Keeping up with video game technology: objective analysis of Xbox Kinect™ and PlayStation 3 Move™ for use in burn rehabilitation

Virtual Reality Animal Rescue World: Pediatric virtual reality analgesia during just noticeable pressure pain in children aged 2-10 years old (crossover design)

BACKGROUND AND AIMS

Excessive pain during medical procedures is a worldwide medical problem. Most scald burns occur in children under 6, who are often undermedicated. Adjunctive Virtual Reality (VR) distraction has been shown to reduce pain in children aged 6-17, but little is known about VR analgesia in young children. This study tests whether desktop VR (VR Animal Rescue World) can reduce the just noticeable pressure pain of children aged 2-10.

METHODS

A within-subject repeated measures design was used. With treatment order randomized, each healthy volunteer pediatric participant underwent brief cutaneous pressure stimuli under three conditions: (1) no distraction, (2) a verbal color naming task (no VR), and (3) a large TV-based desktop VR distraction. A hand-held Wagner pressure pain stimulation device was used to generate just noticeable pain sensations. Participants indicated when a steadily increasing non-painful pressure stimulus first turned into a painful pressure sensation (just noticeable pain).

RESULTS

A total of 40 healthy children participated (43% aged 2-5 years; and 57% aged 6-10 years). Compared to the no distraction condition, the 40 children showed significant VR analgesia (i.e., a significant reduction in pain sensitivity during the VR Animal Rescue World condition), t(39) = 9.83, p < 0.001, SD = 6.24. VR was also significantly more effective at reducing pain sensitivity vs. an auditory color naming task, t(39) = 5.42, p < 0.001, SD = 5.94. The subset of children aged 2-5 showed significant reductions in pain during VR. Children under 6 showed greater sensitivity to pain during no distraction than children aged 6-10.

CONCLUSION

During no distraction, children under 6 years old were significantly more sensitive to pain than children aged 6-10. Virtual reality (VR) significantly reduced the "just noticeable" pressure pain sensitivity of children in both age groups.

Development of a Smartphone-Based mHealth Platform for Telerehabilitation

Telerehabilitation is becoming increasingly valuable as a method for expanding medical services. The smartphone-based mHealth platform (SMPT) has been developed to provide high-quality remote rehabilitation through a smartphone and inertial measurement units. The SMPT uses smartphone as a main platform with connection to medical backend server to provide telerehabilitation. Patients would be referred to therapists to receive a tutorial of exercise technique prior to conducting their home exercise. Once patients begin their home exercises, they can report any problems instantly through the SMPT. The medical staff can adjust the exercise program according to patient feedback and the data collected by the SMPT. After completing the exercise program, patients visit their clinician for re-evaluation. A Service User Technology Acceptability Questionnaire from both medical professional and public perspective revealed a high level of agreement on enhanced care, increased accessibility, and satisfaction and a moderate level of agreement on the use of this platform as a substitute for traditional rehabilitation. Concerns about privacy and discomfort were low in the medical professional and public groups. Concerns about care personnel were also significantly different between the two groups. The SMPT is a promising system for providing telerehabilitation as an adjunct to traditional rehabilitation, which may result in improved outcomes compared with those achieved when using traditional rehabilitation alone.

Effect of exercise mode on physical function and quality of life in breast cancer-related lymphedema: a randomized trial

PURPOSE

This study aimed to compare the effects of virtual reality (VR) training and resistance exercises training on lymphedema symptom severity as well as physical functioning and QoL in women with breast cancer-related lymphedema (BCRL).

METHODS

In a single blinded randomized trial, women diagnosed with unilateral BCRL were randomly divided into two groups: the Xbox Kinect group received VR Kinect-based games (n = 30) and resistance exercise group received resistance training (n = 30). In addition, both groups received complex decongestive physiotherapy (manual lymphatic drainage, compression bandages, skin care, and exercises). The intervention was conducted five sessions per week for 8 weeks. The outcome measures included excessive limb volume, visual analogue scale (VAS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, shoulder range of motion (ROM), shoulder muscles strength, hand grip strength, and Study Short-Form (SF-36). The outcomes were evaluated pre and post intervention (week 8).

