Telerehabilitación con videojuegos para niños con parálisis cerebral.

Un sistema de ejercicios en el domicilio con feedback basado en videojuegos podría ser útil para rehabilitación de la mano de niños y adolescentes con parálisis cerebral. El sistema es de investigadores de las universidades de Inidana y Rutgers y se ha probado para rehabilitación de la movilidad de la mano en niños con hemipléjia por parálisis cerebral. Los resultados de los primeros ensayos son prometedores. En el futuro los terapeutas podrán monitorizar la terapia de los pacientes por internet. Esto permitirá hacer terapias más largas y en el propio domicilio del paciente que además estará más motivado para continuar durante periodos largos haciendo los ejercicios recomendados. Según se progrese se podrán añadir más videojuegos-ejercicio diferentes y que exigan mayores habilidades.
Para captar los movimientos de la mano del niño se utilizaron guantes de realidad virtual con sensores de fibra de vidrio. Estos movimientos se transladaron a un avatar virtual de la mano en la pantalla y en determinados videojuegos sencillos se pidió completar tareas que exigian movimientos de los dedos y la mano. El objetivo era mejorar la capacidad de agarrar objetos. entre otras cosas para valorar los resultados se obtuvieron imágenes de fMRI (Resonancia Magnética Funcional, RMNf)

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Tenía que venir de MedGadget.
El artículo original ha sido publicado en la revista Physical Medicine and Rehabilitation y presentado en los dos últimos congresos de la International Society for Virtual Rehabilitation.

Aquí estoy con el responsable de este trabajo: Grigore Burdea en el congreso Virtual Rehabilitation de julio de 2009 en Haifa, Israel. Todo un gusto conocerle después de seguir su trabajo durante los últimos años.

En este vídeo se muestra a los pacientes antes y después de la terapia.

Tuesday, January 12, 2010

Rehab Gaming System Helps Kids With Cerebral Palsy

Filed under: Neurology , Rehab

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

In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy

Presented to the Virtual Rehabilitation International Conference, August 25–27, 2008, Vancouver, Canada, and the Virtual Rehabilitation International Conference, June 29–July 2, 2009, Tel Aviv, Israel.

Meredith R. Golomb, MD, MScab, Brenna C. McDonald, PsyDbc, Stuart J. Warden, PT, PhDe, Janell Yonkman, MS, OTRd, Andrew J. Saykin, PsyDbc, Bridget Shirley, OTRd, Meghan Huber, BSfg, Bryan Rabin, BSfg, Moustafa AbdelBaky, BSfg, Michelle E. Nwosu, MBBSab, Monica Barkat-Masih, MBBS, MDab, Grigore C. Burdea, PhDfg

Abstract

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.

Objective

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.

Design

A 3-month proof-of-concept pilot study.

Setting

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.

Participants

Adolescents (N=3) with severe hemiplegic cerebral palsy.

Intervention

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.

Results

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).

Conclusions

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.

Key Words: Cerebral palsy, Child, Fiber optic technology, Hand, Hemiplegia, Internet, Perinatal care, Rehabilitation, Stroke, Video games

List of Abbreviations: BMC, bone mineral content, CIMT, constraint-induced movement therapy, DXA, dual-energy x-ray absorptiometry, FA, flip angle, fMRI, functional magnetic resonance imaging, FOV, field of view, LSC, least significant change, MP-RAGE, magnetization prepared rapid acquisition gradient echo, MRI, magnetic resonance imaging, fMRI, functional magnetic resonance imaging, NEX, number of excitations, pQCT, peripheral quantitative computed tomography, ROM, range of motion, TE, echo time, TMS, transcranial magnetic stimulation, TR, repetition time, VR, virtual reality

Autor: Samuel Franco Domínguez