Sheryl Flynn

Development of an interactive game-based rehabilitation tool for dynamic balance training.

Abstract Conventional physical therapy techniques have been shown to improve balance, mobility, and gait following neurological injury. Treatment involves training patients to transfer weight onto the impaired limb to improve weight shift while standing and walking. Visual biofeedback and force plate systems are often used for treatment of balance and mobility disorders. Researchers have also been exploring the use of video game consoles such as the Nintendo Wii Fit as rehabilitation tools. Case studies have demonstrated that the use of video games may have promise for balance rehabilitation. However, initial usability studies and anecdotal evidence suggest that the current commercial games are not compatible with controlled, specific exercise required to meet therapy goals. Based on focus group data and observations with patients, a game has been developed to specifically target weight shift training using an open source game engine and the Nintendo Wii Fit Balance Board. The prototype underwent initial usability testing with a sample of clinicians and with persons with neurological injury. Overall, feedback was positive, and areas for improvement were identified. This preliminary research provides support for the development of a game that caters specifically to the key requirements of balance rehabilitation.

Comparison of Single Bout Effects of Bicycle Training Versus Locomotor Training on Paired Reflex Depression of the Soleus H-Reflex After Motor Incomplete Spinal Cord Injury

OBJECTIVE To examine paired reflex depression changes post 20-minute bout each of 2 training environments: stationary bicycle ergometer training (bicycle training) and treadmill with body weight support and manual assistance (locomotor training). DESIGN Pretest-posttest repeated-measures. SETTING Locomotor laboratory. PARTICIPANTS Motor incomplete SCI (n=12; mean, 44+/-16y); noninjured subjects (n=11; mean, 30.8+/-8.3y). INTERVENTION All subjects received each type of training on 2 separate days. MAIN OUTCOME MEASURE Paired reflex depression at different interstimulus intervals (10 s, 1 s, 500 ms, 200 ms, and 100 ms) was measured before and after both types of training. RESULTS (1) Depression was significantly less post-SCI compared with noninjured subjects at all interstimulus intervals and (2) post-SCI at 100-millisecond interstimulus interval: reflex depression significantly increased postbicycle training in all SCI subjects and in the chronic and spastic subgroups (P<.05). CONCLUSIONS Phase-dependent regulation of reflex excitability, essential to normal locomotion, coordinated by pre- and postsynaptic inhibitory processes (convergent action of descending and segmental inputs onto spinal circuits) is impaired post-SCI. Paired reflex depression provides a quantitative assay of inhibitory processes contributing to phase-dependent changes in reflex excitability. Because bicycle training normalized reflex depression, we propose that bicycling may have a potential role in walking rehabilitation, and future studies should examine the long-term effects on subclinical measures of reflex activity and its relationship to functional outcomes.

Breath: A game to motivate the compliance of postoperative breathing exercises

The use of breathing exercises post surgery can reduce pulmonary complications. Incentive spirometry is a widely used device that provides visual feedback for patients during breathing exercises. This paper describes the initial development of an interaction device, game design and initial playtesting and usability of a game to motivate patients to perform post operative breathing exercises.

Development of an interactive stepping game to reduce falls in older adults

Abstract More than one-third of people over the age of 65 years experience falls each year, and those who fall once are two to three times more likely to fall again. A fall can significantly limit a person’s ability to remain self-sufficient. Fall injuries are responsible for significant disability, reduced physical function, and loss of independence. However, falls are not an inevitable result of aging. Systematic reviews of fall intervention studies have established that prevention programs can reduce falls. Physical activities, including strengthening exercises, Tai Chi, dancing and walking have been demonstrated to improve balance and decrease risk of falls in older adults. Modified dance-based exercises that include step-based movements have been demonstrated to improve endurance and balance in older adults. Dance video games, using a dance mat with areas that the player must step on in time with cues on the screen, have been demonstrated to improve activity and mood and reduce weight in children and youth. However, these dance games often include fast paced music, frequent jumping and an overload of visual information, movement and colors on the screen. This paper outlines the development of a prototype rhythm game that leverages the benefits of step-based exercise and dance video games to improve balance and reduce falls in older adults.

Breathe: A Game to Motivate the Adherence of Breathing Exercises

Background and Purpose. Breathing often becomes impaired or difficult after surgeries or in the presence of disease or injury. Breathing exercises are imperative to ensure the health of lungs. Despite this, patient adherence with breathing exercise regimes is not commonly assessed. There is a need for breathing exercise programs that will stimulate motivation, the lack of which is often associated with exercise. Typically, breathing exercises must be performed at regular intervals throughout the day while recovering from surgery or undertaking cycles of prophylactic breathing exercises. Furthermore, there is a need for a device that will provide quantitative measures of patient progress and adherence. An incentive spirometer apparatus measures the volume of air inspired and expired, and provides visual feedback while performing breathing exercises. The development of a game-based incentive spirometry system aims to overcome the typical exercise inertia to motivate patients to perform breathing exercises and to provide individualized challenge levels and quantitative measurement of progress and adherence. Method/Model Description and Evaluation. This research involves an interdisciplinary team of physical therapists, game designers, engineers, and computer scientists. The iterative game-design process was used to develop 6 prototype games. The games underwent a series of user tests. Two game prototypes underwent further refinement and user testing with a sample of physical therapists and people with disabilities. Game usability was assessed and feedback was provided on the incentive spirometry device, game play, system goals, and potential improvements. Outcomes. Initial assessment of the prototype system indicated that both physical therapists and potential users enjoyed the incentive spirometry game and encouraged further development. The potential end users indicated their excitement about the concept of using games for breathing exercises and look forward to the completed game. Discussion and Conclusions. Following further refinement and development, the game-based breathing system will be assessed for effectiveness in improving patient adherence and reducing pulmonary complications, compared to standard treatment techniques. The integration of medical devices with video game technologies offers great potential to improve assessment and treatment tools and patient adherence with physical therapy.

Comparison of Soleus H-Reflexes in Two Groups of Individuals With Motor Incomplete Spinal Cord Injury Walking With and Without a Walker

Objective: To compare phase- and task-dependent H-reflex modulation in standing and walking in 2 spinal cord injury (SCI) groups with and without a walker. Methods: Fourteen subjects with American Spinal Injury Association Impairment Scale D SCI (40±10 years) participated. Tibial nerve was stimulated to evoke 15 H-reflexes (at M-wave 7%-13% of maximum-M). Results: H-reflex was greater in the walker group during stance (but not standing/swing). Conclusion: Differences in H-reflex modulation between groups walking with and without a walker may be explained by sensory mechanism that enhances central excitation, difference in motor activation levels between groups, and other complex mechanisms that influence balance or stability.