A Comparative study to find out the effect of Task Oriented Training along with specially developed serious games and Task Oriented Training alone on Lower Extremity Function in Diplegic Cerebral Palsy

The purpose of the study was to find out the effect of task oriented training alone and task oriented training with specially developed serious games on lower extremity function in Diplegic cerebral palsy. Based on the statistical analysis Group B subjects shows a significant improvement than Group A. The task oriented training was proved to improve balance and gait whereas the task oriented training along with specially developed serious games gives much more improvement of balance and gait in lower extremity function in Diplegic cerebral palsy. Thus the study was concluded that task oriented training with specially developed serious games helps to improve the balance and gait in children with Diplegic cerebral palsy

Games used with serious purposes: a systematic review of interventions in patients with cerebral palsy

The purpose of the present systematic review was to examine extant research regarding the role of games used seriously in interventions with individuals with cerebral palsy. Therefore, PubMed, PsyINFO, Web of Science, Scopus, and IEEE databases were used. Search terms included: "serious games" OR "online games" OR "video games" OR "videogame" OR "game based" OR "game" AND "intervention" AND "cerebral palsy." After the full reading and quality assessment of the papers, 16 studies met the inclusion criteria. The majority of the studies reported high levels of compliance, motivation, and engagement with game-based interventions both at home and at the clinical setting intervention. Regarding the effectiveness of the use of games, the results of the studies show both positive and negative results regarding their effectiveness. The efficacy was reported to motor function (i.e., improvements in the arm function, hand coordination, functional mobility, balance and gait function, postural control, upper-limbs function) and physical activity. Findings of this review suggest that games are used as a complement to conventional therapies and not as a substitute. Practitioners often struggle to get their patients to complete the assigned homework tasks, as patients display low motivation to engage in prescribed exercises. Data of this review indicates the use of games as tools suited to promote patients' engagement in the therapy and potentiate therapeutic gains.This study was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). SL and AP were supported by a Ph.D. fellowship from the Portuguese Foundation for Science and Technology (FCT). PM was supported by a Post-Doctoral fellowship from the Psychology Research Centre (CIPsi), University of Minho. JM was supported by a research scholarship from the Psychology Research Centre (CIPsi), University of Minho

The effects of virtual rehabilitation therapy on multiple sclerosis

In this review article, the effect of virtual rehabilitation therapy on multiple sclerosis, a neurodegenerative disorder, is explored. Multiple sclerosis is characterized by damaged nerves that result in incomplete signal processing between the brain and the spinal cord. The symptoms of this condition can include vision loss, decreased coordination, pain, fatigue, and deteriorating motor output. The severity of the symptoms and the rate of progression of multiple sclerosis can vary from person to person; some individuals live the majority of their lives with mild symptoms while others become bedridden and immobile. There is no cure for this disease, however implementation of virtual reality rehabilitation therapy shows promise in slowing the progression of deterioration in motor output and cognition. Through a variety of methods incorporating virtual reality, this review investigates the effects of this type of therapy on balance, manual dexterity, and mental health in patients with multiple sclerosis

Use of Active Video Gaming in Children with Neromotor Dysfunction: A Systematic Review

