Navid Shirzad

Video games and rehabilitation: using design principles to enhance engagement in physical therapy.

Patient nonadherence with therapy is a major barrier to rehabilitation. Recovery is often limited and requires prolonged, intensive rehabilitation that is time-consuming, expensive, and difficult. We review evidence for the potential use of video games in rehabilitation with respect to the behavioral, physiological, and motivational effects of gameplay. In this Special Interest article, we offer a method to evaluate effects of video game play on motor learning and their potential to increase patient engagement with therapy, particularly commercial games that can be interfaced with adapted control systems. We take the novel approach of integrating research across game design, motor learning, neurophysiology changes, and rehabilitation science to provide criteria by which therapists can assist patients in choosing games appropriate for rehabilitation. Research suggests that video games are beneficial for cognitive and motor skill learning in both rehabilitation science and experimental studies with healthy subjects. Physiological data suggest that gameplay can induce neuroplastic reorganization that leads to long-term retention and transfer of skill; however, more clinical research in this area is needed. There is interdisciplinary evidence suggesting that key factors in game design, including choice, reward, and goals, lead to increased motivation and engagement. We maintain that video game play could be an effective supplement to traditional therapy. Motion controllers can be used to practice rehabilitation-relevant movements, and well-designed game mechanics can augment patient engagement and motivation in rehabilitation. We recommend future research and development exploring rehabilitation-relevant motions to control games and increase time in therapy through gameplay. Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A61) for more insights from the authors.

Usability Testing of Gaming and Social Media Applications for Stroke and Cerebral Palsy Upper Limb Rehabilitation

As part of the FEATHERS (Functional Engagement in Assisted Therapy Through Exercise Robotics) project, two motion tracking and one social networking applications were developed for upper limb rehabilitation of stroke survivors and teenagers with cerebral palsy. The project aims to improve the engagement of clients during therapy by using video games and a social media platform. The applications allow users to control a cursor on a personal computer through bimanual motions, and to interact with their peers and therapists through the social media. The tracking applications use either a Microsoft Kinect or a PlayStation Eye camera, and the social media application was developed on Facebook. This paper presents a usability testing of these applications that was conducted with therapists from two rehabilitation clinics. The “Cognitive Walkthrough” and “Think Aloud” methods were used. The objectives of the study were to investigate the ease of use and potential issues or improvements of the applications, as well as the factors that facilitate and impede the adoption of technology in current rehabilitation programs.

Perceptions of Technology and Its Use for Therapeutic Application for Individuals With Hemiparesis: Findings From Adult and Pediatric Focus Groups

Background Digital technology is becoming an increasingly popular means of delivering meaningful therapy to individuals with neurological impairments. An understanding of clients’ technology use and their perspectives on incorporating technology into rehabilitation can provide researchers and designers with valuable information to inform development of technologies and technology-based rehabilitation programs. Objective This study was designed to establish the current use and perceptions of gaming, social media, and robotics technologies for rehabilitative purposes from the perspective of adults and children with upper limb impairments to identify barriers and enablers to their adoption and use. Methods We conducted three focus groups consisting of pediatric (n=7, mean age 11.0 years) and adult (n=8, mean age 60.8 years) participants with hemiparesis affecting their upper limb. We applied thematic analysis methods to the resulting data. Results We identified three key themes: (1) clients’ use of technology in everyday life and rehabilitation, (2) barriers to use, and (3) enablers to therapy. Participants had limited exposure to technology for therapeutic purposes, but all acknowledged the potential benefits in providing motivation and interest for the performance of repetitive task practice. Adult participants requested efficacious, simple, and easy-to-use technology for rehabilitation with programs that could be individualized for them and expressed that they wanted these programs to provide a motivating means of repeated practice of therapeutic movements. In contrast, pediatric participants emphasized a desire for technology for rehabilitation that offered opportunities for social interaction and interactive games involving their whole body and not only their affected limb. Perceived safety and privacy were concerns for both groups. Conclusions Our findings highlight that all participants were open to the integration of technology into rehabilitation. Adult participants were more pragmatically motivated by potential recovery gains, whereas pediatric participants were more intrinsically motivated by access to games.

A reliability assessment of constrained spherical deconvolution-based diffusion-weighted magnetic resonance imaging in individuals with chronic stroke.

BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) is commonly used to assess white matter properties after stroke. Novel work is utilizing constrained spherical deconvolution (CSD) to estimate complex intra-voxel fiber architecture unaccounted for with tensor-based fiber tractography. However, the reliability of CSD-based tractography has not been established in people with chronic stroke. NEW METHOD Establishing the reliability of CSD-based DW-MRI in chronic stroke. High-resolution DW-MRI was performed in ten adults with chronic stroke during two separate sessions. Deterministic region of interest-based fiber tractography using CSD was performed by two raters. Mean fractional anisotropy (FA), apparent diffusion coefficient (ADC), tract number, and tract volume were extracted from reconstructed fiber pathways in the corticospinal tract (CST) and superior longitudinal fasciculus (SLF). Callosal fiber pathways connecting the primary motor cortices were also evaluated. Inter-rater and test-retest reliability were determined by intra-class correlation coefficients (ICCs). RESULTS ICCs revealed excellent reliability for FA and ADC in ipsilesional (0.86-1.00; p<0.05) and contralesional hemispheres (0.94-1.00; p<0.0001), for CST and SLF fibers; and excellent reliability for all metrics in callosal fibers (0.85-1.00; p<0.05). ICC ranged from poor to excellent for tract number and tract volume in ipsilesional (-0.11 to 0.92; p≤0.57) and contralesional hemispheres (-0.27 to 0.93; p≤0.64), for CST and SLF fibers. COMPARISON WITH EXISTING METHOD Like other select DW-MRI approaches, CSD-based tractography is a reliable approach to evaluate FA and ADC in major white matter pathways, in chronic stroke. CONCLUSION Future work should address the reproducibility and utility of CSD-based metrics of tract number and tract volume.

FEATHERS, A bimanual upper limb rehabilitation platform: A case study of user-centred approach in rehabilitation device design

The healthcare sector is increasingly becoming dependent on medical devices and technologies. This is facilitated, in part, by the emphasis that is being put on the robustness of the design of medical and rehabilitation devices. The robustness of the design, and thus the adoption of a new medical device, relies heavily on its ability to fit into the multifaceted medical environment and satisfy a wide range of user needs. In order to achieve this, users and stakeholders must be involved early and frequently in the design process. In this paper, we outline a user-centred approach to design of physical therapy devices using a case study on developing an upper-body motor rehabilitation platform.

Physiological responses to error amplification in a robotic reaching adaptation task.

Analysis of physiological responses provides an objective measure of a persons affective state and has been proposed as a way to evaluate motivation and engagement of therapy clients during robot-assisted therapy regimens. This paper presents the analysis of three physiological responses to different levels of error amplification in a robotic reaching task to understand the feasibility of using physiological signals in order to modify therapy exercises to achieve higher participant attentiveness. In a pilot study with 22 healthy participants, we analyzed skin conductance, skin temperature, and respiration signals, with two main goals: 1) to compare physiological parameters between baseline (rest) and error-amplified reaching motion periods; and 2) to compare physiological parameters between reaching motion periods with different levels of error amplification. Results show that features extracted from skin conductance and respiration signals show significant differences between different error amplification levels. Features extracted from the skin temperature signal are not as reliable as measures of skin conductance and respiration, however they can provide supplementary information.

The use of physiological signals and motor performance metrics in task difficulty adaptation : improving engagement in robot-assisted movement therapy

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