RESULTS

Statistical significant differences were recorded in VAS (pain intensity), DASH, shoulder ROM (p < 0.001), bodily pain (p = 0.002), general health (p < 0.001), and vitality (p = 0.006) in favor of the Xbox Kinect group. However, there were statistically significant differences in shoulder flexion strength (p = 0.002), external rotation strength (p = 0.004), and abduction strength and handgrip strength (p < 0.001) in favor of the resistance exercise group.

CONCLUSIONS

The VR training was superior to resistance exercises training in BCRL management. The empirical findings support the VR as a new effective and encouraging intervention modality which can assist in improving physical functioning and quality of life in women with BCRL.

TRIAL REGISTRATION

This study is retrospectively registered at ClinicalTrials.gov (ID: NCT04724356).

Hybrid Program Based on Virtual and Real Games Increases Fundamental Movement Skills in Children With Intellectual Disability: A Quasi-Experimental Study

The purpose of this study was to examine the effects of two pedagogical strategies in adapted physical education (hybrid virtual/real vs. conventional) on fundamental movement skills (FMS) in children with intellectual disability age 7-10 years. Children with intellectual disability (N = 24) were randomly assigned to either the hybrid (experimental group) or the conventional (control group) group and were evaluated across 10 weeks. The hybrid program was based on virtual and real game situations, while the conventional program was based on adapted sports. FMS were evaluated using the Test of Gross Motor Development-2 at pre- and postprogram for both groups. Both programs significantly improve locomotor skills, with significantly better improvement in the experimental group. However, a significant improvement was observed only among the experimental group for object-control skills and gross motor quotient. Based on these results, a hybrid program may be considered for FMS improvement.

Impact of Kinect-based virtual reality training on physical fitness and quality of life in severely burned children: a monocentric randomized controlled trial

BACKGROUND

Pediatric burns lead to persistent and detrimental muscle breakdown, weakness and poor quality of life, so rehabilitation is integral for improving physical and psychological outcomes. However, children with burns are a major challenge to a rehabilitation team. To overcome these challenges, enjoyable and interesting interventions are suggested.

OBJECTIVE

We aimed to determine the impact of the Xbox Kinect on cardiopulmonary fitness, muscle strength, lean mass, quality of life and enjoyment in severely burned children after hospital discharge.

METHODS

This was a randomized controlled trial in a single centre. Participants (n= 40 children) with burn injuries were randomized to the Xbox training group (n=20) or control group (n=20) during 12 weeks. All children received a home programme rehabilitation and Xbox training children received Xbox training. Outcomes included cardiopulmonary fitness (VO2peak), muscle strength (peak torque), lean mass (whole-body and regional), quality of life and physical activity enjoyment at baseline, immediately after hospital discharge, and 12 weeks after the intervention.

RESULTS

The mean (SD) age of the 40 children was 12.97 (1.42) years and total body surface area of burn was 51% (5). The groups did not differ in characteristics at baseline (P < 0.05). After 12 weeks of the intervention, the groups significantly differed in VO2peak, peak torque, quality of life (p<0.001), lean mass and leg lean mass (p<0.05) in favour of Xbox training. The mean difference in VO2peak, peak torque, lean mass and leg lean mass was 3.25 (2.1; 4.5) ml/kg/min, 7.5 (5.8; 9.2) Nm, 1.81 (0.5; 3.1) kg, and 1.1 (0.1; 2.1) kg, respectively. Lean trunk mass did not significantly differ between groups (p=0.07). The Xbox training group reported significantly more enjoyment than did the control group (p<0.001).

CONCLUSION

Xbox Kinect training can increase cardiopulmonary fitness, muscle strength, lean mass and quality of life in burned children. It is one of the most enjoyable, motivated and efficient treatment modalities that should be widely introduced into the pediatric burn rehabilitation.

