Bootle Blast, a Movement Tracking Video Game for Home-based Motor Therapy: Understanding the Family Experience
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 60
- 试验地点
- 2
- 主要终点
- Performance Quality Rating Scale (PQRS)
研究概览
简要总结
One in 60 children have a physical disability that can impact activities and participation. Occupational and physical therapies can be of great benefit, but are costly and difficult to access. Working with children, parents and clinicians, the investigators developed a mixed reality video game, Bootle Blast, which children can play to develop motor skills. Using a 3D sensor, Bootle Blast tracks movements and manipulation of real-life objects. Since 2017, Bootle Blast has been used in clinics by Holland Bloorview, Canada's largest children's rehabilitation hospital. Home use of Bootle Blast has resulted in positive clinical outcomes for children with cerebral palsy. Bootle Blast is not yet commercially available and has yet to be trialed in "real-world" contexts.
To understand real-world implementation, Bootle Blast will be trialed for 14 weeks in the homes of 60 young people (6 to 17 years) with any motor condition that could be addressed by the Bootle Blast system, regardless of their diagnosis. The investigators will assess feasibility (e.g. independent home setup, ability to set/meet self-directed play time goals), enablers/barriers to use, and perceived value. User experience will inform product, training and resource development. The research team combines expertise in engineering design, medicine, physiotherapy, qualitative methods, commercialization, knowledge translation, and includes young people with lived experience.
详细描述
One in 60 Canadian children has a physical disability that impacts function, activity and participation. Physical and occupational therapies are important for improving/maintaining their coordination, flexibility, strength, dexterity and function. These therapies can enhance children's independence, education and employment opportunities, as well as leisure play and social inclusion. Therapies can also mitigate need for surgical intervention, secondary injuries and other complications that result from compensatory movements and poor conditioning as the child grows. While the benefits of therapy are significant, costs for families and the healthcare system are escalating. Demand for therapy outpaces availability. Families in rural areas may travel long distances to access services or miss out. Even when resources are available, therapy is seldom offered more than 1 or 2 times/week for 30 - 60 minutes while the literature suggests that 30 - 45 min of practice per day is necessary to drive neuroplastic change and motor learning. This underlies the need for home-based programs to increase opportunities for practice of goal-directed movements. While home-based therapy improves outcomes, nearly half of families report poor adherence due to limited time, lack of motivation, or forgetfulness. For parents, the role of "therapist at home" is associated with many challenges (i.e. structuring practices, ensuring good form, initiating/sustaining participation) and, in fact, can negatively impact parent-child relationships and elevate parental stress and burden of care. Maintaining child and parent motivation in home-based therapies is a long-standing challenge of great importance in pediatric practice. In fact, clinicians rate child motivation to be the most influential trait predicting success in motor therapies.
Movement-tracking video games for home-based therapy practice (i.e. therapy gaming) appeal to clinicians, children and parents. Video games are a popular pastime for 82% of children with disabilities and 88% of children without, with an average play time of 13 hrs/week. As such, therapy gaming is well aligned with the practice of family-centred care which favours treatments preferred by children.Therapy gaming is also compelling from a motor learning perspective with potential for intense practice, feedback, individualized programs, task specificity (i.e. similarity between virtual and real-world tasks), and social equalization. These five features are considered the "active ingredients" (i.e. reasons why a treatment is expected to be effective) of video games for motor therapy.
8 years ago, families and clinicians at Canada's largest children rehabilitation hospital, Holland Bloorview Kids Rehabilitation Hospital (Holland Bloorview), and partner organizations affiliated with Empowered Kids Ontario (EKO), asked: Can video games be used to create fun, effective opportunities for motor practice for children with CP? Finding no suitable technologies to deliver the active ingredients for motor therapy, the investigators partnered with knowledge users (i.e. children with disabilities, siblings, caregivers, clinicians), interdisciplinary researchers, specialists (e.g. engineers, games designers) and with guidance from provincial networks (CP-NET) and external partners (Toronto Innovation Acceleration Partners (TIAP), formerly MaRS Innovation; Ubisoft), developed Bootle Blast. Bootle Blast overcomes many established limitations of video games for motor therapy including: inability to target fine motor skills, solo gameplay and failure to sustain engagement without significant parent/therapist involvement. Bootle Blast is the first video game for motor therapy to apply best practices in motor learning, game design, and motivation theory. It provides high quality biofeedback and is built on a theoretical framework of engagement used in pediatric rehabilitation, as summarized in two systematic reviews the investigators generated in the research process. Using computer vision, Bootle Blast provides real-time feedback on skeletal movements and interactions with real-life objects used in gameplay (e.g. building blocks). This "mixed reality" play experience offers greater task specificity to enhance transfer of skills to everyday activities. It enables individualized treatment plans by supporting a wide range of motor skills with activities that can be calibrated to each child's abilities. Bootle Blast enables differently abled people to play together, enhancing social equalization.
