Upper Body Physical Rehabilitation for Children with Ataxia through IMU-Based Exergame.
Ontology highlight
ABSTRACT:
SUBMITTER: Romano A
PROVIDER: S-EPMC8876617 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
Publications
Upper Body Physical Rehabilitation for Children with Ataxia through IMU-Based Exergame.
Romano Alberto A Favetta Martina M Summa Susanna S Schirinzi Tommaso T Bertini Enrico Silvio ES Castelli Enrico E Vasco Gessica G Petrarca Maurizio M
Journal of clinical medicine 20220218 4
<h4>Background</h4>Children with ataxia experience balance and movement coordination difficulties and needs intensive physical intervention to maintain functional abilities and counteract the disorder. Exergaming represents a valuable strategy to provide engaging physical intervention to children with ataxia, sustaining their motivation to perform the intervention. This paper aims to describe the effect of a home-conducted exergame-based exercise training for upper body movements control of chil ...[more]
Similar Datasets
Project description:BackgroundHome-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting.MethodsFifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31-69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged.ResultsThe usability of the system was considered average to satisfying (mean 60.1-93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems.ConclusionsDespite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system.Trial registrationClinicalTrials.gov NCT02368223.
| S-EPMC4806437 | biostudies-literature
Project description:BackgroundExergames are increasingly used in rehabilitation, yet their usability and user experience for patients and therapists, particularly for functional model systems, are underresearched. The diverse needs and preferences of users make conducting usability studies challenging, emphasizing the need for further investigation in real-world settings.ObjectiveThis study aimed to evaluate the usability, safety, and user experience of a novel exergame functional model, the ExerG, from the perspectives of patients and therapists in a rehabilitation setting.MethodsIn this mixed methods study, 15 patients undergoing rehabilitation (primary end users [PEUs]) and 20 therapists (secondary end users [SEUs]) from 2 rehabilitation centers in Switzerland and Austria participated in exercising and observation sessions with the ExerG. SEUs received training on system use and technical issue management, enabling them to fulfill their therapist roles while treating patients or mock patients. Rapid Iterative Testing and Evaluation was used and the training software adjusted based on participant feedback. Usability was assessed with questionnaires, semistructured interviews, and through observations during the ExerG testing. System acceptability was evaluated using specific quantitative thresholds based on PEU performance and feedback. An observation protocol tracked SEUs' correct use, errors, hesitations, task completion time, and needed assistance across scenarios.ResultsPatients and therapists reported overall good usability and positive experiences with the exergame. PEUs rated 23/29 (79%) instructions as acceptable, showed good-to-very-good exercise performance in 19/29 (65%) tasks, and completed 28/29 (97%) tasks. Patients reported no adverse events, showing improved performance and enjoyment across ExerG exercising rounds, with 79/90 (88%) expressing positive emotions and reporting median scores of 9 (IQR 7.5-10) on a 1-10 user satisfaction scale. Patients were willing to continue using the device if the graphic design was improved (5/15), tracking systems and projector quality were enhanced (each 3/15), instructions clarified (12/15), and the game variety increased (2/15). PEUs felt secure in the safety harness (15/15) but recommended swivel arm movement enhancements (5/15). SEUs effectively executed scenarios, with hesitation and difficulties observed in only 14/41 tasks and 2/41 tasks, across all 20 therapists, accounting for 1.7% and 0.2% of the 820 total task cases, respectively. Therapists' quantitative usability ratings were high (median System Usability Scale score 82.5, IQR 65-95). All SEUs expressed their willingness to use the ExerG (20/20) and reported being able to operate the system using the user handbook (20/20). They emphasized the motivation-enhancing effect of video-game based training (12/20) and considered the activities supportive for physical and cognitive skills (20/20). They suggested incorporating daily living task simulations (13/20), more customizable options (6/20), more targeted motivational feedback (9/20), clearer performance ratings (9/20), and more concise activity instructions (6/20).ConclusionsThe interdisciplinary, iterative ExerG development approach shows promise. The findings will inform future optimizations. Future work will assess long-term impact.
