Computer Game-based Exercise Program Targeting Manual Dexterity for People With Spinal Cord Injury or Stroke.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 35
- 试验地点
- 1
- 主要终点
- Computer game-based Upper Extremity (CUE) assessment of manual dexterity
研究概览
简要总结
Recovery programs of the upper extremity can be extensive, for many adults with neurological disorders/injuries, including maintenance exercises that need to be done continually to maintain function and to prevent secondary disabilities. However increasing demands and shrinking funds are making it harder to meet the rehabilitation needs of Manitobans and Canadians with chronic disabilities. There is a need for innovation to improve the accessibility and engagement of rehabilitation programs for adults with upper extremity (UE) motor impairments due to spinal cord and acquired brain injuries.
The purpose of this research proposal is the further development and validation of a multipurpose plug-n-play rehab gaming system for use in community centers, in particular, at First Step Wellness center. It's no sleight of hand our gaming system provides a basis for repetitive, task-specific therapy focused on manual dexterity; object handling and manipulation for adults with spinal cord and acquired brain injuries. It was designed to transition engaging, highly effective and personalized rehabilitation programs to function in community centers , and with automated monitoring (tele monitoring), which to manage and progress outreach programs.
The gaming system consist of hardware and software components the hardware includes a low-cost, portable smart exercise manipulanduu device (EMD), with assistive technology. The EMD is designed as a HID compliant plug-n-play computer input device that emulates a standard optical computer mouse. Therefore these devices can be used with most any common/ modern computer video game that function by mouse control. Inclusion of "fun" gaming elements is intended to provide extra motivation for the patients in the form of a challenge and a more enjoyable means of encouraging them to follow tedious, repetitive movements that are often a part of the rehabilitation process. Therapeutic value can be derived from both the types of object manipulation tasks (use of the EMD), as well as the choice of computer games. Many inexpensive and readily available common computer games exist that require different levels of movement amplitude, speeds, accuracy repetition, cognitive enhancements, and offer sufficient diversity to appeal to a broad range of individual preferences (both children and adults).
A purpose-built Rehabilitation game (RTP game) has also been developed and validated. It was designed to gather event data and synchronize it with patient movements while they practice a range of game-based exercises with the hand and arm. This will provide; a) automated monitoring, assessment embedded into treatment, b) Immediate feedback to client, and c) electronic outcome measures to quantify and track client's performance over time Clinical support of outreach programs with protocols that can be easily updated will help create better-targeted and personalized solutions for patients and achieve the desired rehabilitation outcomes.
The innovation of this approach comes from the implementation of well-designed, yet inexpensive and easy-to-use hardware and computer software (i.e. in essence a computer mouse and a computer game). It can be judged in terms of the fact that the proposed system would provide highly effective exercise programs with embedded assessment and timely feedback/support for use in community centers and ultimately the home (tele rehabilitation). This research will contribute to the development and validation of promising, new technologies that have he capacity to become widely adopted as a viable, affordable eHealth tool that will support the quality of life and participation of Canadians living with chronic disabilities.
详细描述
Background Many adults with neuromuscular impairments affecting the upper extremity (UE) have deficits in fine motor skills [1-3]. Manual dexterity involving handling and manipulating objects is essential for many daily life activities, and social life. These activities require manipulation of objects with a wide range of physical properties and functional demands which often require a high degree of precision.
Constraint-induced movement therapy (CIMT [4-6]. are promising rehabilitation programs for restoration of hand-arm function. These treatment approaches stress that functional recovery reflects learning achieved through generating real experiences, applying focused attention, simulating close-to-normal movements, and repetition 12-14 Supervised task-specific therapies is preferred, but is challenging to deliver due to early discharge of patients, increasing demands for rehabilitation services by an aging population, as well as financial AND travel distance pressures. To overcome these challenges, we need feasible and cost effective methods to increase accessibility. Ideally, effective therapy programs should be made available in community centers and ultimately in patient homes.
In addition to increasing accessibility, there is a need to improve compliance of exercise regimes. An emerging approach to engage clients in therapy is to incorporate computer games [7-8].
Activities in computer games can provide a behavioral, ecologically valid, and adaptive environment. In addition they can provide immediate feedback as well as, electronic records to assess and assist in THE progression of interventions. Several gaming systems have been used in rehabilitation of the upper extremity. These include, commercial entertainment gaming systems like the Wii [9], Kinect [10], Leaps motion sensor [11], and sensor-equipped glove es [12]. These gaming systems can detect arm segment motions or finger motions-and in real-time-the motion signals are used to control the position and motion of virtual avatars/objects, or to control a game paddle for play. However, these systems are limited, because they do not target object handling and manipulation. Therefore, there is no consideration of sensory processing of skin tactile sensory information required to maintain object stability during movement, and to detect and minimize slip of the moving object [13, 14]. It is crucial to create experiences that improve the brain's ability to learn, and for manual dexterity this is best achieved by performing precise object manipulation tasks through guided and assisted repetition [15].
Based on the above considerations a low cost computer game based rehabilitation platform was developed that combines fine manipulation and gross movement exercises with "fun" computer video game activities appropriate for young children and adults with acquired brain and spinal cord injuries [16-19). Finger-hand function was targeted to extend the utility beyond gross reaching or transport movements since the ability to perform manual dexterity skills with the hands is very much an integral part of everyday life.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inclusion criteria will include:
- •Age 20-70, year
- •six months following a stroke or SCI Less than two hears following a stroke of SCI
- •Actively extend at least ten degrees at the metacarpophalangeal and interphalangeal joints, extend ten degrees at the wrist and had at least 30 degrees of active flexion-extension of the elbow and shoulder.
- •Adequate vision to see the required images on a standard computer monitor. E) Able to provide informed consent
排除标准
- •excessive spasticity (grade three and above on the Ashworth scale) (11),
- •any significant cognitive impairment (Montreal Cognitive Assessment scores less than 25) (12)
- •Any other neurological disorder with the exception of a single stroke prior to testing.
研究组 & 干预措施
Game-based Exercise program
Each exercise session would last 45 minutes and supervised by study staff at First Step Wellness center you will be shown how to handle and move the joystick and how to play a group of computer games. The game activities will require you to move the joystick at various speeds, movement' amplitudes and in different directions. Each game will be played for 2-3 minutes.
A variety of therapy" handles of different shapes and sizes have been produced that Snap-On to joystick handle. These are designed to practice a broad range of manual dexterity skills involving the thumb, fingers, wrist and elbow, o Different games will also be used to vary the movement types and precision levels. To note you will be able to choose the types of movement exercises and games to use.
干预措施: games based exercise (Other)
Range of motion and Strength Exercise program.
This will involve stretching, range of motion and strength exercises as set out by training staff at the First Step Wellness center.
On completion of the ten week exercise program, you will be invited to take part in a 30-minute interview to discuss the experiences you had on receiving the specific hand exercise program. The whole interview session will be audio taped. Your identity will be protected and your privacy will be maintained. All the information discussed and shared during the interview will be kept confidential and safely protected.
干预措施: games based exercise (Other)
结局指标
主要结局
Computer game-based Upper Extremity (CUE) assessment of manual dexterity
时间窗: 10 weeks
goal attainment average of several game events
Wolf motor function test (WMFT)
时间窗: 10 weeks
Upper extremity motor ability
次要结局
未报告次要终点