Marlene Sandlund

Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review

The aim of this review was to examine systematically the evidence for the application of interactive computer play in the rehabilitation of children with sensorimotor disorders. A literature search of 11 electronic databases was conducted to identify articles published between January 1995 and May 2008. The review was restricted to reports of intervention studies evaluating the impact of interactive computer play on motor rehabilitation in children. For each study the quality of the methods and the strength of the evidence were assessed by two independent reviewers using the guidelines of the American Academy for Cerebral Palsy and Developmental Medicine. A total of 74 articles were identified, of which 16 met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and half were case series or case reports. Areas investigated were movement quality, spatial orientation and mobility, and motivational aspects. Thirteen studies presented positive findings. Two of the three RCTs investigating movement quality and one level III study examining spatial orientation showed no significant improvements. Interactive computer play is a potentially promising tool for the motor rehabilitation of children but the level of evidence is too limited to assess its value fully. Further and more convincing research is needed.

Using motion interactive games to promote physical activity and enhance motor performance in children with cerebral palsy

Objective: To explore the feasibility of using low-cost motion interactive games as a home-based intervention for children with cerebral palsy (CP). Methods: Fourteen children with CP, 6–16 years old, practiced with the EyeToy for PlayStation2® in their homes during 4 weeks. Outcome measures were physical activity monitors, Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency (sub-test 5 : 6), 1 Minute Walk Test and gaming diaries. Results: Motivation for practice and compliance of training were high. The childrens physical activity increased during the intervention and activity monitors were feasible to use, although data loss may be a concern. According to mABC-2 the childrens motor performance improved, but there were both floor and ceiling effects. The two additional motor tests showed only non-significant progress. Conclusion: It is highly feasible to use motion interactive games in home rehabilitation for children with CP. Specific motor effects need to be further explored.

Fall Risk Awareness and Safety Precautions Taken by Older Community-Dwelling Women and Men—A Qualitative Study Using Focus Group Discussions

Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women’s and men’s understanding of fall risk and their experiences with safety precautions taken to prevent falls. Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively. Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one’s fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was “Safety precautions through fall risk awareness”. Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts. Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples’ conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.

Training of goal directed arm movements with motion interactive video games in children with cerebral palsy – A kinematic evaluation

Abstract Objective: The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context. Method: Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets. Results: The children’s movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness. Conclusion: Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.

Low-cost motion interactive video games in home training for children with cerebral palsy: A kinematic evaluation

3D motion analysis was applied to assess goal-directed arm movements in 15 children with cerebral palsy (CP) before and after four weeks of home training with low-cost motion interactive video games. The results indicated that the children improved movement precision when playing the virtual games, improved movement smoothness when reaching for real targets, and reduced the involvement of the trunk especially when reaching with the non-dominant side.

A conceptual framework for design of interactive computer play in rehabilitation of children with sensorimotor disorders

Abstract Background: Interactive computer play is a promising tool in rehabilitation of children. There is still little research presented in this field, and thus sparse evidence for its effectiveness. It is however evident that children, parents and therapists are in favour of this form of training and that modern motor learning theories fit very well with the concept of practising in interactive computer-based environments. There is nevertheless a need for development of new systems purposely designed for rehabilitation and this work faces substantial challenges. Objectives: In this paper we briefly present our ongoing research regarding interactive training for children with sensorimotor disorders, and reflections about challenges in the development of new interactive systems for motor rehabilitation. Methods: Interactive training using low-cost motion interactive games was evaluated with three-dimensional kinematic motion analysis, clinical motor tests, physical activity monitors, interviews and gaming diaries. Conclusions: To make interactive computer play feasible in rehabilitation of children, we believe that the technique should be easily accessible in the homes of the children. Games made for the rehabilitation of children should also be flexible, partly to match the various needs of children with different disabilities, but also to enable challenging stimulation to match progress and provide variation that stimulates motivation for practice. Appropriate feedback is crucial for motivation and in order to provide this, it is important to establish optimal solutions for assessing motor control progress. Our experiences from three-dimensional motion analysis suggest that incorporating instruments for kinematic measurements into interactive games would be valuable.

Normal reactions to orthostatic stress in Rett syndrome.

The aim of this study was to investigate orthostatic reactions in females with Rett syndrome (RTT), and also whether the severity of the syndrome had an impact on autonomic reactions. Based on signs of impaired function of the central autonomic system found in RTT, it could be suspected that orthostatic reactions were affected. The orthostatic reactions in 21 females with RTT and 14 normally developed females matched by age were investigated when they rose from a sitting position, and during standing for 3 min. Reactions of the heart, the blood pressure and the time for recovery of systolic blood pressure, were studied in real time, heartbeat by heartbeat, simultaneously. There was no difference between participants with RTT and the normally developed controls regarding general orthostatic reactions (heart rate, systolic and diastolic blood pressure, and mean arterial pressure) when getting up from a sitting position, and when standing erect for 3 min. In the specific immediate response by the heart to standing up, the 30:15 ratio, significantly lower values were found for females with RTT. In the RTT group, the maximum fall of systolic blood pressure showed a tendency to a larger decrease, and the initial decrease in systolic blood pressure was significantly faster. The time for recovery of systolic blood pressure from standing erect did not differ between groups. At baseline the females with RTT had significantly lower systolic blood pressure and a tendency to a higher heart rate. The results do not indicate any autonomic limitations for people with RTT in getting up from a sitting position and standing. The participants with RTT had normal orthostatic reactions indicated by the heart and blood pressure responses when standing erect for 3min. A faster initial drop in systolic blood pressure in people with RTT was notable.

Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review

BackgroundTo offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women’s and men’s views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people’s views or preferences regarding uptake and adherence to exercise to prevent falls.MethodsA review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach.ResultsNine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men’s and women’s views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies.ConclusionAlthough there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women’s and men’s views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.

Activity Qualifiers in an Argumentation Framework as Instruments for Agents When Evaluating Human Activity

Theoretical frameworks have been developed for enabling software agents to evaluate simple activities such as walking and sitting. However, such frameworks typically do not include methods for how practically dealing with uncertain sensor information. We developed an argument-based method for evaluating complex goal-based activities by adapting two qualifiers: Performance and Capacity defined in the health domain. The first one evaluates what a person does, and the second one how “well” or “bad” an activity is executed. Our aim is to deal with uncertainty and inconsistent information; generate consistent hypotheses about the activity execution; and resemble an expert therapist judgment, where an initial hypothesis assessment can be retracted under new evidence. We conducted a pilot test in order to evaluate our approach using a Physiotherapy assessment test as a goal-based activity. Results show that skeptic argumentation semantics are may be useful for discriminating individuals without physical issues by considering Performance and Capacity; conversely, credulous semantics may be suitable for obtaining information in the evaluation of activity, which an intelligent agent may use for providing personalized assistance in an ambient assisted living environment.

Interactive Games in Motor Rehabilitation for Children with Sensorimotor Disorders

Interactive computer environments may be a good way to make motor practice more fun and motivating for children with sensorimotor disorders. However, appropriate computer environments that could be used for this purpose need to be systematically tested in rehabilitation settings in order to evaluate their impact on motor aspects as well as on motivation and activity levels. This abstract describes pilot data from an ongoing intervention study involving children diagnosed with cerebral palsy. The interactive environment used is the Sony¿s EyeToy system for PlayStation2. The intervention is evaluated through interviews as well as with activity monitoring and motor assessments, including 3D motion analysis. Here we will report pilot data based on the interviews.