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ABOVE Games using low-cost technology have exciting potential for effectivehome-based rehabilitation
Videogames instrokerehabilitationJames Burke, PhD Candidatein Game Development forPost-stroke Rehabilitation,University of Ulster
In recent years, researchershave started looking at thepotential benefits of usingvideo games in strokerehabilitation.
Technology and games canoffer a novel. safe andcustomisable training environmentwhich can maintain engagementlevels and boost patientmotivation. Systems typicallycomprise rehabilitation gamingsoftware with an input device(e.g. joystick, motion-sensingcamera. data-gloves,electromagnetic sensors), anoutput device (e.g. monitor.projector. head-mounted display)and a computer. In addition tocustom-built systems, commercialgaming consoles such as theNintendo Wii have also been usedin stroke rehabilitation studies.
The games used in thesesystems emphasise repetitivemovements similar to thoseperformed in traditional therapy.such as reach. grasp, manipulationand release for upper-limbrehabilitation. These games areoften simple and easy to play. Thisis important since a person withstroke may not have played avideo game before or may have
STROKE MATTERS lSSUE 6 FFRUARY 2010
cognitive impairments. Well-designed games are also easilyconfigured, allowing people withvarying degrees of impairedmovements to engage effectivelyin the rehabilitation process.
Good game design allowsrepetitive movements to bepresented in a more challengingand rewarding way than is possiblewith traditional therapy. Forexample, reach actions couldtranslate to a game where playersare required to touch one targetobject (of many objects) on thescreen. To introduce an aspect ofchallenge the target object couldbe 'active' for only a few secondsbefore a new target is selected.One of the advantages of thisapproach is that all the gameelements can be programmed tochange. For example, the size ofthe objects and the length of timethey stay 'active' can be changed
STROKE MATTERS ISSUE 6 FEBRIJARY 2010
to accommodate a variety of playerabilities.
These systems are not designedwith the intention of replacingtraditional therapy; rather they aredesigned to be used in addition totherapy. Therapists will still berequired to assess patients andperhaps recommend particulargames. Therapist involvement tomonitor progress and set newchallenges will also be necessary.Should such systems be availablein hospital stroke units, forexample, It might be possible thatnewly diagnosed stroke patientscan engage in useful andstimulating therapy when theirtherapists are working with otherpatients. There is also great interestin evaluating the technology forhome use as this could lead topatients being able to playrehabilitation games outside oftheir therapy sessions.
The cost of systems variesdepending on the technologyused. Expensive systems such asthose which use virtual realitytechnology can cost over £10,000and may only be sutable in aclinical setting. However,emphasis is increasingly beingplaced on creating viable homerehabilitation by using off-the-shelftechnology such as low-costwebcams or haptic joysticks.Although large studies looking atthe effectiveness of suchtechnology solutions have yet tobe carried out in the UK it is likelythat we will see projects comingforward for health technologyassessment by UK agencies in thenear future.
There have been many studiesinvestigating the use oftechnology in stroke rehabilitationtherapy. A review of the field byCameirao et al1 confirms thattechnology can have a positiveeffect on stroke rehabilitation, withmany studies showing improvedmotor function recovery. Therehave been few studiesinvestigating the use of videogames in stroke rehabilitation;however,feedback from initialstudies has been positive -people with stroke do find theserehabilitation games enjoyableand motivational.2 _
References1 Monca S Cameirao. Sergi Bermidez iBadia; Paul F. M. J. Verschure.Virtual RealityBased Upper Extretremity Rehabilitationfollowing Stroke: a Review. Joumal ofCyberTherapy & Rehabilitation, Vol 1 Issue 1,Spring 2008
2 James W. Burke, Michael D. J. McNeill,Darryl K. Charles, Philip J. Morrow, Jacqui H.Crosbie, Suzanne M. McDonough,'Optimising engagement for strokerehabilitation using serious games', The VisualComputer, Vol 25,Issue 12. p1085-1099.~2009