The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation

Upper limb exercise is often neglected during post-stroke rehabilitation. Video games have been shown to be useful in providing environments in which patients can practise repetitive, functionally meaningful movements, and in inducing neuroplasticity. The design of video games is often focused upon a number of fundamental principles, such as reward, goals, challenge and the concept of meaningful play, and these same principles are important in the design of games for rehabilitation. Further to this, there have been several attempts for the strengthening of the relationship between commercial game design and rehabilitative game design, the former providing insight into factors that can increase motivation and engagement with the latter. In this article, we present an overview of various game design principles and the theoretical grounding behind their presence, in addition to attempts made to utilise these principles in the creation of upper limb stroke rehabilitation systems and the outcomes of their use. We also present research aiming to move the collaborative efforts of designers and therapists towards a model for the structured design of these games and the various steps taken concerning the theoretical classification and mapping of game design concepts with intended cognitive and motor outcomes

Home-based rehabilitation of the shoulder using auxiliary systems and artificial intelligence: an overview

Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.info:eu-repo/semantics/publishedVersio

Proceedings of the 10th international conference on disability, virtual reality and associated technologies (ICDVRAT 2014)

The proceedings of the conferenc

Virtual Reality training for patients with non-specific persistent low back pain and pain-related fear of movement: A single-subject experimental study

Postponed access: the file will be accessible after 2019-10-15Introduction: Non-specific persistent low back pain is one of the most prevalent musculoskeletal conditions in modern society. A growing body of evidence shows graded exposure therapy is the most preferable treatment to target pain-related fear of movement. However, graded exposure therapy has some limitations, e.g. low patient preference and high drop-out rates. Therefore, the emerging nature of Virtual Reality (VR) provides an interesting medium to investigate whether pain and pain-related fear can be targeted through graded exposure using immersive virtual environments. Method: In a sequential replicated and randomized single-subject experimental design with multiple measurements, 10 patients with non-specific persistent low back pain had a 35-day intervention with 6 to 9 VR training sessions. Primary outcome measures (measured daily) were pain intensity, pain-related fear of movement, pain catastrophization and pain anxiety symptoms, while secondary outcome measures (measured pre- and post-intervention) were related to disability and activities of daily life. Results: VR training resulted in a statistically significant reduction of pain intensity, painrelated fear of movement, pain catastrophizing, and pain anxiety. Clinically relevant improvements were observed for disability. Conclusion/Future implications: There is a need to reduce the costs and suffering caused by persistent low back pain. VR may provide opportunities to exercise in specifically tailored virtual environments, with the goal of achieving meaningful and valued life-activities in an engaging fashion. However, the technology is only in its infancy, and thus, opportunities and challenges with implementation must be further investigated. Finally, given the nature of the present study design, the results cannot be generalized to a larger population, and therefore, further research involving rigorous trial designs (randomised controlled trial) is also warranted.Introduksjon: Langvarige korsryggsmerter er blant de mest prevalente muskel- og skjelettplagene i det moderne samfunnet. Stadig mer forskning viser at smerte-relatert frykt for bevegelse kan opprettholde funksjonstap hos mange ryggpasienter, og at gradvis eksponeringsterapi er blant de mest effektive behandlingsmetodene. Men gradvis eksponeringsterapi har begrensninger som bl.a. lav pasient-preferanse og høy drop-out rate. På bakgrunn av den nylige teknologiske utviklingen av Virtual Reality (VR), åpnes det utforskning av effekten av gradvis eksponeringstrening for ryggpasienter i ulike virtuelle miljø. Metode: I et sekvensielt replisert, randomisert singel-subjekt eksperimentelt design med gjentatte målinger, gjennomgikk 10 ryggpasienter en 35-dagers intervensjon som bestod av et minimum av 6 VR-treninger og maksimum av 9 VR-treninger. Primære utfallsmål bestod av smerteintensitet, smerte-relatert frykt, katastrofetanker og angst for smerte, mens sekundære utfallsmål målte endringer i funksjonsnivå og aktiviteter i dagliglivet. Resultater: Studien viste at VR-trening hadde en statistisk signifikant effekt på smerteintensitet, smerte-relatert frykt, katastrofetanker og angst for smerte. Klinisk relevante endringer ble observert for endringer i funksjonsnivå. Konklusjon/Fremtidige implikasjoner: Det er et stort behov for å redusere kostnader og lidelse forbundet med ryggsmerter. Tilpasset trening i ulike virtuelle miljø i VR bør undersøkes nærmere ettersom det fremstår som et motiverende og kostnadseffektivt hjelpemiddel for bruk i fysioterapipraksis. Men teknologien er fortsatt i utviklingsstadiet, og det trengs fortsatt oversikt over muligheter og utfordringer ved implementering. Forskerne i denne studien anerkjenner at resultatene av studien ikke kan generaliseres til en større populasjon grunnet studiedesign, og at det er behov for studier randomiserte kontrollerte studier på dette feltet.Masteroppgave i fysioterapivitenskapFYST39

