Adaptive Esports for People With Spinal Cord Injury: New Frontiers for Inclusion in Mainstream Sports Performance

Development of a novel clinical outcome assessment: digital instrumental activities of daily living

BACKGROUND

Digital technology is integral to activities of daily living, particularly instrumental activities of daily living (IADLs). However, tools that accommodate digital performance of IADLs are lacking. The aim of this study was to develop a novel Digital IADL Scale.

METHODS

The multi-stage methodology included: (i) deductive item generation via a systematic review and assignment to domains using a Delphi process, (ii) inductive item generation via a survey of individuals with lived experience (IWLE) of severe paralysis, (iii) item refinement via item rating surveys of content experts and IWLE, and (iv) focus group discussions with key opinion leaders.

FINDINGS

The systematic review identified 1250 IADL items from validated IADL measures, of which 353 met criteria. Deduplication reduced the deductive item set to 77, of which 42 remained following the Delphi process. IWLE generated 152 items, of which 132 met criteria. Deduplication reduced the inductive item set to 41. The combined item pool was reduced to 69 following the item rating surveys. Following focus group feedback, a list of nine domains, containing 37 items, and suggested response scale options are presented.

INTERPRETATION

We describe the initial development of a scale to assess functional independence within IADLs that may be completed digitally, which will be submitted to further validation.

FUNDING

Support for this project was provided in kind by the Abilities Research Center. No formal funding was received.

Adherence and perceptions of a home sports video gaming program in persons with spinal cord injuries: A pilot study

OBJECTIVE

Sports video-gaming can facilitate increased activity levels in persons with limited exercise options. Understanding how persons with spinal cord injuries (SCI) participate in home-based video-gaming and its potential impact on maintaining or enhancing physical function remains largely unexplored. The purpose of this study was to evaluate adherence, perceptions, and potential physical effects of a home sports video-game program for persons with chronic SCI.

PARTICIPANTS

Fourteen individuals with chronic SCI (9 tetraplegia, 5 paraplegia).

DESIGN

This was a prospective study. Wii video-gaming systems that included four sports games were provided to participants for home use. Participants were instructed to play for 8 weeks 3-4 days/week. The video consoles recorded the time and number of sessions played.

OUTCOME MEASURES

At baseline and at the conclusion of the program, measurements were made of upper extremity strength, perceived exertion, active heart rate, pain, balance, and a functional upper extremity (UE) test. The total time and number of sessions were compared to the prescribed game play as a measure of adherence. Scores from a self-reported survey were used to gauge participants' satisfaction and perceptions of their gaming experience.

RESULTS

Overall mean gaming adherence was 85% during the first 4 weeks and 69% for the second 4 weeks. There were no significant changes in upper extremity strength, active heart rate, balance, pain, or functional UE test for either group. All of the participants rated video gaming as enjoyable and 85.7% perceived that it could be used as a form of exercise.

CONCLUSION

The Wii sports home video-gaming intervention elicited overall high adherence rates and was well received by study participants indicating that it may have value as an adjunctive tool for increasing physical activity for individuals with SCI.

A high-performance brain-computer interface for finger decoding and quadcopter game control in an individual with paralysis

People with paralysis express unmet needs for peer support, leisure activities and sporting activities. Many within the general population rely on social media and massively multiplayer video games to address these needs. We developed a high-performance, finger-based brain-computer-interface system allowing continuous control of three independent finger groups, of which the thumb can be controlled in two dimensions, yielding a total of four degrees of freedom. The system was tested in a human research participant with tetraplegia due to spinal cord injury over sequential trials requiring fingers to reach and hold on targets, with an average acquisition rate of 76 targets per minute and completion time of 1.58 ± 0.06 seconds-comparing favorably to prior animal studies despite a twofold increase in the decoded degrees of freedom. More importantly, finger positions were then used to control a virtual quadcopter-the number-one restorative priority for the participant-using a brain-to-finger-to-computer interface to allow dexterous navigation around fixed- and random-ringed obstacle courses. The participant expressed or demonstrated a sense of enablement, recreation and social connectedness that addresses many of the unmet needs of people with paralysis.

