Long-term hand tele-rehabilitation on the PlayStation 3: benefits and challenges

Interventions in subacute paediatric inpatient neurorehabilitation: an umbrella review

BACKGROUND

Rehabilitation is vital for optimizing recovery following neurological injuries. However, much of what is done for the paediatric population relies heavily on the adult literature or is based on expert opinion. No previous attempt has been made to collate high-quality evidence pertaining to the subacute period.

OBJECTIVES

To summarize and appraise the evidence from systematic reviews regarding the efficacy of inpatient neurorehabilitation interventions for paediatric patients in the 6 months immediately following neurological injury.

METHOD

A systematic search was conducted of PubMed, Ovid Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane databases, as well as using Google Scholar. Selection required an appraisal of efficacy of an inpatient rehabilitation intervention delivered within 6 months of injury.

RESULTS

1,250 papers were found. Titles and abstracts were compared against the selection criteria, with 52 papers being selected for full-text review. None of these met the selection criteria. Exclusions were often due to setting and chronicity.

CONCLUSIONS

This review reveals a critical lack of systematically reviewed evidence within the scope investigated. There is a pressing need for evaluation of current interventions. In the future, alternative approaches to identifying and appraising different forms of available evidence could be considered.

The Keep Moving Together Telerehabilitation for Children With Cerebral Palsy: Protocol of a Randomized Trial

PURPOSE

To compare the keep moving together (KMT) protocol between telerehabilitation (Tele KMT) or face-to-face (Face KMT).

METHODS

A randomized controlled clinical trial, including a goal-oriented training program for gross motor function activities for children/adolescents with cerebral palsy. One group will have supervised sessions with a physical therapist through telerehabilitation while the other will have face-to-face sessions. Both groups will receive sessions supervised only by a caregiver 3 times per week, at home. The KMT protocol is for 12 weeks. The primary outcome will be gross motor function using the Gross Motor Function Measure. Secondary outcomes are mobility, goals achieved, participation, caregivers' satisfaction, and adverse events. Impact statement: If effective, the Tele-KMT may be an alternative when face-to-face interventions are not possible.

Promoting Language Skills in Children With Neuromotor and Intellectual Disorders: Telepractice at the Time of SARS-CoV-2

Purpose The aim of this pilot study is to gather preliminary results on the effectiveness of intensive, parent-oriented, telepractice-based intervention to improve language skills in preschool children with neuromotor and intellectual disorders. Method Nine preschool children (M = 63 months, SD = 8.7 months) underwent a telepractice program 4 times a week designed to promote speech, lexical, and syntactic skills. Families were remotely connected from home with the therapists, who controlled the rehabilitation procedures from the hospital. The number of stable phonemes, of understood and repeated words, and of understood and repeated sentences were evaluated as outcome measures 3 months (prebaseline) and 1 week (baseline) before the intervention, immediately after the intervention (T1) and at a 3-month follow-up (T2). Results An increase in the number of stable phonemes was detected after the treatment, even if it was not statistically significant. After the intervention program, there was a significant increase in the number of understood words (ratio T1 vs. baseline: 1.33; 95% CI [1.03, 1.71]) and repeated words (ratio T1 vs. baseline: 1.39; 95% CI [1.00, 1.92]), as well as of understood sentences (ratio T1 vs. baseline: 1.80; 95% CI [1.24, 2.35]) and repeated sentences (ratio T1 vs. baseline: 4.23; 95% CI [1.96, 9.12]). No significant differences were found when comparing all the outcome measures at prebaseline and at baseline. Conclusion An intensive, parent-oriented, telepractice-based intervention has the potential to increase scores of lexical and syntactic tasks in children with neuromotor and intellectual disorders.

