Add a Sensor = + Data

Pilot study

Kinecting the Moves: The kinematic potential of rehabilitation-specific gaming to inform treatment for hemiplegia

Glegg SMN, Hung CT, Valdés BA, Kim BDG, & Van der Loos HFM

International journal of child health and human development 9(3):351-360 · September 2016

Link to abstract: https://www.researchgate.net/publication/309737850_Kinecting_the_Moves_The_kinematic_potential_of_rehabilitation-specific_gaming_to_inform_treatment_for_hemiplegia

Objective: For upper extremity rehabilitation candidates, can the development of data capture and analysis systems contribute to better rehabilitation game treatment decisions?

Process: to use video games with an additional data collector (Kinect sensor) to promote bimanual therapy, improve data collection and identify therapist-relevant data. Three subjects completed a 90 minute session of game play.

Findings: “With the integration of the Kinect sensor, motion tracking data can be harvested to inform treatment program development and progression by therapists”. This paper supplements the groundwork for further rehabilitation-specific videogame development.

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

Gaming vs.Bobath: Function and Ability

Randomized Trial

Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical therapy

Zoccolillo, L., Morelli, D., Cincotti, F., Muzzioli,L., Gobbetti, T., Paolucci, S. & Iosa, M.
Eur J Phys Rehabil Med. 2015 Feb 5.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/25653079

Objective: In children with cerebral palsy, does video gaming intervention improve upper limb motor movements, hand function (and have more movements) compared to conventional, Bobath-based therapy?

Method: 22 children, 4 to 14 years old, with cerebral palsy (GMFCS levels I – IV) received 16 sessions of conventional therapy before or after 16 sessions of video game therapy, over a period of 8 weeks. QUEST (Quality of Upper Extremity Skills Test) was used to assess upper extremity function and Abilhand-kids for hand ability. Instrumentation was applied to the childrens’ forearms to quantify movements.

Findings: Upper limb functioning measured by QUEST improved more with video gaming than with conventional therapy. Manual ability improved better with conventional therapy. Video gaming resulted in more movements than conventional therapy.

Kinect: Clinician's Resource

Resource development
Levac, D., Espy, D., Fox, E., Pradhan, S. & Deutsch, J. E.
"Kinect-ing" with Clinicians: A Knowledge Translation Resource to Support Decision Making About Video Game Use in Rehabilitation
Physical Therapy 2015;95:426-440.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/25256741

Problem: There is a perceived need for support to use of Kinect clinically.

Objective: “…development and preliminary evaluation of a knowledge translation resource to support clinical decision making about selection and use of Kinect games in physical therapy”.

Process: Interviews or focus groups were conducted with 16 clinician participants over 4 sites.

Outcome: Production of “Kinecting With Clinicians Resource (KWIC). Categories include game selection (player or game driven, stability, mobility, mobility plus); game play (spatial accuracy, temporal accuracy, duration, cognitive operators, augmented feedback, progression, score).

Building a Clinical Videogame Tool

Qualitative Study

"Kinect-ing" with Clinicians: A Knowledge Translation Resource to Support Decision Making about Video Game Use in Rehabilitation
Levac, D., Espy, D., Fox, E., Pradhan, S. & Deutsch, J. E.
Physical Therapy Online, Sept 25, 2014
DOI: 10.2522/ptj.20130618

Link to abstract: ptjournal.apta.org/content/early/2014/09/24/ptj.20130618.abstract

Objective: Virtual reality and active video gaming offer promise yet lack evidence of effectiveness when used in clinical practice. Additionally, clinicians require knowledge translation resources to decide how to use video games in clinical practice. This paper describes development of a clinician’s resource for using Kinect video games in physical therapy.

Method: Sixteen clinicians from four sites completed questionnaires; five physical therapists analyzed the results towards developing a knowledge product.

Findings: "This paper described the process and feedback…for improving and further evaluating the 'Kinecting with Clinicians' resource using the 'Knowledge-to-Action cycle' framework to guide the proposed research methods." Next steps are to put the resource online and evaluate usefulness of online resources in clinical practice.

