Tuesday, January 12, 2010
Researchers from Indiana University and Rutgers have been testing whether a specially designed video gaming system can help children with hemiplegic cerebral palsy improve their hand coordination. The results are promising, and underscore the value of modifying underlying technologies to suit the needs of the patients.
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 Golomb [Dr. Meredith R. Golomb, Indiana University School of Medicine associate professor of neurology].
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.
Press release: Virtual reality tele-rehab improves hand function
Abstract in Archives of Physical Medicine and Rehabilitation: In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy
Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy.
To investigate whether in-home remotely monitored virtual reality videogame-based telerehabilitation in adolescents with hemiplegic cerebral palsy can improve hand function and forearm bone health, and demonstrate alterations in motor circuitry activation.
A 3-month proof-of-concept pilot study.
Virtual reality videogame-based rehabilitation systems were installed in the homes of 3 participants and networked via secure Internet connections to the collaborating engineering school and children's hospital.
Adolescents (N=3) with severe hemiplegic cerebral palsy.
Participants were asked to exercise the plegic hand 30 minutes a day, 5 days a week using a sensor glove fitted to the plegic hand and attached to a remotely monitored videogame console installed in their home. Games were custom developed, focused on finger movement, and included a screen avatar of the hand.
Main Outcome Measures
Standardized occupational therapy assessments, remote assessment of finger range of motion (ROM) based on sensor glove readings, assessment of plegic forearm bone health with dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), and functional magnetic resonance imaging (fMRI) of hand grip task.
All 3 adolescents showed improved function of the plegic hand on occupational therapy testing, including increased ability to lift objects, and improved finger ROM based on remote measurements. The 2 adolescents who were most compliant showed improvements in radial bone mineral content and area in the plegic arm. For all 3 adolescents, fMRI during grip task contrasting the plegic and nonplegic hand showed expanded spatial extent of activation at posttreatment relative to baseline in brain motor circuitry (eg, primary motor cortex and cerebellum).
Use of remotely monitored virtual reality videogame telerehabilitation appears to produce improved hand function and forearm bone health (as measured by DXA and pQCT) in adolescents with chronic disability who practice regularly. Improved hand function appears to be reflected in functional brain changes.
Autor: Samuel Franco Domínguez