Hedonic and Utilitarian Motivations of Home Motion-Sensing Game Play Behavior in China: An Empirical Study

As an important branch of video games and the integration of emerging motion-sensing technology, home motion-sensing games cannot only bring hedonic entertainment but also promote utilitarian benefits including exercise and social interaction for people to improve their physical and psychological health. As one of the most populous countries in the world, China has the largest number of households in the world but quite a low home game penetration rate due to the 13 year game industry winter for international enterprises. Whether Chinese customers have the intention of using motion-sensing games to improve their health status in the home environment will directly determine the commercial potential of the relevant industry in the Chinese market. In order to understand the motives of users and explore the market possibility and prospects of the game industry, this study adopts empirical research and structural equation modeling to construct a motivation model of Chinese consumers toward motion-sensing gameplay behavior in the household environment. We distributed 515 questionnaires to conduct a survey; 427 valid responses have been received, and 203 data, which meet the inclusion criteria of the required game experience, have been analyzed by SPSS25.0 and AMOS25.0. A structural equation model for the gameplay motivation has been constructed. The result shows that the three functional motivators, exercise (Path efficient = 0.40, p < 0.01), entertainment (Path efficient = 0.27, p < 0.01), and social interaction (Path efficient = 0.36, p < 0.01) of home motion-sensing games have a significantly positive impact on the user's intention to play. Furthermore, the diversity and the time-and-place flexibility variables exert an important positive influence on the users' gameplay behavior through their effects on the three main functional motive variables. To sum up, (1) exercise, (2) entertainment, and (3) social interaction are the main functional motivations of the Chinese consumers' gameplay behaviors; (4) diversity and (5) time-and-place flexibility are the two main attribute motivators. The acceptance of Chinese users for home motion-sensing games remains positive and high. The motion-sensing game industry has broad market prospects in China through its potential in promoting consumer's wellness and health in the home environment.

Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery?

PURPOSE

Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement.

METHODS

Forty women with breast cancer who had undergone unilateral mastectomy with axillary lymph node dissection and who were receiving adjuvant therapy were included in the study and randomly assigned to two groups: the Kinect-based rehabilitation group (KBRG) and the standardized physical therapy group (SPTG). The KBRG (n = 20) received VR therapy using Xbox Kinect-based games and the SPTG (n = 20) received standard physiotherapy. Study subjects were assessed at baseline and after the 6-week treatment. Outcome measures were pain (visual analogue scale), grip strength (dynamometer), functionality (disabilities of the arm shoulder and hand questionnaire), muscle strength (handheld dynamometer), ROM (digital goniometer), and fear of movement (Tampa kinesiophobia scale (TKS)).

RESULTS

Both groups detected significant changes in pain, ROM, muscle strength, grip strength, functionality, and TKS scores after the treatment (p < 0.01). Fear of movement was significantly improved in the KBRG and the SPTG displayed more improvement in functionality (p < 0.05). There were no differences in ROM, muscle strength, grip strength, and pain between the groups after the treatment (p > 0.05).

CONCLUSION

Kinect-based VR therapy resulted in significant outcomes that were comparable to those obtained under standard physiotherapy in the early postoperative phase in patients who had undergone breast cancer surgery.

TRIAL REGISTRATION

This study is registered at ClinicalTrials.gov ( ClinicalTrials.gov identifier: NCT03618433).

The use of exercise in burns rehabilitation: A worldwide survey of practice

INTRODUCTION

Exercise-based interventions have been used to enhance the recovery of burn patients affected by hypermetabolism, muscle wasting and contractures. Although the benefits of exercise in burn population have been previously reported, the extent of exercise prescription in burn patients worldwide remains unknown. Therefore, the purpose of this study is to identify the extent and characteristics of exercise use in specialised and non-specialised burn centres worldwide.

METHODS

A web-based survey was developed in English and translated into Spanish and Chinese languages. Distribution of the surveys was made via email using personal contacts of the authors and through six scientific societies related to burn care in 2018. Data were analysed using descriptive statistics and comparisons between frequency distribution on variables of interest using the Chi-Square test and contingency tables.

RESULTS

One hundred and fifty-six surveys were completed (103 from the English version, 20 from the Chinese version, and 33 from the Spanish version). The response rate varied from 36.2% (English version) to 9.3% (Chinese version). Fifty eight percent of the surveyed clinicians worked in cities of 1 million inhabitants or more, and 92.3% worked in hospital-based burn centres. Exercise was used by 64.1% of the participants at the intensive care unit level, 75% in burn wards prior to complete wound healing, and 80.1% in rehabilitation units after wound healing. The type of exercise offered, parameters assessed, and characteristics of exercise programs varied notably among burn centres and clinicians consulted.