Objective evaluation of seat discomfort on eRacing performance

BACKGROUND

While physical and mental health training guidelines have received much attention and scientific scrutinisation for traditional sports, these guidelines have not yet been developed for electronic sports (eSports). One important factor for developing these guidelines is to find appropriate ways to objectively measure performance and wellbeing of eSport participants through a combination of behavioural and physiological measurements.

OBJECTIVE

To determine the effect of perceived discomfort on stress levels and task performance during racing simulation (eRacing) activities using physiological and behavioural measurements.

METHODS

Discomfort and stress were analysed using questionnaires, electro-encephalography, electrocardiography, and galvanic skin response while 17 participants engaged in off-line Assetto Corsa racing simulation competitions.

RESULTS

Discomfort slightly increased with prolonged seating, and perceived task difficulty significantly increased stress and self-assessed task performance. While significant differences could be observed in electro-encephalographic (EEG) alpha-, beta-band activity and galvanic skin responses (GSR) data, these were not correlated to perceived stress, discomfort, or performance.

CONCLUSIONS

This study showed the potential for using physiological measurements to monitor eSport player performance before, after and during eRacing activities. While no significant correlations with behavioural assessments were found, further studies could build on the suggested physiological markers to determine effects of competitive environments on eSport participants' wellbeing.

Relationship between employment and adaptive video gaming in individuals with physical disabilities

PURPOSE

The purpose of this study was to assess employment characteristics of individuals with physical disabilities who currently participate in adaptive gaming and determine if there is a positive association between adaptive gaming and employment.

MATERIALS AND METHODS

A survey was administered to individuals with disabilities who currently use adaptive video gaming equipment to gather information on demographics, gaming habits, employment characteristics, and subjective benefits of gaming on employment.

RESULTS

The study included 606 participants. Over 57% of participants reported full-time or part-time employment. Nearly half of the participants reported using their equipment either most or all of the time to complete tasks related to work. Participants using their equipment to complete work tasks most or all of the time were more likely to be employed full-time (p = 0.0021). Over 75% of participants reported subjective benefits of adaptive video gaming on their employment.

CONCLUSION

Participants in this study had higher rates of employment compared to national averages for individuals with physical disabilities. More frequent use of adaptive gaming equipment for work was associated with a higher likeliness of full-time employment. Most participants who were employed reported subjective benefits of adaptive gaming on employment through improvements in mental health, physical function, and cognition.

A real-time, high-performance brain-computer interface for finger decoding and quadcopter control

People with paralysis express unmet needs for peer support, leisure activities, and sporting activities. Many within the general population rely on social media and massively multiplayer video games to address these needs. We developed a high-performance finger brain-computer-interface system allowing continuous control of 3 independent finger groups with 2D thumb movements. The system was tested in a human research participant over sequential trials requiring fingers to reach and hold on targets, with an average acquisition rate of 76 targets/minute and completion time of 1.58 ± 0.06 seconds. Performance compared favorably to previous animal studies, despite a 2-fold increase in the decoded degrees-of-freedom (DOF). Finger positions were then used for 4-DOF velocity control of a virtual quadcopter, demonstrating functionality over both fixed and random obstacle courses. This approach shows promise for controlling multiple-DOF end-effectors, such as robotic fingers or digital interfaces for work, entertainment, and socialization.

Pain and quality of life in athletes vs non-athletes with spinal cord injury: Observational study

