Activity-promoting gaming systems in exercise and rehabilitation

Commercial activity-promoting gaming systems provide a potentially attractive means to facilitate exercise and rehabilitation. The Nintendo Wii, Sony EyeToy, Dance Dance Revolution, and Xbox Kinect are examples of gaming systems that use the movement of the player to control gameplay. Activity-promoting gaming systems can be used as a tool to increase activity levels in otherwise sedentary gamers and also be an effective tool to aid rehabilitation in clinical settings. Therefore, the aim of this current work is to review the growing area of activity-promoting gaming in the context of exercise, injury, and rehabilitation

Trends in virtual reality technologies for the learning patient

NextMed convened the Medicine Meets Virtual Reality 22 (MMVR 22) conference in 2016. Since 1992, the conference has brought together a diverse group of researchers to share creative solutions for the evolving challenge of integrating virtual reality tools into medical education. Virtual reality (VR) and its enabling technologies utilize hardware and software to simulate environments and encounters where users can interact and learn. The MMVR 22 symposium proceedings contain projects that support a variety of learners: medical students, practitioners, soldiers, and patients. This report will contemplate the trends in virtual reality technologies for patients navigating their medical and healthcare learning. The learning patient seeks more than intervention; they seek prevention. From virtual humans and environments to motion sensors and haptic devices, patients are surrounded by increasingly rich and transformative data-driven tools. Applied data enables VR applications to simulate experience, predict health outcomes, and motivate new behavior. The MMVR 22 presents investigations into the usability of wearable devices, the efficacy of avatar inclusion, and the viability of multi-player gaming. With increasing need for individualized and scalable programming, only committed open source efforts will align instructional designers, technology integrators, trainers, and clinicians. Curriculum and InstructionCurriculum and Instructio

Increasing physical activity for individuals with intellectual disability through indoor bike cycling and exergaming

Studies reveal that individuals with intellectual disabilities have more sedentary lifestyles than the general population. Regular physical activity is of both medical and social importance, reducing risks of cardiovascular diseases and obesity. Health organizations recommend that everyone should at least engage in 150 minutes of physical activity each week because of the beneficial health effects. There exist several technical solutions that aim to encourage physical activity. Among these solutions are exergames, where the users must move their body to control game-objects. The idea behind exergames is that a user needs to engage in physical activity in order to play the video game. The point is that it should motivate the user to perform physical activity. Exergames comes in several forms and types on the market today. However, most of them are not user-friendly for individuals with intellectual disabilities. The video-game designs do not adapt to the many challenges that are present for this group. In this project we developed hardware and software modules to record the amount of physical activity on an indoor stationary bicycle and an ergometer bike. An app receives the recorded activity data and uses it to display entertainment for the user, which makes the app an exergame. The design and development process uses knowledge about individuals with intellectual disabilities to customize the system for this group. Information about individuals with intellectual disability has been gathered through literature searches, conferring with experts, talking with parents of children with intellectual disability, and staff working at institutions providing services for individuals with intellectual disabilities. The system is tested at an institution where several individuals with an intellectual disability could try it out. Feedback from testing indicates that the users with an intellectual disability enjoyed using the system, and it was a useful tool for the staff to promote physical activity for the users at the institution. Testing also gave valuable information on what should be included in the further development of the system to improve it. This project has shown that with close user interaction during the development, it is possible to create promising technical solutions for individuals with intellectual disability. The results of this project provide valuable information on beneficial technological interventions for individuals with intellectual disabilities to promote regular physical activity

CorpOperatio: Game-inspired App for Encouraging Outdoor Physical Activity for People with Intellectual Disabilities