| S-EPMC11844876 | biostudies-literature
Project description:The study aimed to elucidate the influence of cognitive engagement comprised in an acute bout of exergame-based physical activity on executive functions (inhibition, cognitive flexibility) in adolescents. Therefore, the level of cognitive engagement and the intensity of physical activity were systematically varied across three experimental conditions. Sixty-five healthy male adolescents (13-16 years) were randomly assigned to one of three conditions: (a) physical activity with high levels of cognitive engagement during active video gaming, (b) physical activity with low levels of cognitive engagement during active video gaming, (c) sedentary with low levels of cognitive engagement during passive video watching. Manipulation checks, including subjective and objective operationalizations of cognitive engagement, were applied. Executive functions were assessed before and after each condition using the D-KEFS design fluency test. Results showed that cognitive engagement, operationalized by subjects' ratings and heart rate variability, differed between conditions. The physical activity condition with a high level of cognitive engagement resulted in significantly better performance in cognitive flexibility compared to conditions with low levels of cognitive engagement. Regarding benefits for executive functions in male adolescents, the results indicate that acute physical activity with high cognitive engagement could be more efficient than physical activity of the same intensity with low cognitive engagement. Even though further evidence is needed, these results extend previous research and suggest a methodological approach for measuring cognitive engagement.
| S-EPMC5193332 | biostudies-literature
Project description:BACKGROUND:Friedreich ataxia (FRDA) is a disease with neurological and systemic involvement. Clinical assessment tools commonly used for FRDA become less effective in evaluating decay in patients with advanced FRDA, particularly when they are in a wheelchair. Further motor worsening mainly impairs upper limb function. In this study, we tested if serious games (SG) developed for rehabilitation can be used as an assessment tool for upper limb function even in patients with advanced FRDA. METHODS:A specific SG has been developed for physical rehabilitation of patients suffering from neurologic diseases. The use of this SG, coupled with Kinect sensor, has been validated to perform functional evaluation of the upper limbs with healthy subjects across lifespan. Twenty-seven FRDA patients were included in the study. Patients were invited to perform upper limb rehabilitation exercises embedded in SG. Motions were recorded by the Kinect and clinically relevant parameters were extracted from the collected motions. We tested if the existence of correlations between the scores from the serious games and the severity of the disease using clinical assessment tools commonly used for FRDA. Results of patients were compared with a group a healthy subjects of similar age. RESULTS:Very highly significant differences were found for time required to perform the exercise (increase of 76%, t(68)?=?7.22, P?<?0.001) and for accuracy (decrease of 6%, t(68)?=?-?3.69, P?<?0.001) between patients and healthy subjects. Concerning the patients significant correlations were found between age and time (R?=?0.65, p?=?0.015), accuracy (R?=?-?0.75, p?=?0.004) and the total displacement of upper limbs. (R?=?0.55, p?=?0.031). Statistically significant correlations were found between the age of diagnosis and speed related parameters. CONCLUSIONS:The results of this study indicate that SG reliably captures motor impairment of FRDA patients due to cerebellar and pyramidal involvement. Results also show that functional evaluation of FRDA patients can be performed during rehabilitation therapy embedded in games with the patient seated in a wheelchair. TRIAL REGISTRATION:The study was approved as a component of the EFACTS study ( Clinicaltrials.gov identifier NCT02069509 , registered May 2010) by the local institutional Ethics Committee (ref. P2010/132).
