Marcus King

Bilateral upper-limb rehabilitation after stroke using a movement-based game controller

This study aimed to determine the effectiveness of a bilateral, self-supported, upper-limb rehabilitation intervention using a movement-based game controller for people with chronic stroke. Fourteen participants received a control treatment, followed by a washout period, and then the intervention. The intervention comprised playing computer games with the CyWee Z (CyWee Group Ltd; Taipei, Taiwan), a movement-based game controller similar to the Nintendo Wii remote. The CyWee Z was incorporated into a handlebar, making bilateral exercises possible by allowing the unaffected side to support and assist the affected side. The intervention lasted for 8 to 10 sessions of 45 to 60 minutes over a period of 2.5 weeks. The Fugl-Meyer Assessment upper-limb section (FMA-UL) was used as the primary outcome. The Wolf Motor Function Test and the Disabilities of Arm, Shoulder, and Hand outcome measure were used as secondary outcomes. Postintervention, motor performance as measured by the FMA-UL was significantly improved compared with all preintervention assessments (p < 0.001), whereas no changes were found on both secondary outcomes. It can be concluded from this pilot study that upper-limb motor performance of adults with chronic stroke improves with repetitive, game-assisted, self-supported bilateral exercises.

An affordable, computerised, table-based exercise system for stroke survivors

Purpose. Loss of hand function as a result of upper limb paresis after a stroke leads to reduced independence. Robotic-assisted therapy with virtual reality leads to improvements in motor function, but there is a need to improve the cost-benefit ratio of these therapies. This case series study investigated augmented reality computer games which provided a rewarded, goal-directed task to upper limb rehabilitation via a gravity supported reaching task. Methods. A computer game was developed to motivate chronic stroke survivors to undertake gravity supported reaching tasks performed on a table, and a focus group study investigated the application of this device for rehabilitation. From the focus group, a simple device was developed to improve the quality of the exercise and a further focus group study investigated a variety of computer games to determine motivations for undertaking rehabilitation exercises. Results. Of the four participants in the case study, two showed improvement in ability to play the game and in arm function. Participants enjoyed playing a range of computer games and felt that the system provided a worthwhile exercise. Motivation for undertaking exercise with the system included: intellectual stimulation during game play, feedback such as game score, gaining physical benefits from the exercise, the system tolerating varying levels of disability, ability to relate to the game and ability to use the system in social groups. Conclusions. A low-cost device has been developed which increases the exercise of gravity supported reaching movements, provides goal-directed tasks with rewards and motivates the user to undertake extended rehabilitation.

Bilateral upper limb trainer with virtual reality for post-stroke rehabilitation: case series report

Purpose. Stroke is a leading cause of disability with many survivors having upper limb (UL) hemiparesis. UL rehabilitation using bilateral exercise enhances outcomes and the Bilateral Upper Limb Trainer (BUiLT) was developed to provide symmetrical, bilateral arm exercise in a ‘forced’ and self-assistive manner, incorporating virtual reality (VR) to provide direction and task specificity to users as well as action observation–execution and greater motivation to exercise. Methods. The BUiLT + VR system was trialled on five post-stroke participants with UL hemiparesis: one sub-acute and four chronic. The intervention was supplied for 45 min, 4 days/week for 6 weeks. The Fugl-Meyer Upper Extremity score (FMA-UE) was used as the primary outcome measure. Secondary outcome measures used were UL isometric strength and the Intrinsic Motivation Inventory (IMI) questionnaire. Results. The BUiLT + VR therapy increased FMA-UE scores from 1 to 5 and overall strength in the shoulder and elbow. Motivation at the end of intervention was positive. Conclusions. Therapy using the BUiLT + VR system is reliable, can be administered safely and has a positive trend of benefit as measured by the FMA-UE, isometric strength testing and IMI questionnaire.

An affordable, computerized, table-based exercise system for stroke survivors

Loss of hand function as a result of upper limb paresis after a stroke leads to a loss of independence and the strength of the paretic upper limb is strongly related to measures of activity. Robotic-assisted therapy with virtual reality, leads to improvements in motor function, but, there is a need to improve the cost-to-benefit ratio of these therapies. This case series study investigated an augmented reality computer game which provided a rewarded, goal-directed task to upper limb rehabilitation via a reaching task motivated by a computer game. A device was developed to increase the exercise effort for the table-based therapy. Of the 4 participants in the case study, 2 showed improvement in ability to play the game and in arm function. Participants felt that the system provided a worthwhile exercise that they would carry out in a home rehabilitation setting.

Participant perceptions of use of CyWee Z as adjunct to rehabilitation of upper-limb function following stroke

This article reports on the perceptions of 14 adults with chronic stroke who participated in a pilot study to determine the utility, acceptability, and potential efficacy of using an adapted CyWee Z handheld game controller to play a variety of computer games aimed at improving upper-limb function. Four qualitative in-depth interviews and two focus groups explored participant perceptions. Data were thematically analyzed with the general inductive approach. Participants enjoyed playing the computer games with the technology. The perceived benefits included improved upper-limb function, concentration, and balance; however, six participants reported shoulder and/or arm pain or discomfort, which presented while they were engaged in play but appeared to ease during rest. Participants suggested changes to the games and provided opinions on the use of computer games in rehabilitation. Using an adapted CyWee Z controller and computer games in upper-limb rehabilitation for people with chronic stroke is an acceptable and potentially beneficial adjunct to rehabilitation. The development of shoulder pain was a negative side effect for some participants and requires further investigation.

