NEW BRUNSWICK, N.J. – Engineers at Rutgers University have modified a popular home video game system to help teenagers with cerebral palsy improve hand functions. In a pilot trial with three participants, the system improved the teens’ abilities to perform a range of daily personal and household activities.
The modified system combined a Sony PlayStation 3 console and a commercial gaming glove with custom-developed software and games to provide exercise routines aimed at improving hand speed and range of finger motion.
The Rutgers engineers, who are members of the university’s Tele-Rehabilitation Institute (http://ti.rutgers.edu), worked with clinicians at the Indiana University School of Medicine to deploy systems in participants’ homes for up to 10 months. A description of the modified system and its use in the pilot trial appeared this week in the journal, IEEE Transactions on Information Technology in Biomedicine.
“Based on early experience, the system engages the interest of teens with cerebral palsy and makes it convenient for them to perform the exercises they need to achieve results,” said Grigore Burdea, professor of electrical and computer engineering and director of the Rutgers Tele-Rehabilitation Institute.
Each system communicated via the Internet to allow the Indiana and Rutgers researchers to oversee participants’ exercise routines and evaluate the effectiveness of the systems. The system is an example of both virtual rehabilitation, where patients interact with computer-generated visual environments to perform exercises, and tele-rehabilitation, where patients perform exercises under remote supervision by physical or occupational therapists.
“All three teens were more than a decade out from their perinatal strokes, yet we showed that improvement was still possible ,” said Meredith Golomb, associate professor of neurology at the Indiana University School of Medicine and Riley Hospital for Children pediatric neurologist in this study. “The virtual reality telerehabiltiaiton system kept them exercising by rewarding whatever movements they could make, and all three showed significant progress in hand function.”
Golomb oversaw the pilot study where participants were asked to exercise their affected hand 30 minutes a day, five days a week, using games custom developed by the Rutgers engineers. The games were calibrated to the individual teen’s hand functionality. An on-screen image of a hand showing normal movements guided the participants in their exercises.
After three months of therapy, two participants progressed from being unable to lift large, heavy objects to being able to do so. Participants showed varying improvement in such activities as brushing teeth, shampooing, dressing, and using a spoon. At 10 months, one participant was able to open a heavy door.
The modified PlayStation 3 is the second system based on commercial video gaming technology that Burdea and his institute have developed to investigate economical and engaging rehabilitation therapy tools. Earlier work involved modifying an older model Microsoft Xbox to help stroke victims recover hand functions.
“Systems like this have the potential for widespread deployment in outpatient clinics or the homes of people needing rehabilitation services for any number of illnesses or injuries,” said Burdea, a noted inventor of virtual rehabilitation technology. “Well-designed custom games are likely to hold patients’ attention and motivate them to complete their exercises, versus conventional therapy regimens, which patients may find boring or tedious.”
Burdea acknowledged the popularity of gaming platforms and many newer games that physically engage their players, but noted that they generally are not suitable off-the-shelf for rehabilitation needs. Games for rehabilitation need to focus on the specific impairment, and they require professional oversight to ensure that patients exercise within therapeutic bounds while not over-exercising and risking stress or injury.
The systems that Burdea and his colleagues built combined a PlayStation 3 console with a Fifth Dimension Technologies 5 Ultra sensing glove, a flat-panel television, mouse, keyboard and digital subscriber line modem for Internet communication. They reprogrammed the game console using the open-source Linux operating system and developed games written in Java3D.
One game promoted range of finger motion by asking participants to clean up bars of “dirty” pixels on the screen to reveal an image. Another promoted finger movement speed by asking participants to flick away an on-screen butterfly. A third promoted hand opening and closing speed by asking participants to manipulate an on-screen unidentified flying object.
The developers also wrote software to manage participant scheduling and performance data and to administer subjective evaluation questionnaires.
In addition to Burdea and Golomb, the article’s co-authors are Meghan Huber and Bryan Rabin, both Rutgers undergraduates during the study, and Ciprian Docan and Moustafa AbdelBaky, Rutgers graduate students. The study was funded in part by the National Institutes of Health and the Clarian Foundation.
INDIANAPOLIS – Remotely monitored in-home virtual reality videogames improved hand function and forearm bone health in teens with hemiplegic cerebral palsy, helping them perform activities of daily living such as eating, dressing, cooking, and other tasks for which two hands are needed.
“While these initial encouraging results were in teens with limited hand and arm function due to perinatal brain injury, we suspect using these games could similarly benefit individuals with other illness that affect movement, such as multiple sclerosis, stroke, arthritis and even those with orthopedic injuries affecting the arm or hand,” said Meredith R. Golomb, M.D, M.Sc., Indiana University School of Medicine associate professor of neurology. A pediatric neurologist at Riley Hospital for Children, she is the first author of a pilot study which reported on the rehabilitative benefits of these custom videogames.
This project was done in collaboration with the Rutgers University Tele-Rehabilitation Institute, headed by Grigore Burdea, Ph.D., professor of electrical and computer engineering. The study appears in the January 2010 issue of Archives of Physical Medicine and Rehabilitation.
The researchers also reported that improved hand function appears to be reflected in brain activity changes as seen on functional magnetic resonance imaging (fMRI) scans.
The three study participants were asked to exercise the affected hand about 30 minutes a day, five days a week using a specially fitted sensor glove linked to a remotely monitored videogame console installed in their home. Games, such as one making images appear (“sliders”) were custom developed at Rutgers, calibrated to the individual teen’s hand functionality, included a screen avatar of the hand, and focused on improvement of whole hand function.
“Popular off-the-shelf games are targeted to people with normal hand and arm function and coordination. These games don’t work for or benefit those with moderate-severe hemiplegic cerebral palsy and many other disorders that affect movement. They just aren’t made to be used by or improve hands that can’t pinch or grasp” said Dr. Golomb.
In the future, physical therapists could remotely monitor patients’ progress and make adjustments to the intensity of game play to allow progressive work on affected muscles. In addition to meeting an unfulfilled need, this could potentially also save healthcare dollars and time.
Typically, insurance or government program coverage for rehabilitation therapy for cerebral palsy does not cover teens. Long term physical rehabilitation is costly. And even if cost is not an issue, taking an adolescent out of school and transporting him or her to the hospital or rehab center puts stress on both the patient and their parents. These specially developed games motivated rehabilitation exercises in the home at a time convenient for the teens, broadening access to rehabilitation
The research was funded by the National Institute of Neurological Disorders and Stroke (part of the National Institutes of Health) and by the Clarian Values Fund.
In addition to Dr. Golomb and Dr. Burdea, co-authors of the study are Brenna C. McDonald, PsyD; Stuart J. Warden, PT, Ph.D.; Janell Yonkman, MS, OTR; Andrew J. Saykin, PsyD; Bridget Shirley, OTR Michelle E. Nwosu, MBBS; and Monica Barkat-Masih, MBBS, M.D of Indiana University and Meghan Huber, B.S.; Bryan Rabin, B.S.; Moustafa AbdelBaky, B.S., of Rutgers University.
The IU School of Medicine and Riley Hospital are located on the campus of Indiana University-Purdue University Indianapolis.
The Tele-Rehabilitation Institute is located on the Busch Campus of Rutgers University in Piscataway, N.J.
The Archives of Physical Medicine and Rehabilitation article and an accompanying video demonstration can be found at http://www.archives-pmr.org