| S-EPMC6172838 | biostudies-literature
Project description:This study aims to explore the possibility of estimating a multitude of kinematic and dynamic quantities using subject-specific musculoskeletal models in real-time. The framework was designed to operate with marker-based and inertial measurement units enabling extensions far beyond dedicated motion capture laboratories. We present the technical details for calculating the kinematics, generalized forces, muscle forces, joint reaction loads, and predicting ground reaction wrenches during walking. Emphasis was given to reduce computational latency while maintaining accuracy as compared to the offline counterpart. Notably, we highlight the influence of adequate filtering and differentiation under noisy conditions and its importance for consequent dynamic calculations. Real-time estimates of the joint moments, muscle forces, and reaction loads closely resemble OpenSim's offline analyses. Model-based estimation of ground reaction wrenches demonstrates that even a small error can negatively affect other estimated quantities. An application of the developed system is demonstrated in the context of rehabilitation and gait retraining. We expect that such a system will find numerous applications in laboratory settings and outdoor conditions with the advent of predicting or sensing environment interactions. Therefore, we hope that this open-source framework will be a significant milestone for solving this grand challenge.
| S-EPMC7961635 | biostudies-literature
Project description:Virtual reality games are playing a greater role in rehabilitation settings. Previously, commercial games have dominated, but increasingly, bespoke games for specific rehabilitation contexts are emerging. Choice and design of tasks for VR-games are still not always clear, however; some games are designed to motivate and engage players, not necessarily with the facilitation of specific movements as a goal. Other games are designed specifically for the facilitation of specific movements. A theoretical background for the choice of tasks seems warranted. As an example, we use a game that was designed in our lab: VR Walk. Here, the player walks on a treadmill while wearing a head-mounted display showing a custom-made virtual environment. Tasks include walking on a glass bridge across a drop, obstacle avoidance, narrowing path, walking in virtual footsteps, memory, and selection tasks, and throwing and catching objects. Each task is designed according to research and theory from movement science, exercise science, and cognitive science. In this article, we discuss how for example walking across a glass bridge gives perceptual challenges that may be suitable for certain medical conditions, such as hearing loss, when perceptual abilities are strained to compensate for the hearing loss. In another example, walking in virtual footsteps may be seen as a motor and biomechanical constraint, where the double support phase and base of support can be manipulated, making the task beneficial for falls prevention. In a third example, memory and selection tasks may challenge individuals that have cognitive impairments. We posit that these theoretical considerations may be helpful for the choice of tasks and for the design of virtual reality games.
| S-EPMC8593199 | biostudies-literature
Project description:BACKGROUND:Exergames have the potential to provide an accessible, remote approach for poststroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed, and lack of motivation to pursue exercise programs, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant's completion and adherence. At present, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation. OBJECTIVE:This study aims to (1) determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life, and motivation in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program; GRASP); (2) examine the feasibility of using the technology with participants diagnosed with stroke at home; and (3) identify the obstacles and facilitators for its use by participants diagnosed with stroke and stroke therapists and understand the shared decision-making process. METHODS:A mixed methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct videoconferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 participants diagnosed with stroke, randomly assigned to a control group (n=26; 2-month on-paper home exercise program: the GRASP with no supervision) and an experimental group (n=26; 2-month home program using the technology). The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE), Stroke Impact Scale-16 (the quality of life), and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process, resources, management, and scientific outcomes. Qualitative data will be collected by interviews with both participants and therapists. RESULTS:At present, data collection was ongoing with one participant who had completed the exergame- telerehabilitation based intervention. We expect to collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke; collect feasibility data with users at home (adherence, safety, and technical difficulties); and identify the obstacles and facilitators for the technology use and understand the shared decision-making process. CONCLUSIONS:This paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation. TRIAL REGISTRATION:ClinicalTrials.gov NCT03759106; http://clinicaltrials.gov/show/NCT03759106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/14629.
