CAOT Tele-occupational therapy Position statement
www.caot.ca/default.asp?pageid=187

Wednesday, September 8, 2010

Virtual reality for children with physical impairments

An update on the use of virtual reality technology to improve movement in children with physical impairments,
Danielle Levac and Cheryl Missiuna
Published and distributed by CanChild Centre for Childhood Disability Research in ‘Keeping Currents’, 2009

www.canchild.ca/en/canchildresources/VirtualRealityTechnology.asp

The potential role of virtual reality technology in pediatric rehabilitation is promising; however, this is a developing field and early evidence is inconclusive (Sandlund et al., 2009). New developments in rehabilitation-specific and commercially-available technology imply that opportunities to integrate virtual reality technology within rehabilitation will continue to increase. Research is required to explore the effectiveness of these interventions, their application in different populations of children and youth, and their potential effectiveness to promote participation in daily functional activities.


'Keeping Currents' are based on hot issues in children's rehabilitation to provide an objective review of the issue and to move the field of childhood disability forward. 'Keeping Currents' present a summary of research evidence from the literature and may include opinions from experts in the field.

Friday, September 3, 2010

Practice Guidelines

These links document how thought about telerehabilitation is currently organized. With time, more practice guidelines will be produced. The American Telemedicine Association is working on telerehabilitation practice guidelines currently, and that document will be linked from here when completed.

ATA Telemedicine Standards and Guidelines
www.americantelemed.org/i4a/pages/index.cfm?pageid=3311

Canadian Association of Speech-Language Pathologists and Audiologists: Position Paper
www.caslpa.ca/PDF/position%20papers/telepractice.pdf

Canadian Association of Occupational Therapists: Position Statement
www.caot.ca/pdfs/telehealthPS.pdf

American Speech-Language-Hearing Association: Professional issues in Telepractice
www.asha.org/docs/html/PI2010-00315.html

American Physical Therapy Association: Definitions
www.apta.org/AM/Template.cfm?Section=Policies_and_Bylaws1&CONTENTID=67459&TEMPLATE=/CM/ContentDisplay.cfm

American Telemedicine Association: Telemental health practice guidelines
www.atmeda.org/files/public/standards/PracticeGuidelinesforVideoconferencing-Based%20TelementalHealth.pdf

Thursday, August 19, 2010

Internet searches for telerehabilitation

Telerehabilitation: using videoconferencing or internet video to provide rehabilitation. Broader search terms include telemedicine, telehealth and telestroke.

Pubmed

The following searches run in Hubmed, the friendlier younger sibling of Pubmed. The search looks for all the articles indexed in Pubmed, and it updates when you use it, so the results are current. Results are organized by date. Through the results you can link to abstracts of the articles, and some full text.

Telerehabilitation and…

Articles published in the last year
www.hubmed.org/search.cgi?q=%28telerehabilitation%29+AND+%28%22last+1+year%22%5BPDat%5D%29&x=6&y=7

Physical
www.hubmed.org/search.cgi?q=telerehabilitation+physical&sort=date

Brain injury or cerebral palsy
www.hubmed.org/search.cgi?q=%28telehealth+OR+telerehabilitation+OR+videoconference%29+AND+%28brain+OR+cerebral%29&x=12&y=9

Children
http://www.hubmed.org/search.cgi?q=telerehabilitation+AND+%28child+OR+pediatric%29&x=13&y=8

Speech
http://www.hubmed.org/search.cgi?q=telerehabilitation+and+speech

Teleassessment
http://www.hubmed.org/search.cgi?q=%28teleassessment%29+OR+%28videoconference+AND+physical+AND+assessment%29&x=7&y=7


Other searches


Google Scholar for articles published in 2009 to date.
=http://scholar.google.ca/scholar?as_q=telerehabilitation&num=10&btnG=Search+Scholar
&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=
&as_ylo=2009&as_yhi=2010&as_sdt=1.&as_sdts=5&hl=en&


Cinahl (nursing and allied health journals) Telerehabilitation
web.ebscohost.com/ehost/resultsadvanced?vid=3&hid=13&sid=dc9cd71e-b9eb-4029-ac97-f5aefae97e49%40sessionmgr4&bquery=(AB+(telerehabilitation))&bdata=JmRiPWM4aCZ0eXBlPTEmc2l0ZT1laG9zdC1saXZl

Wikipedia definition:
en.wikipedia.org/wiki/Telerehabilitation

Monday, August 16, 2010

Computer games in rehabilitation

With the availability of low-cost motion sensing hardware has come the opportunity for games that target segments of the market, such as rehabilitation users. An example is the development of Nintendo Wii http://www.nintendo.com/wii . Dr. Glenna Dowling of University of California at San Francisco has partnered with Red Hill studios http://redhillstudios.com/ to develop games specifically for individuals with Parkinson's disease and for children with cerebral palsy. This partnership resulted from two grants provided by the National Institutes for Health http://www.nih.gov/ for 1.1 million dollars. Read more... http://news.ucsf.edu/releases/red-hill-studios-ucsf-partnership-awarded-1.1-million-for-health-based-comp/