Background and Purpose: Active video games (AVG) are gaining popularity as a strategy for improving motor function in children with neurologically-based movement disorders, but there is no consensus regarding AVG’s utility or effectiveness in this population. The purpose of this systematic review was to examine current evidence on the use of AVG to improve motor function in children 2-17 years of age with neurologically-based movement disorders. Methods: Authors followed standard criteria for systematic review conduct and rating quality of evidence including the PRISMA checklist. Databases searched were Scopus, MEDLINE, Cochrane Library, EMBASE, and CINAHL. Systematic reviews, randomized control trials, or longitudinal studies were included if they investigated AVG for improving movement-related outcomes in children aged 2-17 years with neurologically-based movement disorders. Parameters studied included: health condition, strength of evidence, delivery methods or systems for AVG, capacity for adjusting to individual needs and skill levels, outcomes addressed with AVG, effectiveness for achieving targeted outcomes [primarily activity-level motor outcomes (n=36)], and challenges/limitations. Results: The 20 articles included in the review varied in quality from high (n=6), to moderate (n=4) to low (n=8) with two strong quality single subject research design (SSRD) studies. Studies involved children with 6 neurologic conditions using AVG in clinical, home or school settings for 49 different outcomes. Frequency and duration of dosage varied. Choice of games played and difficulty level were controlled by therapists (n=6) or the child (n=14). The most commonly reported limitations were small sample sizes and difficulty providing task-specific practice of functional movements via AVG. All studies reported improvement with AVG, though differences were not consistently significant compared to traditional therapy. Discussion: Heterogeneity of measurement tools and target outcomes prevented meta-analysis or development of formal recommendations. However, AVG has demonstrated feasibility and shows potential for improving activity-level outcomes (including those assessing balance, gross motor function, and upper and lower limb function) of children with neuromotor disorders, and should be considered when developing plans of care for this population. Additional research with larger samples, and investigations that explore dosing variables and utility for extending practice by home programming are merited

Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury

Background: Acquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo¿ Wii Balance Board¿ (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance. Methods. In this contribution, we present a randomized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients. This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation (n = 9) versus standard rehabilitation (n = 8). Effectiveness was evaluated by means of traditional static and dynamic balance scales. Results: The final sample consisted of 11 men and 6 women. Mean ±SD age was 47.3 ± 17.8 and mean SD chronicity was 570.9 ± 313.2 days. Patients using eBaViR had a significant improvement in static balance (p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test) compared to patients who underwent traditional therapy. Regarding dynamic balance, the results showed significant improvement over time in all these measures, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. There were no serious adverse events during treatment in either group. Conclusions: The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population. These results have encouraged us to reinforce the virtual treatment with new exercises, so an evolution of the system is currently being developed. © 2011 Gil-Gómez et al; licensee BioMed Central Ltd.This study was funded in part by Ministerio de Educacion y Ciencia Spain, Projects Consolider-C (SEJ2006-14301/PSIC), "CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII" and the Excellence Research Program PROMETEO (Generalitat Valenciana. Conselleria de Educacion, 2008-157).Gil-Gómez, J.; Llorens Rodríguez, R.; Alcañiz Raya, ML.; Colomer Font, C. (2011). Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal of NeuroEngineering and Rehabilitation. 8(30):1-9. https://doi.org/10.1186/1743-0003-8-30S19830Nichols-Larsen, D. S., Clark, P. C., Zeringue, A., Greenspan, A., & Blanton, S. (2005). Factors Influencing Stroke Survivors’ Quality of Life During Subacute Recovery. Stroke, 36(7), 1480-1484. doi:10.1161/01.str.0000170706.13595.4fTeasell, R., Meyer, M. J., McClure, A., Pan, C., Murie-Fernandez, M., Foley, N., & Salter, K. (2009). Stroke Rehabilitation: An International Perspective. Topics in Stroke Rehabilitation, 16(1), 44-56. doi:10.1310/tsr1601-44Sveistrup, H. (2004). Journal of NeuroEngineering and Rehabilitation, 1(1), 10. doi:10.1186/1743-0003-1-10Holden, M. K. (2005). Virtual Environments for Motor Rehabilitation: Review. CyberPsychology & Behavior, 8(3), 187-211. doi:10.1089/cpb.2005.8.187Crosbie, J. H., Lennon, S., Basford, J. R., & McDonough, S. M. (2007). Virtual reality in stroke rehabilitation: Still more virtual than real. Disability and Rehabilitation, 29(14), 1139-1146. doi:10.1080/09638280600960909Haas, B. M., & Burden, A. M. (2000). Validity of weight distribution and sway measurements of the Balance Performance Monitor. Physiotherapy Research International, 5(1), 19-32. doi:10.1002/pri.181Srivastava, A., Taly, A. B., Gupta, A., Kumar, S., & Murali, T. (2009). Post-stroke balance training: Role of force platform with visual feedback technique. Journal of the Neurological Sciences, 287(1-2), 89-93. doi:10.1016/j.jns.2009.08.051Deutsch, J. E., Borbely, M., Filler, J., Huhn, K., & Guarrera-Bowlby, P. (2008). Use of a Low-Cost, Commercially Available Gaming Console (Wii) for Rehabilitation of an Adolescent With Cerebral Palsy. Physical Therapy, 88(10), 1196-1207. doi:10.2522/ptj.20080062Yong Joo, L., Soon Yin, T., Xu, D., Thia, E., Pei Fen, C., Kuah, C., & Kong, K. (2010). A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. Journal of Rehabilitation Medicine, 42(5), 437-441. doi:10.2340/16501977-0528Clark, R. A., Bryant, A. L., Pua, Y., McCrory, P., Bennell, K., & Hunt, M. (2010). Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait & Posture, 31(3), 307-310. doi:10.1016/j.gaitpost.2009.11.012Young, W., Ferguson, S., Brault, S., & Craig, C. (2011). Assessing and training standing balance in older adults: A novel approach using the ‘Nintendo Wii’ Balance Board. Gait & Posture, 33(2), 303-305. doi:10.1016/j.gaitpost.2010.10.089Shih, C.-H., Shih, C.-T., & Chiang, M.-S. (2010). A new standing posture detector to enable people with multiple disabilities to control environmental stimulation by changing their standing posture through a commercial Wii Balance Board. Research in Developmental Disabilities, 31(1), 281-286. doi:10.1016/j.ridd.2009.09.013Shih, C.-H., Shih, C.-T., & Chu, C.-L. (2010). Assisting people with multiple disabilities actively correct abnormal standing posture with a Nintendo Wii Balance Board through controlling environmental stimulation. Research in Developmental Disabilities, 31(4), 936-942. doi:10.1016/j.ridd.2010.03.004Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). «Mini-mental state». Journal of Psychiatric Research, 12(3), 189-198. doi:10.1016/0022-3956(75)90026-6Geurts, A. C. H., de Haart, M., van Nes, I. J. W., & Duysens, J. (2005). A review of standing balance recovery from stroke. Gait & Posture, 22(3), 267-281. doi:10.1016/j.gaitpost.2004.10.002Marsden, J. F. (2005). The vestibular control of balance after stroke. Journal of Neurology, Neurosurgery & Psychiatry, 76(5), 670-679. doi:10.1136/jnnp.2004.046565Perron, M., Malouin, F., & Moffet, H. (2003). Assessing advanced locomotor recovery after total hip arthroplasty with the timed stair test. Clinical Rehabilitation, 17(7), 780-786. doi:10.1191/0269215503cr696oaMcDowell, B. C., Kerr, C., Parkes, J., & Cosgrove, A. (2005). Validity of a 1 minute walk test for children with cerebral palsy. Developmental Medicine & Child Neurology, 47(11), 744. doi:10.1017/s0012162205001568O’Shea, S. D., Taylor, N. F., & Paratz, J. D. (2007). Measuring Muscle Strength for People With Chronic Obstructive Pulmonary Disease: Retest Reliability of Hand-Held Dynamometry. Archives of Physical Medicine and Rehabilitation, 88(1), 32-36. doi:10.1016/j.apmr.2006.10.002Tyson, S. F., Hanley, M., Chillala, J., Selley, A. B., & Tallis, R. C. (2007). The Relationship Between Balance, Disability, and Recovery After Stroke: Predictive Validity of the Brunel Balance Assessment. 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Methods and metrics for the improvement of the interaction and the rehabilitation of cerebral palsy through inertial technology