Spinal Cord Injuries (SCI) may cause non-motor symptoms, such as chronic pain, which impair quality of life (QoL)Objective: To investigate the relationship between adapted competitive sports, pain, and QoL in people with SCI in a limited resources setting population.Methods: This prospective cross-sectional observational study involved 16 athletes and 24 non-athletes with SCI and collected data on demographic and clinical variables including scores for pain and pain interference in daily life (Brief Pain Inventory, BPI), neuropathic pain severity (Neuropathic Pain Symptoms Inventory, NPSI) and Quality of life (Word Health Organization Quality of Life Assessment, WHOQOL-BREF). Non-parametric testing was used to compare the groups, and due to athletes being younger, multiple linear regression analyses were used to adjust for the effect of sports practice on the outcome variables when adjusting for age.Results: Athletes were younger (median age 36y) than non-athletes (median age 41.5y; Mann-Whitney U test P = 0.011), and QoL was superior in athletes for the Physical, Psychological, Social Relationships, Self-Evaluation domains, and Total Score when adjusted for age (P < 0.01). Despite having no significant differences in pain intensity scores (NPSI, P = 0.742 and BPI, P = 0.261) athletes had less pain interference on "Relationship with Others", "Enjoyment of Life", and Total score (P < 0.05). Participation in competitive adapted sports (P = 0.004) and Total Pain Interference (P = 0.043) were significantly associated with QoL scores in the multiple linear regression analyses.Conclusion: Athletes with SCI have better QoL and less pain interference in some aspects of life when compared to non-athletes.

Social disconnectedness and perceived social isolation in persons with spinal cord injury/dysfunction living in the community: A scoping review

Context: Persons with spinal cord injury/dysfunction (SCI/D) are particularly at risk for social disconnectedness and/or perceived social isolation, which are key components to overall well-being. However, there is limited evidence that aims to understand these phenomena in this population.Objective: To investigate what is known about social disconnectedness and perceived social isolation for adults with SCI/D living in the community.Methods: A scoping review was conducted. A computer assisted search of four online databases was completed on all articles published until May 18th, 2021. Gray literature and key agencies were also searched for relevant documents. Two key concepts (spinal cord injury/dysfunction and social disconnectedness/perceived social isolation) and associated terms were used. All articles were double screened for inclusion by two reviewers.Results: Following deduplication, title and abstract screening and full-text screening, 37 articles met the criteria for inclusion in this review. Most of the included articles were published in North America, used quantitative methods and a cross-sectional design. Articles identified several factors that influenced social disconnectedness and perceived social isolation including participant characteristics, social support, psychological well-being, participation in activities, the built environment and physical health.Conclusion: The current literature suggests that issues with social disconnectedness and perceived social isolation exist for persons living with SCI/D in the community. More work is needed to better understand the relationship between these constructs. A more nuanced understanding can inform targeted interventions to help mitigate the impact of these phenomena on the SCI/D population.

The eSports Medicine: Pre-Participation Screening and Injuries Management-An Update

Recently, electronic sports (eSports) became one of the growing forms of new media due to the wide diffusion of games and online technologies. Even if there is still a debate about the definition and characterization of eSports, eAthletes train heavily, compete in tournaments, must abide by competition, association, and governing body rules, just like all other athletes. Furthermore, as in any other competitive discipline, there can be injuries. Aberrant sitting posture, repetitive movements, screen vision, prolonged playing hours, and a sedentary lifestyle can lead to several medical hazards in musculoskeletal, ophthalmology, neurological, and metabolic systems. Moreover, several cardiovascular changes occur in eAthletes. This paper aims to explore the different injuries that can occur in a professional eAthlete, suggesting how every high-level gamer could benefit from a pre-participation evaluation and a correct injury prevention strategy.

Adaptive Sports in Spinal Cord Injury: a Systematic Review

Purpose of Review

Recent Findings

Summary

Gamified Neurorehabilitation Strategies for Post-stroke Motor Recovery: Challenges and Advantages

Abstract

Purpose of Review

Stroke is the leading cause of permanent motor disability in the United States (US), but there has been little progress in developing novel, effective strategies for treating post-stroke motor deficits. The past decade has seen the rapid development of many promising, gamified neurorehabilitation technologies; however, clinical adoption remains limited. The purpose of this review is to evaluate the recent literature surrounding the adoption and use of gamification in neurorehabilitation after stroke.

Recent Findings

Gamification of neurorehabilitation protocols is both feasible and effective. Deployment strategies and scalability need to be addressed with more rigor. Relationship between engaged time on task and rehabilitation outcomes should be explored further as it may create benefits beyond repetitive movement.

Summary

As gamification becomes a more common and feasible way of delivering exercise-based therapies, additional benefits of gamification are emerging. In spite of this, questions still exist about scalability and widespread clinical adoption.