Developing the Next Generation of Augmented Reality Games for Pediatric Healthcare: An Open-Source Collaborative Framework Based on ARCore for Implementing Teaching, Training and Monitoring Applications

Augmented Reality (AR) provides an alternative to the traditional forms of interaction between humans and machines, and facilitates the access to certain technologies to groups of people with special needs like children. For instance, in pediatric healthcare, it is important to help children to feel comfortable during medical procedures and tests that may be performed on them. To tackle such an issue with the help of AR-based solutions, this article presents the design, implementation and evaluation of a novel open-source collaborative framework that enables to develop teaching, training, and monitoring pediatric healthcare applications. Specifically, such a framework allows for building collaborative applications and shared experiences for AR devices, providing functionalities for connecting with other AR devices and enabling real-time visualization and simultaneous interaction with virtual objects. Since all the communications involved in AR interactions are handled by AR devices, the proposed collaborative framework is able to operate autonomously through a Local Area Network (LAN), thus requiring no cloud or external servers. In order to demonstrate the potential of the proposed framework, a practical use case application is presented. Such an application has been designed to motivate pediatric patients and to encourage them to increase their physical activity through AR games. The presented games do not require any previous configuration, as they use ARCore automatic surface detection technology. Moreover, the AR mobile gaming framework allows multiple players to engage in the same AR experience, so children can interact and collaborate among them sharing the same AR content. In addition, the proposed AR system provides a remote web application that is able to collect and to visualize data on patient use, aiming to provide healthcare professionals with qualified data about the mobility and mood of their patients through an intuitive and user-friendly web tool. Finally, to determine the performance of the proposed AR system, this article presents its evaluation in terms of latency and processing time. The results show that both times are low enough to provide a good user experience.

Virtual Reality for Pediatric Traumatic Brain Injury Rehabilitation: A Systematic Review

Objective. Pediatric traumatic brain injury (TBI) is associated with physical and psychobehavioral impairment in children. Effective rehabilitation programs postinjury are critical for children with TBI. Virtual reality (VR) has been increasingly adopted for brain injury rehabilitation. However, scientific synthesis is lacking in evaluating its effectiveness in pediatric TBI rehabilitation. This article aimed to conduct a systematic review on the effectiveness of VR-based pediatric TBI rehabilitation. Methods. A systematic literature search was conducted in PubMed, PsycInfo, SCOPUS, CENTRAL, BioMed Central, CiNAHL, and Web of Science through November 2015. Personal libraries and relevant references supplemented the search. Two authors independently reviewed the abstracts and/or full text of 5824 articles. Data extraction and qualitative synthesis was conducted along with quantitative assessment of research quality by 2 authors. Results. A positive impact was found for VR-based interventions on children's physical rehabilitation post-TBI. The quality of research evidence was moderate, which largely suffered from small samples, lack of immersive VR experience, and lack of focus on socioemotional outcomes post-TBI. Conclusions. The present review identified positive effects of VR interventions for pediatric TBI rehabilitation especially in physical outcomes. Future research should include larger samples and broader post-TBI outcomes in children using VR-based interventions.

Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study

Background

Traumatic brain injury (TBI) is a major health problem that often requires intensive and long-term rehabilitation.

Objective

The aim of this study was to determine whether rehabilitative digital gaming facilitates cognitive functioning and general well-being in people with TBI.

Methods

A total of 90 Finnish-speaking adults with TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The participants were randomly allocated to one of the three groups: a rehabilitation gaming group (n=29, intervention), an entertainment gaming group (n=29, active control), or a passive control group (n=32). The gaming groups were instructed to engage in gaming for a minimum of 30 min per day for 8 weeks. Primary and secondary outcomes were measured at three time points: before the intervention, after the intervention, and 3 months following the intervention. The primary outcome was cognitive status measured by processing speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks). Secondary outcomes were attention and executive functions (Simon task), working memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT), depression (Patient Health Questionnaire-9), self-efficacy (General Self-efficacy Scale), and executive functions (Behavior Rating Inventory of Executive Function-Adult Version). Feasibility information was assessed (acceptability, measurement instruments filled, dropouts, adherence, usability, satisfaction, and possible future use). Cognitive measurements were conducted in face-to-face interviews by trained psychologists, and questionnaires were self-administered.