CONCLUSION

The majority of the surveyed clinicians used exercise for rehabilitation of patients following burn injuries. Further investigation is required to elucidate the access to exercise interventions prescribed by health professionals in remote areas, in less developed countries, and the extent of home-based exercise performed by patients.

Prescripción del ejercicio físico y sus implicaciones en adultos que han sufrido quemaduras

Introducción. La prescripción del ejercicio físico y sus implicaciones en pacientes que han sufrido quemaduras es objeto de estudio en diferentes investigaciones debido al impacto físico, psicológico y social que tiene en las personas.Objetivo. Describir la prescripción de ejercicio físico y sus implicaciones en la población adulta que ha sufrido quemaduras.Materiales y métodos. Se realizó una revisión de tema por medio de exploración de artículos de manera electrónica con filtros de búsqueda en distintas bases de datos con términos DeCS y MeSH.Resultados. Se seleccionaron 11 artículos con intervención de ejercicio físico en fases aguda y crónica. Se incluyeron estrategias sobre la fuerza muscular en cinco de los artículos: tres de resistencia cardiovascular; dos de rango de movimiento, flexibilidad y características tróficas de la piel, y uno de dolor.Conclusiones. Las variables de la prescripción se determinan de acuerdo a las características propias que presenta la persona con quemadura, las cuales se resumen en esta revisión.

Repeated Measures Models Applied to Cancer Patients Treated with Exergames

Objective:

The objective of this study was to define an appropriate linear model to analyse data on muscular fatigue in cancer patients over time through repeated measures techniques.

Methods:

Using the split plot in time system and linear mixed models, three groups of individuals were compared as to the methods used to reduce muscle fatigue. Group Cancer consisted of individuals who had already been treated; group Control consisted of healthy individuals and group Chemo / radio-therapy consisted of individuals diagnosed with cancer undergoing chemo and radiation therapy. Sessions were tested with exergames. A series of muscle strength data for each of the six muscles studied, in the pre-treatment, mid-treatment and final sessions.

Result:

The structure that best fit the covariance matrix was ARMA (1,1), according to AIC and BIC. There were significant differences and tendencies in the data series, especially for the left tibial muscle, in which the interactions between group and session and between group and time were significant, showing that exergames treatment increased muscle strength in debilitated patients and, with 20 sessions, the groups equalled in muscle strength.

Conclusion:

The linear mixed model proved to be efficient in modelling plots subdivided in time. Identifying the best structure of the covariance matrix allowed us to better estimate the effects, using tests appropriately to verify differences between factors that were not detected when using the median frequency of strength.

Person-Generated Health Data in Simulated Rehabilitation Using Kinect for Stroke: Literature Review

BACKGROUND

Person- or patient-generated health data (PGHD) are health, wellness, and clinical data that people generate, record, and analyze for themselves. There is potential for PGHD to improve the efficiency and effectiveness of simulated rehabilitation technologies for stroke. Simulated rehabilitation is a type of telerehabilitation that uses computer technologies and interfaces to allow the real-time simulation of rehabilitation activities or a rehabilitation environment. A leading technology for simulated rehabilitation is Microsoft's Kinect, a video-based technology that uses infrared to track a user's body movements.

OBJECTIVE

This review attempts to understand to what extent Kinect-based stroke rehabilitation systems (K-SRS) have used PGHD and to what benefit.

METHODS

The review is conducted in two parts. In part 1, aspects of relevance for PGHD were searched for in existing systematic reviews on K-SRS. The following databases were searched: IEEE Xplore, Association of Computing Machinery Digital Library, PubMed, Biomed Central, Cochrane Library, and Campbell Collaboration. In part 2, original research papers that presented or used K-SRS were reviewed in terms of (1) types of PGHD, (2) patient access to PGHD, (3) PGHD use, and (4) effects of PGHD use. The search was conducted in the same databases as part 1 except Cochrane and Campbell Collaboration. Reference lists on K-SRS of the reviews found in part 1 were also included in the search for part 2. There was no date restriction. The search was closed in June 2017. The quality of the papers was not assessed, as it was not deemed critical to understanding PGHD access and use in studies that used K-SRS.