Therapist-friendly Kinect games

Qualitative study

Design and Evaluation of Virtual Reality-Based Therapy Games with Dual Focus on Therapeutic Relevance and User Experience for Children with Cerebral Palsy Ni, L. T., Fehlings, D. & Biddiss, E., Games for Health, 3(3), 2014-07-18
DOI 10.1089/g4h.2014.0003

Link to abstract: online.liebertpub.com/doi/abs/10.1089/g4h.2014.0003 journalCode=g4h

Objective: This qualitative study evaluates two therapist-made Xbox Kinect games, designed for fun, engagement and therapeutic value, for therapeutic relevance and user experience.

Process: Six therapists and eight 8 – 12 year old children (GMFCS I – III) scored questionnaires before and after playing custom Kinect games designed by therapists.

Outcomes: Therapists rated the games as of "average usability" and were able to focus and grade game play. They reported tracking problems (the system had difficulty distinguishing children’s movements from the assisting therapist’s). Children learned to beat the game. The games were "engaging to the child and therapeutically relevant".

Kinect game for children with CP

Gamification of physical therapy for the treatment of pediatric cerebral palsy: A pilot study examining player preferences. Whittinghill, D. & Brown, J. (2014), American Society for Engineering Education 121st Annual Conference & Exposition, Indianapolis, IN.

Pilot study

Link to content: www.asee.org/public/conferences/32/papers/10954/view

Objective: Few active games are made to meet the clinical needs of children with cerebral palsy. The authors created a Microsoft Xbox Kinect game based on the upper body physical therapy routines typically prescribed for children with cerebral palsy, and tested it for player satisfaction. Burnie is juvenile, whimsical and rich in positive feedback. "Reframing the therapy experience is the essence of Burnie’s gamification."

Method: A convenience sample of 21 6 – 34 year olds with and without cerebral palsy played Burnie for 15 minutes, then completed a post-game questionnaire.

Results: A Likert scale with 1 being least favourable and 10 most favourable returned values of overall enjoyment 6.75, pleasing esthetics 7.65 and pleasing game controls 5.4. A lower value on game controls may be a function of the discomfort experienced as a part of therapy exercise, a desired therapy outcome. Overall, the authors feel this study leads to a better 'behaviorally oriented physical therapy game experience'.

Xbox engagement and children with Autism

Design: Repeated-measures study
Exploring motion-based touchless games for Autistic children’s learning
Bartoli, L., Corradi, C., Garzotto, F. & Valoriani, M. Proceedings of Interaction Design and Children (IDC) conference, June 24 – 27, 2013, New York, NY, USA

Link to abstract... http://dl.acm.org/citation.cfm?id=2485774

Objective: Do children with autism increase in selective and sustained attention after motion-based video game play?

Method: A convenience sample of five 10 – 12 year old autistic boys were selected from a larger group of children at a therapeutic centre in Florence, Italy. The boys attended five “gaming meetings” of 45 minutes gameplay over a period of three months. Five Kinect Xbox 360 games were chosen in order to present the boys with a variety of short games with graded tasks. The Bells test for visual neglect, used here to measure attention, was administered before, during and one week after the treatment regime.

Results: Children showed increased selective and sustained attention up to seven days following the end of treatment sessions. These results “are in line with existing studies concerning the positive effects of motion-based games on engagement”.

Experimenting with Kinect

This Peter Wayner article from the New York Times of July 20th details how the hacker-friendly Kinect is being adapted for artistic uses and as a unique home amusement. Kinect’s cameras collect body movements in three dimensions. This could create an opportunity for adapted game playing. Various software helps non-programmers easily create visual or sound feedback environments operated by gestures and movements. It is also possible to do keyboard activities using gestures instead.

Link to this article: nytimes.com/2011/07/21/technology/personaltech/kinect-hacking-finds-a-wider-crowd.html?_r=1&ref=technology

Related New York Times article:
nytimes.com/2010/11/22/technology/22hack.html

Kinect hacks
kinecthacks.net
kinecthacks.com
hackaday.com

Blog
kinecteducation.com/