Off the Shelf Kinect Games for Stroke Rehabilitation

Perspective of the Therapist

Penny Standen Division of Rehabilitation and Aging

University of Nottingham Nottingham, UK

p.standen@nottingham.ac.uk

Luke Shires, James Lewis, David Brown, Nasser Sherkat

Computing and Technology team Nottingham Trent University

Nottingham, UK

luke.shires2007@my.ntu.ac.uk

Stroke

Stroke is the third most common disease in the UK with over 100,000 cases annually (Bupa 2011).

Stroke is also the leading cause for long term disability. The cost of treatment and dealing with the long term disabilities

afterwards is estimated to cost the UK economy £8.9 billion a year (Saka, McGuire and Wolfe 2009)

BUPA, 2011. Stroke [online]. . Available at: http://www.bupa.co.uk/individuals/health-information/directory/s/stroke [Accessed 12/9 2012].

SAKA, Ö., MCGUIRE, A. and WOLFE, C., 2009. Cost of stroke in the United Kingdom. Age and Ageing, 38 (1), 27-32.

Upper Limb Rehabilitation

Rehabilitation for an impaired upper limb following stroke requires early and repetitive exercise to maximize recovery (Feys, et al. 2004).

Outpatient facilities can be difficult to travel to for survivors with

mobility problems or long travel distances. New thinking suggests long term rehabilitation may have a

positive effect but clinical resources are directed towards new patients.

FEYS, H., et al., 2004. Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke: a 5-year follow-up study of a randomized trial. Stroke, 35 (4), 924-929.

Home Based Rehab

Gives patients the means to rehabilitate as much as they like, when they like. Without increasing clinical resources.

Allows patients to perform effective rehabilitation exercises

independently. Increases the amount of rehabilitation time available to the

patient, and allow cost effective rehabilitation in the long term.

COTS Games

Commercial off the shelf games. Cons

• Games are designed for able bodied users. • Might not encourage the ‘right’ kind of exercise. • Visual and GUI design are often not accessible

Pros • Relatively low cost. • Easily available. • Designed for use in a home setting.

• Recent increase in the popularity of motion controls.

• Games with high production values.

Xbox 360 Kinect

Study Rational

COTS systems have previously been shown to have a positive impact when used in conjunction with a normal course of rehabilitation.

Kinect games provide full body tracking, and new possibilities of

exercises based interaction with games. Want to learn about what works well with COTS games for

stroke, and use this to inform decisions about future rehab systems.

MOUAWAD, M.R., et al., 2011. Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study. Journal of Rehabilitation Medicine, 43 (6), 527-533.

Study Rational

COTS studies have focused on proving improvement in limb functionality, but ignored issues surrounding usability of the device for a wide range of stroke patients.

We want to explore the individual joint movements encouraged. And the minimum joint functionality the patients requires to

participate.

Study Configuration Recruit occupational and physiotherapists with experience of

working with stroke patients Participants received a demonstration of each Kinect game. Then

offered unlimited time to play. Answer questionnaire on joint functionality required by the

Kinect game. Allowed to return to the game at any point during the

questionnaire.

Study Configuration

Two games were chosen. Kinect Sports Bowling and Kinect Sports Table Tennis.

Easy to learn as rules match real life equivalent. Short play times allow study to be conducted in reasonable

timeframe. Relatively low excretion for Kinect games titles explored.

Kinect Sports Bowling

Kinect Sports Table Tennis

Interim Results

Recruited six therapists. All therapists completed study. Aiming to recruit twelve overall.

0

1

2

3

4

Min

imum

join

t fun

ctio

nalit

y re

quire

d to

pla

y

Joint movement

0. No motion required. 1. Reduced range of motion. 2. Partial range of motion. 3. Partial range of motion against gravity. 4. Full range of motion against gravity.

Bowling Joint Function Required

0

1

2

3

4

Min

imum

Join

t Fun

ctio

nalit

y Re

quire

d to

pla

y

Joint movement

0. No motion required. 1. Reduced range of motion. 2. Partial range of motion. 3. Partial range of motion against gravity. 4. Full range of motion against gravity.

Table Tennis Joint Function

0. Not encouraged. 1. Encouraged but not required. 2. Implicit to fulfilling required task. 3. Explicit to fulfilling required task.

Bowling Movement Encouraged

0

1

2

3

Join

t Exe

rcise

Enc

oura

ged

Joint movement

0. No exertion. 1. Low. 2. Medium. 3. High. 4. Dangerous.

Bowling Joint Exertion

0

1

2

3

4

Max

imum

Lev

el o

f Exe

rtio

n En

cour

aged

Joint movement

Informal Findings

Requirement to stand presents a serious risk of falling. Especially during table tennis.

Interface is not accessible, confusing to follow. Too many moving

elements.