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International Clinic of Rehabilitation

WEB-BASED HOME REHABILITATION GAMING SYSTEM

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International Clinic of Rehabilitation

• Prof. Volodymyr Kozyavkin, MD, Director of International Clinic of Rehabilitation,

• Dr. Oleh Kachmar, MD, Head of Innovative Technologies Department,

• Dr. Taras Voloshyn, MD, child neurologist,

• Mr. Vadym Markelov, software developer,

• Mrs. Iryna Ablikova, Physical Therapist,

• Mr. Bohdan Kachmar, software developer

Research and Development Team

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• Provides Intensive treatment for patients with Cerebral Palsy and other neurological diseases

• More than 4.000 patients came for treatment each year

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Background• Virtual reality (VR) have great potential in the neurological rehabilitation of patients with movement disorders

• Most VR systems for motor training are quite expensive and could be used only in clinical setting

• Low-cost, commercially available gaming systems are widely used, but:• typical games are too difficult for disabled

children• no means for distant supervision by therapists

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Our Experience• Using Computer Games in Motor Rehabilitation for more than 12 years

• Now gaming rehabilitation is used on regular daily basis

• Custom Made Gaming Hardware• Hand training device• Training chair• Universal gaming device

Special Rehabilitation Gaming Software

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Objective

• Develop a low-cost rehabilitation game training system • for patients with movement disorders, • suitable for home use,• with supervision of a therapist

• Preliminary assessment of its benefits for training balance in patients with Cerebral Palsy

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System Description

application installed on a home computer

Tasks:• connect gaming hardware

through USB or Bluetooth: • convert data from different

hardware to one format, • send the game controlling data

to the games and receive feedback

Hosted in the Internet

Tasks:• user management • repository for rehabilitation

games with training guidelines

• usage statistics • messaging

Game Device Controller VR Game Server

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Internet

Therapist

Rehabilitation Game

Browser

Patient

Game

Developer

GDC

Game Server

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Rehabilitation Gaming Hardware

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Nintendo Balance Board

Nintendo Wii Remote

MS Kinect

Universal Gaming Device

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Rehabilitation Games

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• Could be played with different gaming hardware• Appropriate for people with movement disorders • Calibrated according to patient’s possibilities• 5 difficulty levels • Unified scoring system (max score 100)• Multilingual – game messages are separate

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with Rehabilitation Gaming System

BALANCE TRAINING

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Training Positions

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Standing, left-right bending

Standing, front- back bending

Standing with supportStanding one foot in

front

Kneeling on the board Sitting on the board

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Supervision by physical therapist

• Physical therapist evaluates the patient and draws up a training program, indicating recommended games, training positions, frequency and duration of sessions.

• Duration, timing and score of gaming sessions are stored on the server

• Using this information therapist may adjust the program, if necessary

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Stabilometry, a diagnostic game

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• Child stands still on the balance board for 15 sec

• Mean velocity of center of pressure (CoP) displacement and area of CoP displacement are calculated

• Higher velocities and larger areas indicate poor balance

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PRELIMINARY OUTCOME ASSESSMENT

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Patients

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• Two weeks Daily home training sessions (30 min duration)

PatientAge

(years)Gender (M/F)

Diagnosis GMFCS level

A 5 MCP, spastic right-sided hemiplegia

І

B 5 FCP, spastic right-sided hemiplegia

ІІ

C 7 F CP, spastic right diplegia І

D 7 MCP, spastic right-sided hemiplegia

І

E 11 MCP, spastic left-sided hemiplegia

І

F 8 F CP, spastic tetraplegia ІІІ

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Evaluation tools

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• Gross Motor Function Classification System - a five level classification system that describes the gross motor function of children with Cerebral Palsy

(Level I can walk without limitations, Level V – transported in wheelchair)

• Pediatric Balance Scale a scale with proven reliability and validity, designed to evaluate the child’s balance function.

(14 tasks, each from 0 to 4 points, 56 max)

• Stabilometry a specials diagnostic game measuring Velocity and Area of Center of Pressure (CoP) displacement while staying still on the board

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Results

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Patient, age

GMFCS level

diagnosis,

Before training After training

Balance Scale

CoP Velocity

CoP Area Balance Scale

CoP Velocity

CoP Area

A, 5 years Level I, hemiplegia

52 25 8 53 23 8

B, 5 years Level II, hemiplegia

45 50 8 46 46 7

C, 7 years Level I, diplegia 47 29 14 48 25 9

D, 7 years Level I, hemiplegia

48 22 3 50 26 4

E, 11 years

Level I, hemiplegia

49 31 8 51 24 7

F, 8 years Level III, tetraplegia

7 48 (with

support)

7 (with

support)

7 44 (with

support)

5 (with

support)

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Results

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cale

Balance scale Center of Pressure (CoP) Velocity

CoP Area

game.reha.lviv.ua

Conclusions• A Home Rehabilitation Gaming System was developed in order to transfer the virtual rehabilitation of patients with motor disorders from clinical to home settings.

• Preliminary results suggest that home gaming training is beneficial for improving balance function in patients with Cerebral Palsy

Limitations of the study• a small number of patients • without control group • evaluation performed by a therapist working with them, so his assessments may have been biased

• important to determine how balancing skills, obtained during training sessions, can be adapted to everyday life

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Acknowledgements• The authors express their gratitude to the administration of the International Clinic of Rehabilitation for their support in developing the system,

• as well as to doctors and therapists for testing the system and offering critical and constructive suggestions

Home Rehabilitation Gaming System is available free-of-charge to both therapists and patients at http://game.reha.lviv.ua.

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Visit our demo at ***

THANK YOU

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