Wednesday, November 21, 2012

Gamer's Accessibility Holiday Guides

Ablegamers http://www.ablegamers.com evaluates game software, hardware and devices. Games are rated on scales for visual, auditory and movement requirements.

Ablegamers have released their annual “Holiday Gift guide for disabled gamers”. http://www.ablegamers.com/Disabled-Gamers-General-News/ablegamers-holiday-gift-guide-for-disabled-gamers-2012.html

DAGERS http://dagersystem.com/ evaluates games to characterize the accessibility of the video game software. The DAGERS system considers how limitations in auditory, visual and fine motor performance limit being able to advance through the game. DAGERS currently rates games as inaccessible, partly, thoroughly accessible or barrier free. DAGERS have also produced a “Holiday accessibility buying guide” http://dagersystem.com/index.php/features/45-featured/117-holiday-buying-guide

Monday, August 13, 2012

Games for Health Journal - Volume 1, Number 4

Table of Contents
http://online.liebertpub.com/toc/g4h/1/4

Original Articles

Acceptability of an Online Health Videogame to Improve Diet and Physical Activity in Elementary School Students: “Fitter Critters”; Kristin L. Schneider, John Ferrara, Bri Lance, Andrew Karetas, Susan Druker, Emily Panza, Barbara Olendzki, Victoria Andersen, and Lori Pbert
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0009

Improvements in Dynamic Balance Using an Adaptive Snowboard with the Nintendo Wii; Brendan Sullivan, Alexandra G. Harding, John Dingley, and Laura Z. Gras
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0006

Looking Similar Promotes Group Stability in a Game-Based Virtual Community, Catherine L. Lortie and Matthieu J. Guitton
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.00016

When Losing Means Winning: The Impact of Conflict in a Digital Game on Young Adults' Intentions to Get Protected from Cancer, Georges E. Khalil
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0017

A Comparison of Solo and Multiplayer Active Videogame Play in Children with Unilateral Cerebral Palsy; Jennifer Howcroft, Darcy Fehlings, Virginia Wright, Karl Zabjek, Jan Andrysek, and Elaine Biddiss
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0015

Clinical Briefs

A Qualitative Study to Inform the Development of a Videogame for Adolescent Human Immunodeficiency Virus Prevention; Kimberly Hieftje, Marjorie S. Rosenthal, Deepa R. Camenga, E. Jennifer Edelman, and Lynn E. Fiellin
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0025

Gamification and the Internet: Experts Expect Game Layers to Expand in the Future, with Positive and Negative Results; Janna Anderson and Lee Rainie
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0027

Using Alice 2.0 to Design Games for People with Stroke, Rachel Proffitt, Caitlin Kelleher, M. Carolyn Baum, and Jack Engsberg
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0029

Using Games to Improve Functioning in Children with Fetal Alcohol Spectrum Disorders, Jacqueline Pei and Kimberly Kerns
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0036

Importance of Patient Culture and Exergaming Design for Clinical Populations: A Case Series on Exercise Adherence in Soldiers with Depression; Greg M. Reger, Kevin M. Holloway, Joe Edwards, and Amanda Edwards-Stewart
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0014

Letter to the Editor
Games for Health: A Rookie’s Observations, Marc L. Demers

Interview
Using Health Games for Physical Therapy: An Interview with Ernie Medina, DrPH
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0028

Review
Fun and Games and Boredom; Richard Buday, Tom Baranowski, and Debbe Thompson
Link to abstract: //online.liebertpub.com/doi/abs/10.1089/g4h.2012.0026

Roundtable Discussion
Game Interventions for Autism Spectrum Disorder Moderator: Bill Ferguson, Participants: Cay Anderson-Hanley, Micah O. Mazurek, Sarah Parsons, and Zachary Warren

Program Profile
The Road Not Traveled: The Role of Telehealth in the New Era of Mobile Healthcare, Terry Duesterhoeft

Thursday, August 2, 2012

Video games for physical therapy

Single group experimental study

Active Video Game Play in Children with Cerebral Palsy: Potential for Physical Activity Promotion and Rehabilitation Therapies

Howcroft, J., Klejman, S., Fehlings, D., Wright, V., Zabjek, K., Andrysek, J., & Biddiss, E. Arch Phys Med Rehabil Vol 93, August 2012; pp.1448 – 1456

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/22571917

Objective: How much energy do children with cerebral palsy expend and how much enjoyment do they find in active video games (AVG)?

