Modified Home Video Game System Improves Hand Function for Teenagers With Cerebral Palsy

In a pilot trial, a home video game system modified by engineers at
Rutgers University in Piscataway, N.J. improved hand function in teenagers with
cerebral palsy.

Rutgers engineers, members of the university’s Tele-Rehabilitation
Institute, worked with clinicians at the Indiana University School of Medicine
for the trial.

  Grigore Burdea
  Grigore Burdea

The three participants, involved in the pilot conducted by Meredith R.
Golomb, MD, associate professor of neurology at the Indiana University School
of Medicine, were able to perform a range of daily personal and household
activities by the end of the study.

According to the study, the modified system combined a Sony PlayStation
3 console, a sensing glove, a flat-panel TV, mouse, keyboard and a DSL modem
with virtual reality custom software and games developed specifically for hand
rehabilitation. Participants performed exercise routines aimed
at improving hand speed and range of finger motion.

Researchers set up the systems in participants’ homes for use for
30 minutes each day, 5 days a week, for 6 to 10 months. These data were
uploaded remotely from the patients’ homes to the clinical database server
at Rutgers, more than 620 miles away.

Clinical evaluation data was obtained by an occupational therapist
through several methods, such as the Jebsen–Taylor Hand Function Test and
the mechanical dynamometer and pinch meter to measure strength, Grigore Burdea,
PhD, professor of electrical and computer engineering and director of the
Rutgers Tele-Rehabilitation Institute, told O&P Business News.
Additional data was obtained by the modified PlayStation 3 system itself —
which collected computerized data, including the finger range and speed of
motion through sensing gloves, game scores, and session dates and duration
— and an online subjective evaluation questionnaire.

  PlayStation 3 therapy aims to improve hand speed and range of finger motion.
  PlayStation 3 therapy aims to
improve hand speed and range of finger motion.
  Image: Rutgers Tele-Rehabilitation

After 3 months of therapy, two participants progressed to being able to
lift large, heavy objects, which they had been unable to do before.
Participants also showed varying improvement in activities such as brushing
their teeth, shampooing their hair, dressing and using a spoon, according to a
press release. After 10 months, one participant was even able to open a heavy

“There are many possible explanations for these groundbreaking
results, including engaging therapy, our method of mapping limited finger range
to full range of the hand avatar, diminishing spasticity due to improved
sensorial feedback and improved grasp strength,” Burdea said.

This type of virtual rehabilitation is the future of therapy, he said.

“Virtual reality creates a highly motivating environment,
increasing attendance and compliance to protocol,” Burdea said.

He urged health care professionals not to see this technology as a
threat, but instead as a force amplifier.

Like with any other new technology, this system has its own technical
problems that the team hopes to improve upon.

In the future, Golomb, Riley Hospital for Children pediatric neurologist
in the study, said she hopes to test this technology in larger groups to
determine consistency, and complete additional studies to develop dosage
recommendations and comparisons to currently available therapies.

“We would also like to test this for other neurological and
orthopedic conditions,” Golomb said. “We suspect it will work for
many patients, not just CP patients.”

Motivation and accessibility to systems such as this may help people
with cerebral palsy improve hand function even 10 years after their brain
injury, which is thought to be in the perinatal stages in these patients, she

“We believe the use of games and the virtual reality component aid
in motivation; we know that installing these systems in the home improves
accessibility,” Golomb said. — by Stephanie Pavlou

For more information:


The Rutgers [University] modified Sony PlayStation system is the next
step in advancing our therapy modalities. Similar to how the Wii has been used
for therapy, this is a continuation of using new technology. This system
encourages patients to use a gaming system for therapy and recreation. Rather
than traditional static orthoses to prevent contractures, this new technology
allows them to regain motion. As children reach adolescence it’s difficult
to get them to follow through with therapies, as well as wearing their
orthoses, and this system allows them to retrain their muscle function using
what is perceived as a game.

This outcomes research is exciting because it demonstrates in everyday
activities the therapy is achieving the desired outcomes. We need to
incorporate these types of outcomes measurements in O&P to justify using
our new technology.

— Mark A. Porth, CPO, FAAOP
manager, Mary Free Bed Orthotics & Prosthetics

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