Cerebral palsy (CP) is one of the most limiting disabilities in childhood, with 2.2 cases per 1000 1-year survivors. It is a disorder of movement and posture due to a defect or lesion of the immature brain during the pregnancy or the birth. These motor limitations appear frequently in combination with sensory and cognitive alterations generally result in great difficulties for some people with CP to manipulate objects, communicate and interact with their environment, as well as limiting their mobility. Over the last decades, instruments such as personal computers have become a popular tool to overcome some of the motor limitations and promote neural plasticity, especially during childhood. According to some estimations, 65% of youths with CP that present severely limited manipulation skills cannot use standard mice nor keyboards. Unfortunately, even when people with CP use assistive technology for computer access, they face barriers that lead to the use of typical mice, track balls or touch screens for practical reasons. Nevertheless, with the proper customization, novel developments of alternative input devices such as head mice or eye trackers can be a valuable solution for these individuals. This thesis presents a collection of novel mapping functions and facilitation algorithms that were proposed and designed to ease the act of pointing to graphical elements on the screen—the most elemental task in human-computer interaction—to individuals with CP. These developments were implemented to be used with any head mouse, although they were all tested with the ENLAZA, an inertial interface. The development of such techniques required the following approach: Developing a methodology to evaluate the performance of individuals with CP in pointing tasks, which are usually described as two sequential subtasks: navigation and targeting. Identifying the main motor abnormalities that are present in individuals with CP as well as assessing the compliance of these people with standard motor behaviour models such as Fitts’ law. Designing and validating three novel pointing facilitation techniques to be implemented in a head mouse. They were conceived for users with CP and muscle weakness that have great difficulties to maintain their heads in a stable position. The first two algorithms consist in two novel mapping functions that aim to facilitate the navigation phase, whereas the third technique is based in gravity wells and was specially developed to facilitate the selection of elements in the screen. In parallel with the development of the facilitation techniques for the interaction process, we evaluated the feasibility of use inertial technology for the control of serious videogames as a complement to traditional rehabilitation therapies of posture and balance. The experimental validation here presented confirms that this concept could be implemented in clinical practice with good results. In summary, the works here presented prove the suitability of using inertial technology for the development of an alternative pointing device—and pointing algorithms—based on movements of the head for individuals with CP and severely limited manipulation skills and new rehabilitation therapies for the improvement of posture and balance. All the contributions were validated in collaboration with several centres specialized in CP and similar disorders and users with disability recruited in those centres.La parálisis cerebral (PC) es una de las deficiencias más limitantes de la infancia, con un incidencia de 2.2 casos por cada 1000 supervivientes tras un año de vida. La PC se manifiesta principalmente como una alteración del movimiento y la postura y es consecuencia de un defecto o lesión en el cerebro inmaduro durante el embarazo o el parto. Las limitaciones motrices suelen aparecer además en compañía de alteraciones sensoriales y cognitivas, lo que provoca por lo general grandes dificultades de movilidad, de manipulación, de relación y de interacción con el entorno. En las últimas décadas, el ordenador personal se ha extendido como herramienta para la compensación de parte de estas limitaciones motoras y como medio de promoción de la neuroplasticidad, especialmente durante la infancia. Desafortunadamente, cerca de un 65% de las personas PC que son diagnosticadas con limitaciones severas de manipulación son incapaces de utilizar ratones o teclados convencionales. A veces, ni siquiera la tecnología asistencial les resulta de utilidad ya que se encuentran con impedimentos que hacen que opten por usar dispositivos tradicionales aun sin dominar su manejo. Para estas personas, los desarrollos recientes de ratones operados a través de movimientos residuales con la cabeza o la mirada podrían ser una solución válida, siempre y cuando se personalice su manejo. Esta tesis presenta un conjunto de novedosas funciones de mapeo y algoritmos de facilitaci ón que se han propuesto y diseñado con el ánimo de ayudar a personas con PC en las tareas de apuntamiento de objetos en la pantalla —las más elementales dentro de la interacción con el ordenador. Aunque todas las contribuciones se evaluaron con la interfaz inercial ENLAZA, desarrollada igualmente en nuestro grupo, podrían ser aplicadas a cualquier ratón basado en movimientos de cabeza. El desarrollo de los trabajos se resume en las siguientes tareas abordadas: Desarrollo de una metodología para la evaluación de la habilidad de usuarios con PC en tareas de apuntamiento, que se contemplan como el encadenamiento de dos sub-tareas: navegación (alcance) y selección (clic). Identificación de los tipos de alteraciones motrices presentes en individuos con PC y el grado de ajuste de éstos a modelos estándares de comportamiento motriz como puede ser la ley de Fitts. Propuesta y validación de tres técnicas de facilitación del alcance para ser implementadas en un ratón basado en movimientos de cabeza. La facilitación se ha centrado en personas que presentan debilidad muscular y dificultades para mantener la posición de la cabeza. Mientras que los dos primeros algoritmos se centraron en facilitar la navegación, el tercero tuvo como objetivo ayudar en la selección a través de una técnica basada en pozos gravitatorios de proximidad. En paralelo al desarrollo de estos algoritmos de facilitación de la interacción, evaluamos la posibilidad de utilizar tecnología inercial para el control de videojuegos en rehabilitación. Nuestra validación experimental demostró que este concepto puede implementarse en la práctica clínica como complemento a terapias tradicionales de rehabilitación de la postura y el equilibrio. Como conclusión, los trabajos desarrollados en esta tesis vienen a constatar la idoneidad de utilizar sensores inerciales para el desarrollo de interfaces de accesso alternativo al ordenador basados en movimientos residuales de la cabeza para personas con limitaciones severas de manipulación. Esta solución se complementa con algoritmos de facilitación del alcance. Por otra parte, estas soluciones tecnológicas de interfaz con el ordenador representan igualmente un complemento de terapias tradicionales de rehabilitación de la postura y el equilibrio. Todas las contribuciones se validaron en colaboración con una serie de centros especializados en parálisis cerebral y trastornos afines contando con usuarios con discapacidad reclutados en dichos centros.This thesis was completed in the Group of Neural and Cognitive Engineering (gNEC) of the CAR UPM-CSIC with the financial support of the FP7 Framework EU Research Project ABC (EU-2012-287774), the IVANPACE Project (funded by Obra Social de Caja Cantabria, 2012-2013), and the Spanish Ministry of Economy and Competitiveness in the framework of two projects: the Interplay Project (RTC-2014-1812-1) and most recently the InterAAC Project (RTC-2015-4327-1)Programa Oficial de Doctorado en Ingeniería Eléctrica, Electrónica y AutomáticaPresidente: Juan Manuel Belda Lois.- Secretario: María Dolores Blanco Rojas.- Vocal: Luis Fernando Sánchez Sante

