Tony Szturm - Computer aided, Game-Based Telerehabilitation Platform with Telemonitoring...
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Transcript of Tony Szturm - Computer aided, Game-Based Telerehabilitation Platform with Telemonitoring...
Dr. Tony Szturm,
Physical Therapist
Ph.D.Neuroscience
Adjunct Engineering
University of Manitoba
Computer aided, Game-Based
Telerehabilitation Platform with
Telemonitoring ApplicationsBlending of fine/gross motor skill training
with cognitive / educational Activities
TELEREHABILITATION
Most children with neuro-muscular disabilities clearly benefit from
intensive inpatient and well-resourced outpatient care.
While one-to-one, supervised therapy is preferred, due to access and
financial barriers, many children do not have this option.
When Rehab regimens are prescribed for toddlers/children to do at home,
adherence is low due to the fact that rehab exercises are tedious and
boring, and there is little long-term support or follow-up.
Access to Physical & Occupational Therapy in rural areas is limited.
Telerehabilitation is a simplified platform of high quality therapies of
ccombined fine/gross motor exercise and cognitive/educational activities
which address the above problems.
Elements of the Telerehabilitation Platform (TRP)
1. Wireless motion detecting computer mouse of high fidelity & responsiveness..
This mouse allows physical motion to be translated and interpreted as a standard
USB mouse. This allows common and modern computer games to be used and
enjoyed as part of a clinical and home rehabilitation program.
2. A designed software-based Assessment Game - includes advanced data
logging and data analysis methods. Electronic records are generated and are
stored digitally, which can then be manipulated into meaningful graphs and tables
for clinicians to review. With Internet capability, therapist can monitor patients’
performance and rehabilitation progress.
3. The many inexpensive off the shelf computer games having a broad range of
physical, and cognitive therapeutic values, as well as educational content.
The TRP is designed to provide affordable, engaging client-centered programs of
rehabilitation, and importantly the progression from supervised to unsupervised
monitored in-school and home programs.
Organize space of game interactions into
two interrelated categories
Physical Space: howdifferent bodymovements / forces
and natural object movements can be readily
transformed into “therapeutic” input devices with high
fidelityandresponsiveness.–ThusQualityTherapies
Cognitive Space:- based on nature and the
complexity of knowledge structures &
information processing, distractors, (choices
which player is engaged.
Core
balance
Dual-task
Walking
hand-arm
function
Gaze
Control
Multi-Tasking
2. Mouse button
Select unit
USB- RF
Receiver
1. Motion detecting unit
2cm by 3cm
Prototype- separate motion mouse into 2 smaller functional units
Upper Extremity Fine/Gross Motor Skill Telerehabilitation
Because the Air Mouse™ can be easily attached with Velcro to many “therapeutic”
objects this approach provides a highly flexible and personalized clinical or home-
based treatment tool applied to fine or gross upper extremity motor skills.
Multiple objects with varied sizes, shapes, weights, surface properties and functional
demands for precision can be used for exercise and to practice a variety of gross or fine
motor skills, and importantly, while playing fun computer games.
Critically to incorporate graded levels of “movement precision & combined with
common/modern education or “brain-fitness” computer games
Many common objects have Ergonomic properties
which afford ease of manipulation (control)
These are readily available to meet needs of even the
most involved and severely disabled client.
Good starting point for emerging skills
Reduce need for robotic devices.
importantly can be done at home.
Assessment Rehabilitation Game
Electronic monitoring is a critical feature embedded into the
Telerehabilitation platform.
This addresses the challenge of quantitative and objective outcomes
measurement and gave us a means to obtain electronic records for
Telerehabilitation.
Specifically Assessment Games were developed to:
1. objectively measure compliance.
2. produce outcomes & electronic records to detect problems
related to targeted and integrated aspects of movement, vision,
and cognitive performance.
3. means to provide timely feedback and support
4. Conduct trend analysis and identify drivers of change
5. Database: as electronic records are collected, the database,
and exploratory and confirmatory data mining
procedures can be established.
Assessment Game Module 1Analysis of clients movements as compared to
Standardized computer -controlled target motion
Quantify - Movement quality & efficiency
- Temporal accuracy
- amplitude consistency
- Movement endurance (repetition)
Testing Recording
- circle object labeled “T” is game target.
- triangle & rectangle labeled “D” are distracters
- GOAL MOVE PADDLE TO CATCH TARGETS
Automated Outcomes
- Success rate
- Response time
- Execution time
- Absolute error
- Response variation
- Movement efficiency
Treatment Rehabilitation Games
For all age’s computer games can provide an engaging forum in which learning arises as a result of tasks
stimulated by the content of the games, knowledge is developed through the content of the game and
skills are developed as a result of playing the game when using appropriate input devices (physical
requirements of therapy/learning)
There is also the realization of the need to capture existing commercial hardware and computer games so
as to keep price point low enough for home markets.
Not only do the physical movements & exercise have specific therapeutic value, but so does the
choice of computer game. Many common and modern video games require different levels of
movement amplitude, speeds, accuracy, repetition, cognitive demands (mental processing),. Also different
computer games appeal to individual preferences.
Using inexpensive off the shelf games the TRP provides engaging game-based rehabilitation applied to a
broad spectrum of disorders across the life span
- Fine motor skills finger-hand function and arm function
- Gaze stability, visual-vestibular interaction
- Executive cognitive function
- Balance-Mobility, walking, fall risk
- Dual-tasking
NOTE: There will also be the need to produce “designed” “rehabilitation "games with gameplay levels to
match the limited, emerging skills of the more involved and severely disabled clients.
Recent Publication
An In-School Based Program of Combined Fine-Motor
Exercise and Educational Activities for Children with Neuro-
Developmental Disorders.
Tony Szturm1 Eleoussa Polyzoi Jonathan Marotta Cynthia
Swarnalatha.
Games for Health journal in press October 2014
Designing the Telerehabilitation Platform (TRP)
Extensive field testing and worked with knowledge users has been done to shape and
develop the TRP and training programs based on several key principles:
1. Functional: “activity-dependant” and takes advantage of available technologies and
modern concepts of brain plasticity
2. Maximizing motivation and engagement through interactive digital media and gaming is
seen as a main goal of interventions “especially for long-term and intensive therapies
3. Flexible: applied to diverse rehabilitation programs designed to improve: (a) core balance,
(b) mobility, c) gaze control and visual attention, (d) executive cognitive functions, (f) dual-
task functions (blending of a-d, (g) hand function (fine/gross motor skills). All ages toddlers,
children, adolescents, adults, older population
4. Cost Effective: treatment with embedded assessment : (a) objectively measure
compliance, (b) Feedback and support, c) outcomes & electronic records, (d) Trend analysis
(drivers of change) and to establish dose-response relations.
5. Extend Clinical Practice: high quality therapy and cognitive enrichment programs with
monitoring and support) to function in schools, the home and community settings , schools
urban and rural locations.
6. Database and Registry : The developed data mining procedures can establish a basis for
sustained population health status information and for empirically motivated rehabilitation
research.
Assessment Game Module 1Automatic recording of Clients movements as compared
to Standardized computer “reference “ movements
Examples Interactive Rehab Gaming Controllers & Data recording System
Gyration
Head mouse
-Game
Interaction
Motion recording
Pressure-matt
Game Interaction
COP Recording
Treadmill
Unobtrusive
Pressure Mapping
COP/gait variables
Wearable Wireless
Inertial Motion Monitors
Trunk/leg kinematics