REWIRE: Exergames based platform for autonomous...

Eling D. de Bruin

REWIRE: Exergames based platform for autonomous rehabilitation

„Whoever wants to understand much must play much“

Gottfried Benn.

Juni 2007 Vorname / Nachname / Institut


Themes

� [1] Theoretical background

� [2] General Overview

� Technologies

� Study Populations

� [3] Example REWIRE

� [4] Practical Application


Requirements for walking?

� Processes include

� mechanoreceptor stimulation,

� neural transmission,

� integration of the signals by the

central nervous system (CNS),

� transmission of an efferent

signal,

� muscle activation,

� and force production .


Adapted from Hausdorff et al. J Appl Physiol. 90: 2117-2129, 2001



The age-related loss of muscle strength is weakly associated with the loss of muscle mass.

Brian C. Clark , Todd M. Manini. What is dynapenia? Nutrition Volume 28, Issue 5 2012 495 – 503.


Proposed biologic mechanisms contributing to dynapenia (the age-associated loss of strength). It shows the influence of multiple factors that may lead to muscle weakness in the elderly. Adapted from J Gerontol A Biol Sci Med Sci 2008. 63: 829-34


Conceptual model of how nervous and muscle system impairments lead to dynapenia

Brian C. Clark , Todd M. Manini. What is dynapenia? Nutrition Volume 28, Issue 5 2012 495 – 503.


Scott. Nature Reviews Neuroscience 5, 532-546; 2004

Neurophysiologicmechanisms (dynapenia):

• Cortex• Aging ►▼motor cortex

excitability/cortical plasticity ► muscleperformance▼

• Spinal Cord• Aging ►▼ General excitability spinal

reflexes ►∆motor unit discharge ►▼

muscle functional properties

• Muscle• ▼ Maximal motor unit firing rates

Clark & Manini. Nutrition 28(5), 2012: 495 – 503


Microstructural Changes: Different For Different Motor Training Regimes

Nonskilled training : Overlearned,

automatic, or endurance based

tasks

� ↑ number of capillaries in

cerebellum and motor cx

� No change in motor cx

topography, synapse number or

glial cells

Black et al. ’90, Kleim et al. ’02


Microstructural Changes: Different For Different Motor Training Regimes

Skilled training : Tasks that require

a high amount of attentional

guidance

� ↑ synapses/neuron in cerebellum

& motor Cx

� ↑ glial cells/neuron in cerebellar

Cx

� Expansion of cortical motor maps

Black et al. ’90, Kleim et al. ’02

Anderson et al. ’94

Kleim et al. ’02


Motor Learning: Video Game Play

� There is evidence to suggest that certain types of video games positively affect physical functioning� postural control� walking abilities and� general functions of the upper

and lower extremities(Pichierri et al. BMC Geriatrics 2011, 11:29)




Cortical control of movement


Adapted from Hausdorff et al. J Appl Physiol. 90: 2117-2129, 2001

PHYSICAL ACTIVITY

American Geriatrics Society (2001) JAGS 49:664-672.

«……two possible mechanisms that could operate to improve motor function in this [Neurorehabilitation] setting:

volition and motor imagery» Lotze & Cohen, Cog Behav Neurol 2006;19:135–140


Technologies

Five categories according to the physical exercise component

of the intervention:

[1] Step training

[2] Balance board training

[3] Balance board plus aerobic training

[4] Programs using inertial sensors and/or motion capture devices

[5] Aerobic programs - locomotive training using VR displays


Pre-to-post intervention changes in maximal leg extension strength (maximal voluntary contraction [MVC]; left panel) and postural balance (center of pressure velocity moment [CoP-VM], right panel)

adjusted for gender, age, and baseline level in the Nintendo Wii group (dark grey bars) and the control group (light grey bars).

© The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected].

Martin G. Jorgensen et al. J Gerontol A Biol Sci Me d Sci 2013;68:845-852


Molecular Psychiatry (2014) 19, 265-271;

doi:10.1038/mp.2013.120


Seline Wüest

Nunzio Alberto Borghese

Michele Pirovano

Renato Mainetti

Eling D. de Bruin



Pre Pilot Project: Elderly Users

� Do elderly people accept and use the new exergame-based technology developed within the

REWIRE project?

� Do the study participants adhere well to the virtual reality-based REWIRE games

intervention?

� Do the study participants accept the virtual reality-based REWIRE games training method?

� Is the virtual reality-based balance training intervention with the REWIRE games able to

improve the balance of elderly?

� Is the REWIRE games-based training able to improve aspects of gait of elderly?


Background Methods Results & Discussion Conclusion

�Intervention

• Exergame-based balance training

• 3 times / week

• 1 training session: 20 minutes

• In total: 36 training sessions


Background Methods Results & Discussion Conclusion

�Secondary outcomes – BBS, TUG, SPPB

Baseline

(mean ± SD)

Post-

intervention

(mean ± SD)

Pwithin

r

BBS (points) 51.7 ± 3.3 54.8 ± 1.4 0.007 0.51

7-Meter TUG

(seconds)19.8 ± 2.8 17.5 ± 2.4 0.002 0.56

SPPB (points) 9.9 ± 1.0 11.2 ± 0.8 0.013 0.48


Points of discussion

� To what degree and how end-users have been engaged

� What are the unpublished and possibly unpublishable lessons from your work

� What are the challenges and opportunities for the future


“Man does not cease to play because he grows old. Man grows old because he ceases to play”

George Bernard Shaw


Thank youfor your attention!

The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement N. 287713, project REWIRE, of the European Union (EU).


� Good balance skills: an important determinant of walking performance

� Impaired balance ability assumed to be related to decreased locomotor function [Clin Rehabil 20 (11):960-969; Expert review of neurotherapeutics 7 (10):1417-1436]

� Task-related activities lead to greater improvements in post-stroke walking competency vs. non-task-related practices [Annu Rev Med 60:55-68; Clin Rehabil 18 (5):509-519; Arch Phys Med Rehab 81 (4):409-417]

� Variable practice leads to better transfer and retention of motor skills [e.g., Curr Opin Neurol 19 (1):84-90]

� Progression : rehabilitation programs benefit from a continuous adaptation of task difficulty to increasing skill level [Journal of Neurological Physical Therapy 28 (1):35]


Gentile’s Taxonomy of Motor Skills

� Two dimensions:

− Environmental Context

− subdivided into: (1a) regulatory conditions and (1b) intertrial variability

− Action Function

− Involves: (2a) body orientation and (2b) object manipulation

Magill RA. Motor learning and control: Concepts and applications.

McGraw-Hill Boston, MA; 2007


Gentile’s two-dimensions Taxonomy of Motor Skills



• 16 skill categories

• 3 different levels of difficulty per box

− Level 1: No restrictions

− Level 2: Time limit

− Level 3: Time limit + adequate accuracy

• Balance & Strength: each 16 skill categories & 3 levels of

difficulty (for each category) � 96 training exercises


Progression: 7 levels of difficulty

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