The Effects of a 5-Day Virtual-Reality Based Exercise Program on Kinematics and Postural Muscle Activity in Youth with Cerebral Palsy

Aims: To determine the effects of a 5-day virtual reality (VR)-based intervention on anticipatory and reactive mechanisms of postural control in children and adolescents with cerebral palsy (CP). Methods: Eleven youth with CP (GMFCS levels I and II), ages 7–17, were allocated to intervention (N = 5) and control (N = 6) groups. Both groups attended balance assessment sessions 1 week apart. Participants in the intervention group received 1-hour one-on-one physiotherapist-supervised VR balance games for 5 consecutive days between assessments. For balance assessments, participants stood erect with eyes open on a movable platform that translated progressively through four speeds in the anterior/posterior direction. Participants performed two trials each of experimenter-triggered and self-triggered perturbations. Postural muscle activity and kinematics were recorded. The Anchoring Index and body segment cross-correlations were calculated as an indication of body stabilization, and the number of steps taken to regain balance/avoid falling were counted. Mann–Whitney U tests for between group differences in change scores were undertaken with an accepted significance level of 0.01. Results: No consistent differences in change scores were identified between groups. Conclusions: There was no effect of a 5-day VR-based intervention on postural control mechanisms used in response to oscillating platform perturbations. Subsequent studies will further tailor VR interventions to patients’ functional balance needs

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program