Method: 17 children with mean age 9.43 years, GMFCS level 1, played 4 active video games for 8 minutes.

Findings: Children were instrumented with portable cardiopulmonary and optical motion capture equipment, and single differential surface electrodes. Moderate levels of physical activity; 3.2 and 3.36 METs (metabolic equivalent for task) were recorded, as was a high level of enjoyment; 4.5 out of 5 on the PACES (physical activity enjoyment scale). This study elicited differences across dominant and hemiplegic limbs’ range of movements, angular velocity and acceleration.

“Children with mild levels of cerebral palsy can attain moderate levels of physical activity during AVG play with games that require full body movements”. AVGs have the benefits of promoting physical activities and securing higher engagement in physical rehabilitation therapies.

Tuesday, June 5, 2012

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”.

Monday, May 14, 2012

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.

Wednesday, April 25, 2012

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.”

Friday, April 13, 2012

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.

Monday, March 5, 2012

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.

Tuesday, February 21, 2012

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.

Monday, February 13, 2012

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.

Monday, January 30, 2012

Voice access video game


Proof of Concept

King SN, Davis L, Lehman JJ, Ruddy BH. A Model for Treating Voice Disorders in School-Age Children within a Video Gaming Environment. J Voice. 2011 Dec 29. [Epub ahead of print]

Link to abstract:
www.ncbi.nlm.nih.gov/pubmed/22209055


Objective: The authors altered a voice-themed video game to make it voice activated, for use at home with school-age children with hyperfunctional voice disorders.

Video games can provide compelling ‘homework’ for children undergoing voice therapy, and may contribute to generalizing the learned behaviours to the home. The authors modified the video game Opera Slinger, an interactive game that requires players to score points by matching sound pitch and volume.

Process: The article is written about three cycles of trying and modifying the video game: firstly to adapt the game to voice activation, then to increase playability for children and adults. The third iteration was a case study of a 9 year old boy with the target condition. He received weekly one hour traditional speech therapy for two weeks before playing the video game at home for two weeks.

Findings: The voice-activated game was found to be functional, playable, and highly engaging. The players produced vocalizations that may be beneficial therapy outcomes, but video play and traditional therapy outcomes were not compared here. “Voice video games may contribute to the success of voice therapy by helping the generalization that needs to occur from the therapy session to home life”.

Friday, January 20, 2012

CP and Video games: Systematic Review


Sandlund M, McDonough S, Häger-Ross C.
Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review.
Dev Med Child Neurol. 2009 Mar;51(3):173-9

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/19191834

This review is notable because of the focus on cerebral palsy. The researchers used the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) levels of evidence guidelines, and many of the articles used the Bruninks-Oseretsky Test for Motor Efficiency (BOTMP) as an outcome measure.

Objective:
A systematic review of evidence using interactive computer play for motor rehabilitation for children. Therapeutic active video gaming is defined here as “play with virtual objects in a computer-generated environment” (including mouse and keyboard interaction) for improved motor control and motor learning as a primary or secondary outcome.

Method:
Eleven databases were searched for literature from 1995 to May 2008.
Some studies used the Gross Motor Functioning Classification System and included children with level IV and V disabilities. AACPDM levels of evidence guidelines were used to assess and categorize each (quantitative) research design and methodology of the 16 included articles. Of them, three were randomized control trials (level II), four were level III (cohort studies), six were level IV (case series) and three were level V (case reports).

Findings:
Two of the three level II and one level III study found no significant improvements. Several of the level IV, cohort studies used the BOTMP (subtest 5:6), the Peabody Developmental Motor Scale, or the Quality of Upper Extremities Skills Test. One study used the Canadian Occupational Performance Model.

In summary, “nine studies investigated movement quality; two showed no significant improvements and seven, mostly low-level studies, reported positive findings”, and a call for “further and more convincing research”.

Selected References

AACPDM levels of evidence

Butler C. AACPDM methodology to develop systematic reviews
of treatment interventions 1999; (Revision 1.1, 2004). Available
from URL: http://www.aacpdm.org/resources/systematicReviews
Methodology.pdf.

Studies using BOTMP assessing motor quality

Eliasson AC, Rosblad B, Hager-Ross C. Control of reaching
movements in 6-year-old prematurely born children with motor
problems - an intervention study. Adv Physiother 2003; 5: 33–48.