| S-EPMC7273231 | biostudies-literature
Project description:BackgroundVariational AutoEncoders (VAE) might be utilized to extract relevant information from an IMU-based gait measurement by reducing the sensor data to a low-dimensional representation. The present study explored whether VAEs can reduce IMU-based gait data of people after stroke into a few latent features with minimal reconstruction error. Additionally, we evaluated the psychometric properties of the latent features in comparison to gait speed, by assessing 1) their reliability; 2) the difference in scores between people after stroke and healthy controls; and 3) their responsiveness during rehabilitation.MethodsWe collected test-retest and longitudinal two-minute walk-test data using an IMU from people after stroke in clinical rehabilitation, as well as from a healthy control group. IMU data were segmented into 5-second epochs, which were reduced to 12 latent-feature scores using a VAE. The between-day test-retest reliability of the latent features was assessed using ICC-scores. The differences between the healthy and the stroke group were examined using an independent t-test. Lastly, the responsiveness was determined as the number of individuals who significantly changed during rehabilitation.ResultsIn total, 15,381 epochs from 107 people after stroke and 37 healthy controls were collected. The VAE achieved data reconstruction with minimal errors. Five latent features demonstrated good-to-excellent test-retest reliability. Seven latent features were significantly different between groups. We observed changes during rehabilitation for 21 and 20 individuals in latent-feature scores and gait speed, respectively. However, the direction of the change scores of the latent features was ambiguous. Only eleven individuals exhibited changes in both latent-feature scores and gait speed.ConclusionVAEs can be used to effectively reduce IMU-based gait assessment to a concise set of latent features. Some latent features had a high test-retest reliability and differed significantly between healthy controls and people after stroke. Further research is needed to determine their clinical applicability.
| S-EPMC11452054 | biostudies-literature
Project description:Upper limb motor impairment (ULMI) rehabilitation is a long-term, demanding and challenging process to recover motor functionality. Children and adolescents may be limited in daily life activities due to reduced functions such as decreased joint movement or muscle weakness. Home-based therapy with Immersive Virtual Reality can offer greater accessibility, delivery and early rehabilitation to significantly optimise functional outcomes and quality of life. This feasibility study aimed to explore the perceptions and impacts of an immersive and interactive VR scenario suitable for ULMI rehabilitation for children at home. It was analysed using mixed methods (quantitative and qualitative) and from a multidirectional perspective (patients, clinicians and family members). Amongst the main results, it was found that IVR for ULMI home rehabilitation (1) is easy to learn and acceptable; (2) improves motor function; (3) reduces the difficulty in the reproduction of therapeutic movements; (4) is motivating and enjoyable and (5) improves quality of life. This study is the first study on the use of IVR applied to home rehabilitation of ULMI in children. These results suggested that similar outcomes may be possible with self-directed IVR home rehabilitation compared to face to face conventional rehabilitation, which can be costly to both the patient and the healthcare system, decreasing the length of stay at the hospital and treatment duration. It has also presented an innovative solution to the Covid-19 emergency where children could not receive their clinic therapy. Further research is recommended to understand better the mechanisms involved in physiotherapeutic recovery and how IVR rehabilitation helps to improve conventional treatments. Trial Registration Protocol ID NCT05272436. Release Date: 9th March 2022.
| S-EPMC9840166 | biostudies-literature
Project description:For upper extremity rehabilitation, quantitative measurements of a person's capabilities during activities of daily living could provide useful information for therapists, including in telemedicine scenarios. Specifically, measurements of a person's upper body kinematics could give information about which arm motions or movement features are in need of additional therapy, and their location within the home could give context to these motions. To that end, we present a new algorithm for identifying a person's location in a region of interest based on a Bluetooth received signal strength (RSS) and present an experimental evaluation of this and a different Bluetooth RSS-based localization algorithm via fingerprinting. We further present algorithms for and experimental results of inferring the complete upper body kinematics based on three standalone inertial measurement unit (IMU) sensors mounted on the wrists and pelvis. Our experimental results for localization find the target location with a mean square error of 1.78 m. Our kinematics reconstruction algorithms gave lower errors with the pelvis sensor mounted on the person's back and with individual calibrations for each test. With three standalone IMUs, the mean angular error for all of the upper body segment orientations was close to 21 degrees, and the estimated elbow and shoulder angles had mean errors of less than 4 degrees.
| S-EPMC8952413 | biostudies-literature