RESULTS

In part 1, 192 papers were identified, and after assessment only 3 papers were included. Part 1 showed that previous reviews focused on technical effectiveness of K-SRS with some attention on clinical effectiveness. None of those reviews reported on home-based implementation or PGHD use. In part 2, 163 papers were identified and after assessment, 41 papers were included. Part 2 showed that there is a gap in understanding how PGHD use may affect patients using K-SRS and a lack of patient participation in the design of such systems.

CONCLUSIONS

This paper calls specifically for further studies of K-SRS-and for studies of technologies that allow patients to generate their own health data in general-to pay more attention to how patients' own use of their data may influence their care processes and outcomes. Future studies that trial the effectiveness of K-SRS outside the clinic should also explore how patients and carers use PGHD in home rehabilitation programs.

The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial

OBJECTIVES

To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD).

DESIGN

A pilot randomized, controlled, single-blinded trial.

SETTING

A state reference health care center for elderly, a public reference outpatient clinic for the elderly.

PARTICIPANTS

Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank.

INTERVENTION

The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20).

MAIN OUTCOME MEASURES

The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale.

RESULTS

All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups.

CONCLUSIONS

Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants.

Feasibility of Pediatric Game-Based Neurorehabilitation Using Telehealth Technologies: A Case Report

This case report is the first in a series of reports designed to determine the feasibility of implementing game-based neurorehabilitation using telehealth technologies (GbN+TT) for children with cerebral palsy, evaluate the responsiveness of relevant outcome measures to changes in motor impairment and activity participation after intervention, and identify technological challenges associated with implementation of GbN+TT. The participant completed more than 56 hr of game-based neurorehabilitation over 8 wk using the Timocco platform in his home. The primary measures of motor impairment (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition) and function (Pediatric Motor Activity Log) were both sensitive to change. Results indicate that it is feasible to administer GbN+TT to a child with cerebral palsy and monitor outcomes using standardized assessments.

Modifying Kinect placement to improve upper limb joint angle measurement accuracy

STUDY DESIGN

Repeated measures.

INTRODUCTION

The Kinect (Microsoft, Redmond, WA) is widely used for telerehabilitation applications including rehabilitation games and assessment.

PURPOSE OF THE STUDY

To determine effects of the Kinect location relative to a person on measurement accuracy of upper limb joint angles.

METHODS

Kinect error was computed as difference in the upper limb joint range of motion (ROM) during target reaching motion, from the Kinect vs 3D Investigator Motion Capture System (NDI, Waterloo, Ontario, Canada), and compared across 9 Kinect locations.

RESULTS

The ROM error was the least when the Kinect was elevated 45° in front of the subject, tilted toward the subject. This error was 54% less than the conventional location in front of a person without elevation and tilting. The ROM error was the largest when the Kinect was located 60° contralateral to the moving arm, at the shoulder height, facing the subject. The ROM error was the least for the shoulder elevation and largest for the wrist angle.

DISCUSSION

Accuracy of the Kinect sensor for detecting upper limb joint ROM depends on its location relative to a person.

CONCLUSION

This information facilitates implementation of Kinect-based upper limb rehabilitation applications with adequate accuracy.

LEVEL OF EVIDENCE

3b.

Use of Game Console for Rehabilitation of Parkinson's Disease

BACKGROUND

Parkinson's disease (PD) predisposes to falls due to postural instability and decreased coordination. Postural and coordination exercises could ameliorate the incoordination and decrease falls.

AIMS

In this study, we explored the efficiency of a game console as an adjunct to an exercise program in treating incoordination in patients with PD.

STUDY DESIGN

Case-control study.

METHODS

In this single-blind, prospective clinical trial, rehabilitation with the Xbox (Microsoft; Washington, USA) game console was used as an adjunct to a standard rehabilitation program. Thirty-three patients with PD at stages 1-3 were enrolled in the study. All patients received the three-times weekly exercise program and electrotherapy to back and hip extensors for 5 weeks. Study patients played catch the ball and obstacle games on the Xbox in addition to the standard exercise program. Patients were evaluated based on the scores from the Timed Up-and-Go Test, the Berg Balance Scale (BBS), and the Unified Parkinson's Disease Rating Scale-II (UPDRS-II). Post-treatment scores were compared between groups.