Clinical Decision Support Systems with Game-based Environments, Monitoring Symptoms of Parkinson’s Disease with Exergames

Parkinson’s Disease (PD) is a malady caused by progressive neuronal degeneration, deriving in several physical and cognitive symptoms that worsen with time. Like many other chronic diseases, it requires constant monitoring to perform medication and therapeutic adjustments. This is due to the significant variability in PD symptomatology and progress between patients. At the moment, this monitoring requires substantial participation from caregivers and numerous clinic visits. Personal diaries and questionnaires are used as data sources for medication and therapeutic adjustments. The subjectivity in these data sources leads to suboptimal clinical decisions. Therefore, more objective data sources are required to better monitor the progress of individual PD patients. A potential contribution towards more objective monitoring of PD is clinical decision support systems. These systems employ sensors and classification techniques to provide caregivers with objective information for their decision-making. This leads to more objective assessments of patient improvement or deterioration, resulting in better adjusted medication and therapeutic plans. Hereby, the need to encourage patients to actively and regularly provide data for remote monitoring remains a significant challenge. To address this challenge, the goal of this thesis is to combine clinical decision support systems with game-based environments. More specifically, serious games in the form of exergames, active video games that involve physical exercise, shall be used to deliver objective data for PD monitoring and therapy. Exergames increase engagement while combining physical and cognitive tasks. This combination, known as dual-tasking, has been proven to improve rehabilitation outcomes in PD: recent randomized clinical trials on exergame-based rehabilitation in PD show improvements in clinical outcomes that are equal or superior to those of traditional rehabilitation. In this thesis, we present an exergame-based clinical decision support system model to monitor symptoms of PD. This model provides both objective information on PD symptoms and an engaging environment for the patients. The model is elaborated, prototypically implemented and validated in the context of two of the most prominent symptoms of PD: (1) balance and gait, as well as (2) hand tremor and slowness of movement (bradykinesia). While balance and gait affections increase the risk of falling, hand tremors and bradykinesia affect hand dexterity. We employ Wii Balance Boards and Leap Motion sensors, and digitalize aspects of current clinical standards used to assess PD symptoms. In addition, we present two dual-tasking exergames: PDDanceCity for balance and gait, and PDPuzzleTable for tremor and bradykinesia. We evaluate the capability of our system for assessing the risk of falling and the severity of tremor in comparison with clinical standards. We also explore the statistical significance and effect size of the data we collect from PD patients and healthy controls. We demonstrate that the presented approach can predict an increased risk of falling and estimate tremor severity. Also, the target population shows a good acceptance of PDDanceCity and PDPuzzleTable. In summary, our results indicate a clear feasibility to implement this system for PD. Nevertheless, long-term randomized clinical trials are required to evaluate the potential of PDDanceCity and PDPuzzleTable for physical and cognitive rehabilitation effects

The role of HCI in the construction of disability

As a discipline concerned with the design, evaluation and implementation of interactive computing systems for human use, and with the study of major phenomena surrounding them, human computer interaction (HCI) is involved in the phenomenon of disability. For an interaction between humans and computers to take place, there should be an interface mediating between both parties. The design of such an interface may inadvertently impose access barriers to some people. HCI literature addresses the relationship between the theory and practice of HCI and disability from different angles, some of which are diametrically opposed. This thesis explores three modern conceptions, or models, of disability — the individualistic medical, the biopsychosocial and the social models —, investigates which model predominates in the HCI literature, and analyzes why choosing a particular model may determine and constrain the classes of problems that can be identified during a solution discovery process. Departing from HCI’s traditional discourse, which interprets the phenomenon of disability as a problem in the human body, the author, leading a team of engineers and psychologists, carried out a project in a school for children with cerebral palsy. The project was aimed to improve different areas of child development, using non conventional user interfaces — i.e. user interfaces that use other input/output devices than the keyboard, mouse or screen. After two years working directly within the field of operations”, the author had the opportunity to contrast the theory underpinning HCI’s methods with real practice and to expand his understandings about the relationships between HCI and disability. The research process involved an action research approach, which allowed the author and the team of experimenters to formulate new hypotheses as they learned more about the context, to review the process and, ultimately and most importantly,to readapt their actions to better serve the end beneficiaries. The experiences and learnings gathered throughout the process have been included in this thesis as a case study, for the purpose of helping HCI researchers embarking on projects relatable to the one described. Finally, the author urges the HCI community to update its discourse and to connect it with the vast literature related to modern conceptions of the phenomenon of disability

