Patients' use of a home-based virtual reality system to provide rehabilitation of the upper limb following stroke

Background: A low cost, virtual reality system that translates movements of the hand, fingers and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home based rehabilitation. Objective: Effectiveness depends on adherence, so did patients use the intervention to the recommended level. If not, what reasons did they give? Design: Prospective cohort study plus qualitative analysis of interviews. Methods: 17 patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for eight weeks and were advised to use it three times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way. Results: Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak (p=0.053) positive correlation between duration and baseline reported activities of daily living. Participants reported familiarity with technology and competing commitments as barriers to use although appreciated the flexibility of the intervention and found it motivating

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

Custom-designed motion-based games for older adults: a review of literature in human-computer interaction

Many older adults, particularly persons living in senior residences and care homes, lead sedentary lifestyles, which reduces their life expectancy. Motion-based video games encourage physical activity and might be an opportunity for these adults to remain active and engaged; however, research efforts in the field have frequently focused on younger audiences and little is known about the requirements and benefits of motion-based games for elderly players. In this paper, we present an overview of motion-based video games and other interactive technologies for older adults. First, we summarize existing approaches towards the definition of motion-based video games – often referred to as exergames – and suggest a categorization of motion-based applications into active video games, exergames, and augmented sports. Second, we use this scheme to classify case studies addressing design efforts particularly directed towards older adults. Third, we analyze these case studies with a focus on potential target audiences, benefits, challenges in their deployment, and future design opportunities to investigate whether motion-based video games can be applied to encourage physical activity among older adults. In this context, special attention is paid to evaluation routines and their implications regarding the deployment of such games in the daily lives of older adults. The results show that many case studies examine isolated aspects of motion-based game design for older adults, and despite the broad range of issues in motion-based interaction for older adults covered by the sum of all research projects, there appears to be a disconnect between laboratory-based research and the deployment of motion-based video games in the daily lives of senior citizens. Our literature review suggests that despite research results suggesting various benefits of motion-based play for older adults, most work in the field of game design for senior citizens has focused on the implementation of accessible user interfaces, and that little is known about the long-term deployment of video games for this audience, which is a crucial step if these games are to be implemented in activity programs of senior residences, care homes, or in therapy

Home-based therapy programmes for upper limb functional recovery following stroke

Background: With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. Objectives: To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. Search methods: We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. Selection criteria: Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended ADL and motor impairment of the arm. Data collection and analysis: Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. Main results: We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. Primary outcomes: we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). Secondary outcomes: no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). Authors' conclusions: There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care

Synopsis of an engineering solution for a painful problem Phantom Limb Pain

This paper is synopsis of a recently proposed solution for treating patients who suffer from Phantom Limb Pain (PLP). The underpinning approach of this research and development project is based on an extension of “mirror box” therapy which has had some promising results in pain reduction. An outline of an immersive individually tailored environment giving the patient a virtually realised limb presence, as a means to pain reduction is provided. The virtual 3D holographic environment is meant to produce immersive, engaging and creative environments and tasks to encourage and maintain patients’ interest, an important aspect in two of the more challenging populations under consideration (over-60s and war veterans). The system is hoped to reduce PLP by more than 3 points on an 11 point Visual Analog Scale (VAS), when a score less than 3 could be attributed to distraction alone

Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence - key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.The National Health Service (NHS) London Regional Innovation Fund

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

Design Parameters in Multimodal Games for Rehabilitation

Published under the Liebert "Open Option"Objectives: The repetitive and sometimes mundane nature of conventional rehabilitation therapy provides an ideal opportunity for development of interactive and challenging therapeutic games that have the potential to engage and motivate the players. Certain game design parameters that may encourage patients to actively participate by making the games more enjoyable have been identified. In this article, we describe a formative study in which we designed and evaluated some of these parameters with healthy subjects. Materials and Methods: The ‘‘operant conditioning’’ and ‘‘scoring’’ design parameters were incorporated in a remake of a classic labyrinth game, ‘‘Marble Maze.’’ A group of participants (n = 37) played the game twice: Once in the control condition without both modalities and then with either one of the parameters or with both. Measures of game duration and number of fails in the game were recorded along with survey questionnaires to measure player perceptions of intrinsic motivation on the game. Results: Longer playtimes, higher levels of interest/enjoyment, and effort to play the game were recorded with the introduction of these parameters. Conclusions: This study provides an understanding on how game design parameters can be used to motivate and encourage people to play longer. With these positive results, future aims are to test the parameters with stroke patients, providing much clearer insight as to what influences these parameters have on patients un- dergoing therapy. The ultimate goal is to utilize game design in order to maintain longer therapeutic interaction between a patient and his or her therapy medium.Peer reviewedFinal Published versio

Accessibility of 3D Game Environments for People with Aphasia: An Exploratory Study

People with aphasia experience difficulties with all aspects of language and this can mean that their access to technology is substantially reduced. We report a study undertaken to investigate the issues that confront people with aphasia when interacting with technology, specifically 3D game environments. Five people with aphasia were observed and interviewed in twelve workshop sessions. We report the key themes that emerged from the study, such as the importance of direct mappings between users’ interactions and actions in a virtual environment. The results of the study provide some insight into the challenges, but also the opportunities, these mainstream technologies offer to people with aphasia. We discuss how these technologies could be more supportive and inclusive for people with language and communication difficulties

Future Trends of Virtual, Augmented Reality, and Games for Health

Serious game is now a multi-billion dollar industry and is still growing steadily in many sectors. As a major subset of serious games, designing and developing Virtual Reality (VR), Augmented Reality (AR), and serious games or adopting off-the-shelf games to support medical education, rehabilitation, or promote health has become a promising frontier in the healthcare sector since 2004, because games technology is inexpensive, widely available, fun and entertaining for people of all ages, with various health conditions and different sensory, motor, and cognitive capabilities. In this chapter, we provide the reader an overview of the book with a perspective of future trends of VR, AR simulation and serious games for healthcare