Bryan Rabin

In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy

UNLABELLED Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy. OBJECTIVE To investigate whether in-home remotely monitored virtual reality videogame-based telerehabilitation in adolescents with hemiplegic cerebral palsy can improve hand function and forearm bone health, and demonstrate alterations in motor circuitry activation. DESIGN A 3-month proof-of-concept pilot study. SETTING Virtual reality videogame-based rehabilitation systems were installed in the homes of 3 participants and networked via secure Internet connections to the collaborating engineering school and childrens hospital. PARTICIPANTS Adolescents (N=3) with severe hemiplegic cerebral palsy. INTERVENTION Participants were asked to exercise the plegic hand 30 minutes a day, 5 days a week using a sensor glove fitted to the plegic hand and attached to a remotely monitored videogame console installed in their home. Games were custom developed, focused on finger movement, and included a screen avatar of the hand. MAIN OUTCOME MEASURES Standardized occupational therapy assessments, remote assessment of finger range of motion (ROM) based on sensor glove readings, assessment of plegic forearm bone health with dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), and functional magnetic resonance imaging (fMRI) of hand grip task. RESULTS All 3 adolescents showed improved function of the plegic hand on occupational therapy testing, including increased ability to lift objects, and improved finger ROM based on remote measurements. The 2 adolescents who were most compliant showed improvements in radial bone mineral content and area in the plegic arm. For all 3 adolescents, fMRI during grip task contrasting the plegic and nonplegic hand showed expanded spatial extent of activation at posttreatment relative to baseline in brain motor circuitry (eg, primary motor cortex and cerebellum). CONCLUSIONS Use of remotely monitored virtual reality videogame telerehabilitation appears to produce improved hand function and forearm bone health (as measured by DXA and pQCT) in adolescents with chronic disability who practice regularly. Improved hand function appears to be reflected in functional brain changes.

PlayStation 3-based tele-rehabilitation for children with hemiplegia

The convergence of game technology (software and hardware), the Internet, and rehabilitation science forms the second-generation virtual rehabilitation framework. This reduced-cost and patient/therapist familiarity facilitate adoption in clinical practice. This paper presents a PlayStation 3-based hand physical rehabilitation system for children with hemiplegia due to perinatal brain injury (hemiplegic cerebral palsy) or later childhood stroke. Unlike precursor systems aimed at providing hand training for post-stroke adults in a clinical setting, the experimental system described here was developed for in-home tele-rehabilitation on a game console for children and adults with chronic hemiplegia after stroke or other focal brain injury. Significant improvements in Activities of Daily Living function followed three months of training at home on the system. Clinical trials are ongoing at this time.

Maintained Hand Function and Forearm Bone Health 14 Months After an In-Home Virtual-Reality Videogame Hand Telerehabilitation Intervention in an Adolescent With Hemiplegic Cerebral Palsy

Virtual reality videogames can be used to motivate rehabilitation, and telerehabilitation can be used to improve access to rehabilitation. These uses of technology to improve health outcomes are a burgeoning area of rehabilitation research. So far, there is a lack of reports of long-term outcomes of these types of interventions. The authors report a 15-year-old boy with hemiplegic cerebral palsy and epilepsy because of presumed perinatal stroke who improved his plegic hand function and increased his plegic forearm bone health during a 14-month virtual reality videogame hand telerehabilitation intervention. A total of 14 months after the intervention ended, repeat evaluation demonstrated maintenance of both increased hand function and forearm bone health. The implications of this work for the future of rehabilitation in children with neurological disabilities are discussed in this article.

Long-term hand tele-rehabilitation on the playstation 3: Benefits and challenges

Rehabilitation interventions for the hand have shown benefits for children with Hemiplegia due to cerebral palsy or traumatic brain injury. Longer interventions are facilitated if training is provided in the patients home, due to easier access to care and reduced impact on school or work activities. Providing remote rehabilitation over lengthy periods of time has however its own challenges. This paper presents two pediatric patients with hemiplegia, who practiced virtual hand rehabilitation games using a modified PlayStation 3 and 5DT sensing gloves. Despite severe initial hand spasticity, and occasional technology shortcomings, the subjects practiced for about 14 months, and 6 months, respectively. Game performance data for the second patient is presented. Follow-up evaluations 14 months from the removal of the PlayStation 3 from the home of the child with cerebral palsy showed that the patient had good retention in terms of grasp strength, hand function and bone health. Challenges of long-term home tele-rehabilitation are also discussed.

Emotive, cognitive and motor rehabilitation post severe traumatic brain injury-A new convergent approach

Standard of care treats emotive, cognitive and motor rehabilitation needs post severe traumatic brain injury separately. This paper proposes an alternative in the form of convergent rehabilitation, which uses virtual environments to treat the three domains simultaneously. Two clients chronic post severe TBI participated in a feasibility study in which they practiced their affected upper extremity playing custom video games on the Rutgers Arm II. The ABAA protocol consisted of neuro-psychological and motor evaluation pre-, 18 training sessions, then motor and neuro-psychological evaluations post-and at 6 weeks follow up. Training sessions were gradated in duration, difficulty, included dual-tasks, and rewards for good performance. Participants improved in depression, focusing, executive function, shoulder strength and one was faster on the Jebsen test of hand function. Most gains were maintained at follow-up and resulted in improved independence in activities of daily living. Participants liked the technology, giving it a subjective rating of 4.45 out of 5.

Quantifying subcellular dynamics in apoptotic cells with two-dimensional Gabor filters

We demonstrate an optical Fourier filtering method which can be used to characterize subcellular morphology during dynamic cellular function. In this paper, our Fourier filters were based on two-dimensional Gabor elementary functions, which can be tuned to sense directly object size and orientation. We utilize this method to quantify changes in mitochondrial and nuclear structure during the first three hours of apoptosis. We find that the technique is sensitive to a decrease in particle orientation consistent with apoptosis-induced mitochondrial fragmentation. The scattering signal changes were less pronounced in the nucleus and the remainder of the cytoplasm. Particles in these regions were less oriented than mitochondria and did not change orientation significantly.

Direct and highly sensitive measurement of the spatial arrangement of microstructures within biological samples

Quantitative morphological assessment of biological cells and their subcellular environment is important to characterize cellular state in normal and diseased tissue and cellular response to various experimental treatments. Recently, we showed that optical Gabor-like filtering of light scattered by spheres yields an optical measurement which varies linearly with diameter. In addition, the sensitivity to changes in size was superior to post-processing of digital images. Here, we extend our previous results by showing that the linear relationship between Gabor filter period and particle size holds over a size range from 100nm to 2000nm. We also show that this relationship is independent of the particles or mediums refractive index. Using simulations, we provide a theoretical basis for our findings. Unlike previous methods, this technique does not require the presence of single isolated particles and thus may be used to directly extract the characteristic size associated with the local texture of heterogeneous objects. We therefore discuss this applicability of our method in heterogeneous samples consisting of collagen and living cells.

Optimizing Filter Design for Optical Scatter Microscopy

We show a method to quantify the morphology of biological structures by observing the sample through two-dimensional optical Fourier filters implemented on a liquid crystal device. We present filter configurations with sensitivity to sample texture.