Results

The effects of rehabilitation gaming did not significantly differ from the effects of entertainment gaming or being in a passive control group. For primary outcomes and PASAT tests, the participants in all three groups showed overall improvement in test scores across the three measurement points. However, depression scores increased significantly between baseline and after 8 weeks and between baseline and after 3 months in the rehabilitative gaming group. No differences were found in patients’ self-efficacy between the three measuring points in any of the groups. Participants did use the games (rehabilitation group: 93%, 27/29; entertainment group 100%, 29/29). Games were seen as a usable intervention (rehabilitation group: 70%, 14/29; entertainment group: 83%, 20/29). The rehabilitation group was less satisfied with the gaming intervention (68%, 13/29 vs 83%, 20/29), but they were more willing to use the game after the intervention period (76%, 16/29 vs 63%, 15/29). Total time spent on gaming during the intervention period was low (15.22 hour rehabilitation gaming group, 19.22 hour entertainment gaming group).

Conclusions

We did not find differences between the groups in improvement in the outcome measures. The improvements in test performance by all three groups may reflect rehearsal effects. Entertainment gaming had elements that could be considered when rehabilitative games are designed for, implemented in, and assessed in larger clinical trials for persons with TBI.

Trial Registration

ClinicalTrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH)

Development of an EMG-ACC-Based Upper Limb Rehabilitation Training System

This paper focuses on the development of an upper limb rehabilitation training system designed for use by children with cerebral palsy (CP). It attempts to meet the requirements of in-home training by taking advantage of the combination of portable accelerometers (ACC) and surface electromyography (SEMG) sensors worn on the upper limb to capture functional movements. In the proposed system, the EMG-ACC acquisition device works essentially as wireless game controller, and three rehabilitation games were designed for improving upper limb motor function under a clinician's guidance. The games were developed on the Android platform based on a physical engine called Box2D. The results of a system performance test demonstrated that the developed games can respond to the upper limb actions within 210 ms. Positive questionnaire feedbacks from twenty CP subjects who participated in the game test verified both the feasibility and usability of the system. Results of a long-term game training conducted with three CP subjects demonstrated that CP patients could improve in their game performance through repetitive training, and persistent training was needed to improve and enhance the rehabilitation effect. According to our experimental results, the novel multi-feedback SEMG-ACC-based user interface improved the users' initiative and performance in rehabilitation training.

Efficacy of neurodevelopmental treatment combined with the Nintendo(®) Wii in patients with cerebral palsy

[Purpose] The aim of this study was to investigate the efficiency of Nintendo(®) Wii games in addition to neurodevelopmental treatment in patients with cerebral palsy. [Subjects and Methods] Thirty hemiparetic cerebral palsy patients (16 females, 14 males; mean age, 6-15 years) were included in the study and divided into two groups: a neurodevelopmental treatment+Nintendo Wii group (group 1, n=15) and a neurodevelopmental treatment group (group 2, n=15). Both groups received treatment in 45-minute sessions 2 days/week for six weeks. Use of the upper extremities, speed, disability and functional independence were evaluated using the Quality of Upper Extremity Skills Test, Jebsen Taylor Hand Function Test, ABILHAND-Kids test, and Pediatric Functional Independence Measure (self-care) before and after treatment. [Results] There were statistically significant improvements in all parameters for group 1 and group 2 (except quality of function) after six weeks of treatment. Intergroup analysis showed that group 1 was superior to group 2 in mean change differences in the Jebsen Taylor Hand Function Test. [Conclusion] Our results showed that neurodevelopmental treatment is effective for improving hand functions in hemiplegic cerebral palsy. To provide a enjoyable, motivational, safe, and effective rehabilitation program, the Nintendo(®) Wii may be used in addition to neurodevelopmental treatment.

Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Protocol of a Feasibility Study

BACKGROUND

Traumatic brain injury (TBI) is a critical public health problem. The recovery process for people with TBI is typically slow and dependent on complex and intensive assisted rehabilitation programs.

OBJECTIVE

To evaluate the effects and feasibility of digital games for cognitive functioning and general well-being among people with traumatic brain injury.

METHODS

This is a single-site feasibility study conducted in Finland, which uses a pragmatic, randomized controlled trial with three arms, and will recruit patients from the Turku University Hospital, Division of Clinical Neurosciences in Finland. Participants must meet the following inclusion criteria: (1) a Finnish speaking adult, aged 18-65 years; (2) diagnosed with a traumatic brain injury (diagnostic criteria ICD-10, S06.X, T90.5) in the University Hospital; (3) access to a TV, a computer, and the Internet at home; (4) not an active digital gamer (5 hours or less a week); (5) willing to participate in the study. Participants must have been discharged from the neurologic treatment period for traumatic brain injury for over 12 months before the commencement of the trial, and they may not have actively participated in cognitive rehabilitation during the 3 months prior to the trial. Written informed consent will be mandatory for acceptance into the trial. Exclusion criteria are as follows: (1) sensory, cognitive, or physical impairment (eg, severe cognitive impairment); (2) a deficiency restricting the use of computers or computer game control system unaided (eg, impairment in vision, severe astigmatism, hemiplegia, disorder in visuospatial perception, dysfunction of the central vestibular system); (3) apathy identified in previous neuropsychological evaluations; (4) diagnosed severe mental disorders (eg, schizophrenia or severe depressive disorders to be identified in medical records as the secondary diagnosis).

RESULTS

The preparatory phase for the study is fulfilled. Recruitment started in June 2015 and finished November 2015. Results will be reported in 2016.

CONCLUSIONS

The specific outcomes such as primary outcome measures were selected because they are widely used psychological tests and thought to be sensitive to changes in the cognitive functions related to TBI.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH).

Head stabilization shows visual and inertial dependence during passive stimulation: implications for virtual rehabilitation

Sensorimotor coordination relies on the fine calibration and integration of visual, vestibular, and somatosensory input. Using virtual environments (VE) allows for the dissociation of visual and inertial inputs to manipulate human behavioral outputs. Our goal was to employ VE technology in a novel manner to investigate how head stabilization is affected by spatiotemporal properties of dynamic visual input when combined with passive motion on a linear sled. Healthy adults (n = 12) wore a head-mounted display during naso-occipital sinusoidal horizontal whole body translations while seated. Subjects were secured in a seat with a five-point harness, with the head free to move. Frequency and amplitude of sinusoidal input (i.e., inertial conditions) were set to create overlapping conditions of maximum acceleration (amax) or velocity (vmax). Four inertial conditions were combined with four visual conditions (VIS). VIS were created so that direction of optic flow either matched direction of passive motion or did not. The effect of near and far fixation distance within the VE was also tested. Head kinematics were collected with a three-axis gyro. Head stability showed a complex interaction dependent on changes in weighting of visual and inertial inputs that changed with the sled driving frequency. Inertial condition affected amplitude (p < 0.0000) and phase (p < 0.0000) of head pitch angular velocity. In the absence of visual input, head pitch velocity amplitude increased (p < 0.01). An interaction effect between inertial and VIS conditions on head yaw occurred in SW (p < 0.05). There was also a significant interaction of depth of field and inertial condition on amplitude (p < 0.001) and phase (p < 0.05) of head yaw velocity in SW, especially during high vmax conditions. We conclude visual flow can organize lateral cervical responses despite being discordant with inertial input. When using VE for rehabilitation, possible unintended, involuntary or reflexive motor responses that may not be present in traditional training environments should be taken into consideration.