The development and applications of serious games in the public services: defence and health

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University London.The latest advances of Virtual Reality technologies and three-dimensional graphics, as well as the developments in Gaming Technologies in the recent years, have stemmed the proliferation of Serious Games in a broader spectrum of research applications. Among the most popular areas of application are public services such as Defence and Health, where digital technologies realise new challenges and opportunities for research and development of Serious Games and for a variety of contexts. As with all games, the user engagement is elevated and apart from the entertaining aspect, Serious Games serve as a novel and promising alternative experience to knowledge transfer. Furthermore, Serious Games bring to the end user and the overall society a series of attractive benefits. These benefits include safety, cost-effectiveness, increased motivation and personalisation. Hence, this Thesis aims to investigate novel approaches of developing Serious Games that utilise the recent advances of Virtual Reality and Gaming Technology and facilitate the aforementioned benefits. The process of design and development of the novel tools and applications follow an iterative manner and are driven by the review of the available literature as well as end-user feedbackEPSRC (Engineering and Physical Sciences Research Council ) , MOD (UK), NHS (UK

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Efficacy of augmented reality versus conventional physical therapy for the improvement of balance, gait, upper-limb and dual task in people with multiple sclerosis

Introducción: La Esclerosis Múltiple (EM)es un trastorno progresivo multifocal del sistema nervioso central, que a menudo resulta en diversas manifestaciones clínicas. Las personas con Esclerosis Múltiple (pcEM) a menudo sufren diferentes trastornos motores en el equilibrio, la marcha y las extremidades superiores, incluso mientras realizan alguna actividad de la vida diaria, lo que también afecta la doble tarea. La realidad aumentada (RA) se está convirtiendo en una herramienta de entrenamiento popular para la recuperación funcional en fisioterapia. Por tanto, el objetivo era demostrar la eficacia de la RA para el equilibrio, la marcha, los miembros superiores y la tarea dual, como una herramienta más en el amplio abanico de posibilidades de la EF para la EM. Métodos: 30 pcEM fueron igualmente aleatorizados en el grupo de RA o el grupo de terapia convencional (TC). Cada grupo recibió sesiones de entrenamiento de equilibrio, marcha, miembros superiores y tareas duales durante cuatro semanas consecutivas, tres sesiones por semana, sesiones de 45 minutos. Las pruebas clínicas, las medidas de resultado instrumentadas y los cuestionarios autoinformados se recopilaron al inicio de los programas de intervención y al final. Resultados: el análisis final incluyó a 23 pacientes (12F, 11M; edad media, (S.D.) = 49,83 (10,82) años; media EDSS (S.D.) = 4,64 (1,15)). ANOVA reveló cambios estadísticamente significativos en el tiempo pero no en el tiempo por interacción de grupo. Ambos grupos mostraron un efecto principal del tiempo en 36, y solo RA en 7 de las 48 variables consideradas para miembros superiores, equilibrio, marcha y tarea dual. No se observaron diferencias estadísticamente significativas a favor del RA Conclusiones: Se demuestra que el entrenamiento de miembros superiores, equilibrio, marcha y tareas duales basado en RA es un método eficaz como terapia convencional para la EM.Introduction: Multiple Sclerosis is a multifocal progressive disorder of the central nervous system, often resulting in diverse clinical manifestations. People with Multiple Sclerosis (pwMS) often suffer from different motor disturbances in balance, gait, and the upper limbs, including while they are performing some daily life activity, which also affects dual tasking. Augmented reality (AR) is becoming a popular training tool for functional recovery in physical therapy (PT). Therefore, the aim was to demonstrate the efficacy of AR for balance, gait, the upper limbs and dual task, as one more tool in the wide range of possibilities in PT for pwMS. Methods: 30 pwMS were equally randomized into the augmented reality group (ARG) or the conventional therapy group (CTG). Each group received balance, gait, upper-limb and dual task training sessions for four consecutive weeks, three sessions per week, 45-minute sessions. Clinical tests, instrumented outcome measures, and self-reported questionnaires were collected upon initiation of the intervention programs and at the end. Outcomes: Final analysis included 23 patients (12F,11M; mean age, (S.D.) = 49.83(10.82) years; mean EDSS (S.D.) = 4.64 (1.15)). ANOVA revealed statistically significant changes in time but not in the time per group interaction. Both groups showed a main effect of time in 36, and only ARG in 7 out of 48 variables considered for the upper limbs, balance, gait and dual task. No statistically significant differences in favor of the ARG were observed Conclusions: It is demonstrated that upper-limb, balance, gait and dual task training based on AR is an effective method as conventional therapy for pwMS