ImAble system for upper limb stroke rehabilitation

ImAble is an integrated upper limb (UL) exercise system comprising three devices (Able-B, Able-M and Able-X) targeting UL rehabilitation using computer games and virtual reality (VR). The system can be tailored to different levels of ability and strength, depending on the presentation of the stroke. Results from pilot testing and case studies indicate a therapeutic benefit for both movement outcome and patient motivation.

Gravity-Supported Exercise With Computer Gaming Improves Arm Function in Chronic Stroke

OBJECTIVE To investigate the effect of 4 to 6 weeks of exergaming with a computer mouse embedded within an arm skate on upper limb function in survivors of chronic stroke. DESIGN Intervention study with a 4-week postintervention follow-up. SETTING In home. PARTICIPANTS Survivors (N=13) of chronic (≥6 mo) stroke with hemiparesis of the upper limb with stable baseline Fugl-Meyer assessment scores received the intervention. One participant withdrew, and 2 participants were not reassessed at the 4-week follow-up. No participants withdrew as a result of adverse effects. INTERVENTION Four to 6 weeks of exergaming using the arm skate where participants received either 9 (n=5) or 16 (n=7) hours of game play. MAIN OUTCOME MEASURE Upper limb component of the Fugl-Meyer assessment. RESULTS There was an average increase in the Fugl-Meyer upper limb assessment score from the beginning to end of the intervention of 4.9 points. At the end of the 4-week period after the intervention, the increase was 4.4 points. CONCLUSIONS A 4- to 6-week intervention using the arm skate significantly improved arm function in survivors of chronic stroke by an average of 4.9 Fugl-Meyer upper limb assessment points. This research shows that a larger-scale randomized trial of this device is warranted and highlights the potential value of using virtual reality technology (eg, computer games) in a rehabilitation setting.

Augmented Reality Assisted Upper Limb Rehabilitation Following Stroke

Stroke is a rapidly developing loss of brain function(s) resulting from lack of blood flow caused by either a blockage, or a hemorrhage (Sims & Muyderman, 2009). Common motor impairments after stroke include muscle weakness, reduced reaction time, loss of joint range of motion and disordered movement organization: hemiparesis or weakness on one side of the body is common. It is widely regarded as a leading cause of disability in the developed world (Adamson et al., 2004). For survivors of stroke, these impairments can severely limit daily activities and participation in social and family environments (Merians et al., 2002; Werner & Kessler, 1996). The upper limb (UL) in particular remains problematic post stroke. Whereas up to 83% of stroke survivors learn to walk again (Skilbeck et al., 1983), it is estimated that only 5 to 20% of stroke survivors attain complete functional recovery of their affected UL (Kwakkel et al., 2003). This may be in part because the high costs of standard therapy mean that treatment frequently ceases once patients are released from acute care and long term outcomes are often poor (Feys et al., 1998; Carter et al., 2006). Another possibility is that it is possible for the patient to learn to use their unaffected arm almost exclusively for most activities of daily living, whereas the patient has no choice but to use both legs for walking (Feys et al., 1998; Kwakkel et al., 1999). Additionally, significant loss of hand function may cause some people to abandon any residual function in that hand through learned non-use (Sterr et al., 2002).

Training wheelchair navigation in immersive virtual environments for patients with spinal cord injury – end-user input to design an effective system

Abstract Purpose: A user-centred design was used to develop and test the feasibility of an immersive 3D virtual reality wheelchair training tool for people with spinal cord injury (SCI). Method: A Wheelchair Training System was designed and modelled using the Oculus Rift headset and a Dynamic Control wheelchair joystick. The system was tested by clinicians and expert wheelchair users with SCI. Data from focus groups and individual interviews were analysed using a general inductive approach to thematic analysis. Results: Four themes emerged: Realistic System, which described the advantages of a realistic virtual environment; a Wheelchair Training System, which described participants’ thoughts on the wheelchair training applications; Overcoming Resistance to Technology, the obstacles to introducing technology within the clinical setting; and Working outside the Rehabilitation Bubble which described the protective hospital environment. Conclusions: The Oculus Rift Wheelchair Training System has the potential to provide a virtual rehabilitation setting which could allow wheelchair users to learn valuable community wheelchair use in a safe environment. Nausea appears to be a side effect of the system, which will need to be resolved before this can be a viable clinical tool. Implications for Rehabilitation Immersive virtual reality shows promising benefit for wheelchair training in a rehabilitation setting. Early engagement with consumers can improve product development.

A novel communication application to encourage social interaction by children with autism spectrum disorder

Difficulty with social interactions is a feature of Autistic Spectrum Disorder (ASD) and can be present in children who have other developmental disorders. A novel application using computer technology was designed by Callaghan Innovation to improve social interaction in this population by assisting casual conversation between two people with minimal external facilitation. We compared the application with the children’s existing Augmentative and Alternative Communication (AAC) devices and Picture Communication Symbols (PCSTM). A sample of three pairs (n = 6) of adolescents, who have a diagnosis of ASD or another developmental condition affecting their social interaction and communication, were videotaped and analysed using all three modes. The new application provided better social interaction, attention, independence and enjoyment than the existing systems. Graham H, Bond A, McCormick M, Hobbs O, Yoo C, Gupta S, Mulligan H, King M (2016) A novel communication application to encourage social interaction by children with autism spectrum disorder. New Zealand Journal of Physiotherapy 44(1): 50-57. doi: 10.15619/NZJP/44.1.06