Creating a product that can be successfully used at home by families as a complement to conventional therapies, as well as by those on waitlists or who no longer qualify for clinical services (e.g. children no longer considered for "early intervention"), will greatly expand the market potential of Bootle Blast.
OBJECTIVES. In this project, the investigators will conduct real-world testing to identify potential barriers to home use.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Sequential
- 主要目的
- Health Services Research
- 盲法
- None
盲法说明
Assessors will be trained on practice videos prior to establish consistent scoring practices. Additionally, assessors will be blinded to the time point at which the video recording was collected. Lastly, blinded therapists will observe gameplay videos collected at the beginning and towards the end of the intervention to identify movements made, any compensatory movements observed, repetition counts, fatigue level, as well the child's overall coordination (i.e. the smooth and controlled use of movements in motor performance with consideration of timing, velocity, targeting accuracy, motor planning, directions, force and endurance).
入排标准
- 年龄范围
- 6 Years 至 17 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Any motor condition that can be addressed by the Bootle Blast system;
- •Interest in developing motor skills practiced in BootleBlast;
- •Aged 6-17 years;
- •Sufficient cognitive capacity to play BootleBlast as indicated by caregiver/self report;
- •Able to communicate in English;
- •Intermittent access to internet;
- •Ability to participate in video calling;
- •Have a device to record and upload short videos;
- •Have a caregiver willing to participate.
- •Child Participant
排除标准
- •Uncontrolled epilepsy triggered by video games;
- •Medical condition making the physical activity in BootleBlast unsafe;
- •Visual and/or hearing limitations affecting BootleBlast play;
- •No access to internet at home
- •Has previously participated in a study related to Bootle Blast.
结局指标
主要结局
Performance Quality Rating Scale (PQRS)
时间窗: Weekly throughout study completion (14 weeks)
The PQRS will be used to evaluate parent-recorded videos of children performing one of their COPM each week. The PQRS is an observational, video-based tool that looks at actual performance on client-selected activities, and has been used in the context of SCED research for children with diverse diagnoses, including CP and DCD. It utilizes a 10 point scale with a score of 1 indicating ''can't do the skill at all'' and 10 indicating ''does the skill very well''. Quality takes into account, as applicable to the task, timeliness, accuracy, safety, and overall quality of performance or product. Ratings are based on average of completeness and quality. Inter-rater reliability for the PQRS is moderate ranging from 0.71-0.77. Test-retest reliability is also substantial (\>0.9) across time periods and multiple raters. Assessors will be trained on practice videos to establish consistent scoring practices. Assessors will be blinded to the time point at which the video recording was collected.
Canadian Occupational Performance Measure (COPM)
时间窗: First and last day of Baseline Phase; 8th week of Intervention Phase; 3rd week of Follow-up Phase
The family will complete the Canadian Occupational Performance Measure with the interviewer to establish 1 to 3 goals related to activities of everyday living (e.g. self-care, leisure) that they hope Bootle Blast might help with. The COPM assesses self-perceived performance and satisfaction on activities of importance to child/family. Participants then rate their performance and satisfaction for each goal/challenge area on a scale from 1 to 10 (low to high). Average scores for performance and satisfaction are calculated across the goals. The COPM is extensively used with children with CP in the target age range and with success in the research team's pilot work. It has good validity, responsiveness, reliability, and ability to track change over time. A change of 2 points on either the performance or satisfaction scale is considered clinically significant. The COPM takes \~20 minutes.
次要结局
- Rates of recruitment and attrition(Throughout study (17 weeks))
- Observation of the device set-up: Time Required(Last day of Baseline Phase)
- Children & Adolescent Scale of Participation (CASP)(Week 0; 8th week of Intervention Phase; 3rd week of Follow-up Phase)
- Observation of the device set-up: User Manual Utilization(Last day of Baseline Phase)
- Observation of the device set-up: Affective Responses(Last day of Baseline Phase)
- The ABILHAND-Kids(Week 0; 8th week of Intervention Phase; 3rd week of Follow-up Phase)
- Observation of the device set-up: Participant Interaction with Setup Components(Last day of Baseline Phase)
- Observation of the device set-up: Onboarding Effectiveness(Last day of Baseline Phase)
- Family Information Demographic Form(Following consent but prior to commencement of baseline phase (i.e. Week 0))
- Observation of the device set-up: Complexity of Bootle Blast Setup Process(Last day of Baseline Phase)
- Access To Therapy Services Questionnaire(Following consent but prior to commencement of baseline phase (i.e. Week 0))
- The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)(Day 1 of Baseline Phase; 8th week of Intervention Phase; 3rd week of Follow-up Phase)
- Pre-intervention interview(Day 1 of Baseline Phase)
- System collected data(Throughout intervention phase (Week 1 - 8); Optional Phase (Week 15 - 17))
- Child and Adolescent Factors Inventory (CAFI)(Following consent but prior to commencement of baseline phase (i.e. Week 0))