This thesis presents a serious mobile exergame for people with intellectual disabilities, to help people with intellectual disability be more physically active. Exergames are games with the purpose of physically engaging the user in the gameplay, and intervenes with sedentariness and repetitive behavior. The game is based around the use of augmented reality, which is described as bringing 3D virtual objects into a 3D real environment in real time. As the field of physical activity in people with intellectual disabilities is a low-research field, the project aims to create a technical solution to them improve their physical health. There are few solutions tailored for people with intellectual disabilities to aid in physical exercise, something we wanted to change. A physical activity mobile game was created using the Unity game engine and augmented reality. Requirements and design choices came through literature review, reference meetings and meetings with professional psychologists. The game was tested by intellectually disabled users in a controlled, randomized trial over the course of four days, with interviews after testing to get results. While evaluation of the application rvealed areas of potential improvement, the application is already usable for people with intellectual disabilities. Augmented reality proved to be challenging to understand initially, but also fun, once the concept was understood. We have created an application for encouraging physical activity for people with intellectual disabilities. The application shows promise, but also improvement points for it to be deployed to the public market

Fostering Functional Occupation and Mobility in People with Intellectual Disability and Visual Impairment Through Technology-Aided Support

Objectives: The study assessed a smartphone-based technology system, which was designed to support functional occupation and mobility in people with severe to profound intellectual disability and visual impairment. Methods: The technology system provided (a) verbal orientation cues to guide the participants to a desk with two containers (and two groups of 10 objects that were to be transported to two different destinations), (b) verbal instructions to take the objects (one at a time), (c) verbal orientation cues to reach the destinations where the objects taken had to be transported, (d) instructions to put away the objects at the destinations, and (e) praise and brief periods of preferred stimulation. Seven participants were involved in the study, which was carried out according to a nonconcurrent multiple baseline across participants design. Results: During the baseline (when the technology system was not available), the participants produced few or no correct responses (i.e., failed to collect, transport, and deposit objects at the right destinations). During the intervention phase (i.e., with the support of the technology system), their mean frequency of correct responses per session was between close to 19 and close to 20 (out of a maximum possible of 20) and their mean session duration varied between about 16 and 29 min. Conclusions: The data suggest that the technology system used in this study may be a viable resource to support activity and mobility in people with intellectual and visual disabilities

VRShape: A Virtual Reality Tool for Shaping Movement Compensation

The majority of persons living with chronic stroke experience some form of upper extremity motor impairment that affects their functional movement, performance of meaningful activities, and participation in the flow of daily life. Stroke survivors often compensate for these impairments by adapting their movement patterns to incorporate additional degrees of freedom at new joints and body segments. One of the most common compensatory movements is the recruitment of excessive trunk flexion when reaching with the affected upper extremity. Long-term use of these compensations may lead to suboptimal motor recovery and chronic pain or injury due to overuse. Rehabilitation focuses on repetitive practice with the impaired limb to stimulate motor learning and neuroplasticity; however, few interventions achieve the required repetition dose or address the possible negative effects of compensatory movements. Virtual reality (VR) is an emerging tool in rehabilitation science that may be capable of (1) objectively measuring compensation during upper extremity movement, (2) motivating persons to perform large doses of repetitive practice through the integration of virtual environments and computer games, and (3) providing the basis for a motor intervention aimed at improving motor performance and incrementally reducing, or shaping, compensation. The purpose of this project was to develop and test a VR tool with these capabilities for shaping movement compensation for persons with chronic stroke, and to achieve this we performed three separate investigations (Chapters 2-4).First, we investigated the validity and reliability of two generations of an off-the-shelf motion sensor, namely the Microsoft Kinect, for measuring trunk compensations during reaching (Chapter 2). A small group of healthy participants performed various reaching movements on two separate days while simultaneously being recorded by the two sensors and a third considered to be the gold standard. We found that the second generation Kinect sensor was more accurate and showed greater validity for measuring trunk flexion relative to the gold standard, especially during extended movements, and therefore recommended that sensor for future VR development. Research with a more heterogeneous and representative population, such as persons with stroke, will further improve the evaluation of these sensors in future work.Second, we tested a newly-designed VR tool, VRShape, for use during a single session of upper extremity movement practice (Chapter 3). VRShape integrates the Microsoft Kinect and custom software to convert upper extremity movements into the control of various virtual environments and computer games while providing real-time feedback about compensation. A small group of participants with stroke used VRShape to repetitively perform reaching movements while simultaneously receiving feedback concerning their trunk flexion relative to a calibrated threshold. Our tool was able to elicit a large number of successful reaches and limit the amount of trunk flexion used during a single practice session while remaining usable, motivating, and safe. However, areas of improvement were identified relative to the efficiency of the software and the variety of virtual environments available. Third, we implemented VRShape over the course of a motor intervention for persons with stroke and evaluated its feasibility and effect on compensation during reaching tasks (Chapter 4). A small group of participants took part in 18 interventions session using VRShape for repetitive reaching practice with incrementally shaped trunk compensation. Trunk flexion decreased significantly and reaching kinematics improved significantly as a result of the intervention. Even with extended use, participants were able to complete intense practice and thousands of repetitions while continually rating the system as usable, motivating, engaging, and safe. Our VR tool demonstrated feasibility and preliminary efficacy within a small study, but future work is needed to identify its ideal applications and address its limitations. In summary, this project shows that use of a VR tool incorporating an accurate sensor (Chapter 2) and feedback from initial testing (Chapter 3) is capable of changing the amount of trunk flexion used during reaching movements for persons with stroke (Chapter 4). More research is needed to establish its efficacy and effectiveness, but improvements in motor recovery and associated decreases in compensation associated with the use of VRShape are important rehabilitation goals that may lead to improved participation and quality of life for persons living with long-term impairments due to chronic stroke