Petrofsky JS, Petrofsky D. A simple device to assess and train
motor coordination. J Med Eng Technol 2004; 28: 67–73.

Bartscherer ML, Dole RL. InteractiveMetronome training for a
9-year-old boy with attention and motor coordination difficulties.
Physiother Theory Pract 2005; 21: 257–69.

Krichevets AN, Sirotkina EB, Yevsevicheva IV, Zeldin LM. Computer
games as a means of movement rehabilitation. Disabil Rehabil
1995; 17: 100–5.

Reid DT. The use of virtual reality to improve upper-extremity
efficiency skills in children with cerebral palsy: a pilot study.
Technol Disabil 2002; 14: 53–61.

Reid D, Campbell K. The use of virtual reality with children with
cerebral palsy: a pilot randomized trial. Ther Recreation J 2006;
40: 255–68.

Chen YP, Kang LJ, Chuang TY, et al. Use of virtual reality to
improve upper-extremity control in children with cerebral palsy:
a single-subject design. Phys Ther 2007; 87: 1441–57.

Shaffer RJ, Jacokes LE, Cassily JF, Greenspan SI, Tuchman RF,
Stemmer PJ Jr. Effect of interactive metronome training on
children with ADHD. Am J Occup Ther 2001; 55: 155–62.

You SH, Jang SH, Kim YH, Kwon YH, Barrow I, Hallett M.
Cortical reorganization induced by virtual reality therapy in a
child with hemiparetic cerebral palsy. Dev Med Child Neurol 2005;
47: 628–35.

Study using Peabody Developmental Motor Scale

Chen YP, Kang LJ, Chuang TY, et al. Use of virtual reality to
improve upper-extremity control in children with cerebral palsy:
a single-subject design. Phys Ther 2007; 87: 1441–57.

Study using Quality of Upper Extremities Skills Test

Reid DT. The use of virtual reality to improve upper-extremity
efficiency skills in children with cerebral palsy: a pilot study.
Technol Disabil 2002; 14: 53–61.

Friday, January 13, 2012

Realistic and adapted movements in play


Research article
Berry T, Howcroft J, Klejman S, Fehlings D, Wright V, Biddiss, E. (2011)
Variations in Movement Patterns during Active Video Game Play in Children with Cerebral Palsy. J Bioengineer & Biomedical Sci S1:001. doi:10.4172/2155-9538. S1-001

Link to article: www.omicsonline.org/2155-9538/2155-9538-S1-001.php

Objective:
Low-cost active video games (AVG) such as Ninteno Wii® are popular physical therapy tools for children with cerebral palsy. While not specifically designed to match rehabilitation goals, various studies have found clinically-relevant improvements in functional motor ability. The games reward realistic movements involving more proximal joints and bilateral upper extremity use but play can also proceed with adapted, more conservative movements of distal joints.

This study investigates play styles of three Nintendo Wii® games; boxing, bowling and tennis for realistic movement patterns related to the real-world activity and variations of adapted movement patterns.

Method:
A purposive sample of 16 children with GMFCS level I hemi- or diplegic cerebral palsy played each of three Wii® games. One minute of play was captured and analyzed as realistic or adapted movement.

Findings:
Game play was either realistic or adapted depending on the game and the child. Wii® bowling was performed more realistically, tennis and boxing less so. Children adapted their play style to succeed at the games, favouring their dominant arm in bilateral activities. Therapists need to encourage children to play realistically to derive the most therapeutic benefits from video game playing.

Friday, January 6, 2012

Virtual Reality: Cochrane Review



Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database of
Systematic Reviews
2011, Issue 9. Art. No.: CD008349. DOI: 10.1002/14651858.CD008349.pub2.

Link to abstract: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008349.pub2/abstract

Objective:
To evaluate the effects of virtual reality (VR) and interactive video gaming on upper limb, lower limb and global motor function after stroke.

Method: The authors searched for randomized trials (RT) and quasi-randomized trials for a population of adults that had had strokes, and that met their definition: “an advanced form of human-computer interface that allows the user to "interact’ with and become ’immersed’ in a computer-generated environment in a naturalistic fashion". 19 trials that involved 565 participants met the criteria. These studies largely do not evaluate commercial gaming consoles such as Wii.

Findings:
Significant results imply limited evidence for the benefits of virtual reality over conventional therapies specifically for arm function (7 studies) and for activities of daily living (3 studies). The properties of VR which are effective and how long the results last are not yet conclusively known.