RESULTS

Thirty-three patients were enrolled in the study (15 in the game-console group, and 18 controls). Patients in both groups had improvements in all scores. The end-of-treatment scores were significantly better in the study group compared to the control group in all parameters: UPDRS (10±5 versus 16±6, p=0.002), BBS (53±4 versus 47±8, p=0.004), and TUG (11±4 seconds versus 20±8 seconds, p<0.001).

CONCLUSION

Game-exercise with a game-console was noted to be a significant adjunct to the rehabilitation program in patients with PD in this study.

Motor Improvement Using Motion Sensing Game Devices for Cerebral Palsy Rehabilitation

The authors aimed to investigate the effects of an intervention based on interactive game set with the movement sensor Kinect on children with cerebral palsy (CP). Twenty-eight participants were recruited. Their age was between 3 and 12 years old, and rated as level I, II, or III on the Gross Motor Function Classification System. They played two games from the Xbox 360 Kinect system and were evaluated using the Gross Motor Function Measure (GMFM) after a period of 8 weeks. The intervention led to significant motor function improvement as increase of the global scores on the GMFM (p < .001). Rehabilitation interventions using the Xbox 360 Kinect interactive games may represent useful tools for children with CP.

Pediatric Burn Resuscitation

Children have unique physiologic, physical, psychological, and social needs compared with adults. Although adhering to the basic tenets of burn resuscitation, resuscitation of the burned child should be modified based on the child's age, physiology, and response to injury. This article outlines the unique characteristics of burned children and describes the fundamental principles of pediatric burn resuscitation in terms of airway, circulatory, neurologic, and cutaneous injury management.

Sedation and analgesia for critically ill pediatric burn patients: the current state of practice

The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine. Written sedation policies exist at 63.4% of centers. 90.2% of centers employ scoring systems to guide agent titration. 60.9% of respondents practice sedation holidays "always" or "usually." 90.2% of centers perceive the medications they routinely use are "always" or "often" efficacious in pediatric sedation and analgesia. 53.7% of respondents reported the presence of withdrawal signs and symptoms in their patient population. The lack of consensus guidelines for sedation and analgesia delivery to pediatric intensive care unit patients results in practice variation. The majority of centers perceive their sedation and analgesia strategies to be efficacious despite the heavy reliance on propofol and midazolam, both of which have questionable safety profiles in critically ill children.

Feasibility of an Exoskeleton-Based Interactive Video Game System for Upper Extremity Burn Contractures

BACKGROUND

Burn contractures are common and difficult to treat. Measuring continuous joint motion would inform the assessment of contracture interventions; however, it is not standard clinical practice. This study examines use of an interactive gaming system to measure continuous joint motion data.

OBJECTIVE

To assess the usability of an exoskeleton-based interactive gaming system in the rehabilitation of upper extremity burn contractures.

DESIGN

Feasibility study.

SETTING

Eight subjects with a history of burn injury and upper extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility.

METHODS

Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play.

MAIN OUTCOME MEASURES

Visual analog scale for engagement, difficulty and comfort. Angular range of motion by subject, joint, and game.

RESULTS

The study population had an age of 43 ± 16 (mean ± standard deviation) years and total body surface area burned range of 10%-90%. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game.

CONCLUSIONS

This study demonstrates the feasibility of use of an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors.

A Review on Technical and Clinical Impact of Microsoft Kinect on Physical Therapy and Rehabilitation

This paper reviews technical and clinical impact of the Microsoft Kinect in physical therapy and rehabilitation. It covers the studies on patients with neurological disorders including stroke, Parkinson's, cerebral palsy, and MS as well as the elderly patients. Search results in Pubmed and Google scholar reveal increasing interest in using Kinect in medical application. Relevant papers are reviewed and divided into three groups: (1) papers which evaluated Kinect's accuracy and reliability, (2) papers which used Kinect for a rehabilitation system and provided clinical evaluation involving patients, and (3) papers which proposed a Kinect-based system for rehabilitation but fell short of providing clinical validation. At last, to serve as technical comparison to help future rehabilitation design other sensors similar to Kinect are reviewed.