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

Human-centred design methods : developing scenarios for robot assisted play informed by user panels and field trials

Original article can be found at: http://www.sciencedirect.com/ Copyright ElsevierThis article describes the user-centred development of play scenarios for robot assisted play, as part of the multidisciplinary IROMEC1 project that develops a novel robotic toy for children with special needs. The project investigates how robotic toys can become social mediators, encouraging children with special needs to discover a range of play styles, from solitary to collaborative play (with peers, carers/teachers, parents, etc.). This article explains the developmental process of constructing relevant play scenarios for children with different special needs. Results are presented from consultation with panel of experts (therapists, teachers, parents) who advised on the play needs for the various target user groups and who helped investigate how robotic toys could be used as a play tool to assist in the children’s development. Examples from experimental investigations are provided which have informed the development of scenarios throughout the design process. We conclude by pointing out the potential benefit of this work to a variety of research projects and applications involving human–robot interactions.Peer reviewe

Integrating the Nintendo Wii into Therapy: Resources for Occupational Therapy Practitioners

Therapists have the challenge of identifying a variety of interesting, meaningful, and purposeful intervention activities for individuals needing rehabilitation services (Weiss, Rand, Katz, & Kizony, 2004). The purpose of this project was to develop educational resources for occupational therapists on the integration of the Nintendo Wii as an intervention. An extensive literature review was conducted using PubMed, SCOPUS, CINAHL, professional journals, and news articles to investigate the health related effects of utilizing virtual reality and video games in the rehabilitation process. Currently, there is minimal research identifying the benefits of video games in occupational therapy practice and no protocols were found to assist occupational therapists with implementing the Nintendo Wii into occupational therapy practice. Resources were developed to educate occupational therapy practitioners on integrating the Nintendo Wii as an occupational therapy intervention. Resources include an educational in-service, a system set-up guide, instructions for creating a Mii character, an activity analysis of the Nintendo Wii Sports games, suggested intervention chart for select performance skills, and case scenario application activities. The educational inservice provides information on the role of virtual reality in rehabilitation, benefits and precautions/contraindications of virtual reality, identification of Nintendo Wii equipment, and system set-up instructions. The Adult Learning Theory and the Model of Human Occupation were utilized in the development of the product. This educational in-service provides occupational therapists with information on the integration of the Nintendo Wii. It provides foundational knowledge allowing therapists to adapt and modify the use of the Nintendo Wii to facilitate occupational performance and client-centered practice. The authors of this scholarly project recommend that the Nintendo Wii be used as an adjunct to occupation-based intervention. It is also recommended that more research be conducted regarding the use of video games, specifically the Nintendo Wii, in occupational therapy to determine the efficacy of this type of approach