PB2014 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering UPPER

PB2014

PM&R, Harvard Medical SchoolSpaulding Rehabilitation Hospital

Motion Analysis Laboratory

Wyss Institute forBiologically Inspired Engineering

UPPER LIMB REHABILITATION IN CHILDREN WITH

CEREBRAL PALSY USING A MULTI-TOUCH TABLE

Lucia Bonzi, Gloria Vergara-Diaz, Alan Dunne, Michelle Coldwell,

Giacomo Severini, Donna Nimec, Jim Niemi, Paolo Bonato

Department of Physical Medicine and RehabilitationHarvard Medical School, Spaulding Rehabilitation Hospital

Wyss Institute for Biologically Inspired Engineering

Harvard Medical School

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We have no relevant financial disclosure

We have received permission

to use the pictures

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Cerebral Palsy (CP) and Rehabilitation Gaming Technology

Group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain

(Rosenbaum et al. 2007)

Different treatments for improving functional performance, range of motion and coordination of upper limb in children with CP

Therapy involves a child performing repeated movements of their arms, hands and fingers

(Sakzewski et al. 2014)

Children can be motivated and interested making this movements into videogames Rehabilitation Gaming Technology

( Zocolillo et al. 2015; Valdes et al. 2014; Preston et al. 2014; Chiu et al. 2014)

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Rehabilitation Multitouch Technology

(Leitner et al. 2007; Annett et al. 2009; Alcañiz et al. 2009; Dunne et al. 2010)

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OBJECTIVE

This study aims to assess the usability of a multi-touch

table as a therapeutic tool toward a more effective and

quantifiable rehabilitation of the upper limb by engaging

children in task-specific exercises while playing

interactive games

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SYSTEMM

ult

i-Touch

Ta

ble

Gam

es

Sensors

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STUDY PROTOCOL

Design: Cross-sectional study

Setting: Pediatric rehabilitation hospital (outpatient)

Inclusion/Exclusion Criteria: 6-12 y.o. with an upper extremity dysfunction due to Cerebral Palsy able to fulfill directions in English, without severe vision impairments

Written parental consent and child assent

Main Outcome Measures:

Compensatory trunk movements

Compensatory motions with the unaffected arm

Visual Analog Scale (VAS) of satisfaction

Number of movement repetitions using the affected arm

Fun Boring

Easy

Uncomf.

Difficult

Comfortable

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STUDY PROTOCOL

Interventions:

Demographic and clinical data

Box and Blocks Test

Sensors:

7 wireless sensors

5 interactive games

Video recordings:

Quality of movements

Subjects’ feedback

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SAMPLE DESCRIPTION Population:10 Subjects

Median Age: 9 [7-12] years old

Gender: 60% males

Spastic: 80% hemiparesis, 20% tetraparesis

Box and Block test:

Dominant arm 34.1±12.9; Non dominant 18.7±17.80 (p=0.009)

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QUALITY OF MOVEMENT AND SATISFACTION

Compensatory Movements: 30% trunk and 60% unaffected hand

Satisfaction: High rates measured with a VAS

100% would like to play the games again, either during regular therapy or like home therapy

90% would like to do it instead of regular therapy

Fun Easy Comfortable

Fruits 90.5 [82-95] 53.5 [7-94] 90.5 [85-95]

Boats 94 [89-95] 93.5 [29-96] 95 [85-97]

Butterflies 88.5 [86-95] 58.5 [7-81] 85 [78-95]

Puzzle 91.5 [89-97] 87 [65-95] 90 [80-96]

Hockey 93.5 [90-95] 72 [13-88] 90 [89-931]

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SENSOR DATA

No significant differences Number of repetition

Number of repetition in 1

minute

Correlation

‘Fun‘ and ‘easy‘ rating of

- Hockey and Butterflies and the number of repetition

- Butterflies and number of repetitions in 1 minute

GAMES MOVEMENTAFFECTED

ARM * NON AFFECTED

ARM *

Fruits Repetition Lateral 19 [16,29] 24 [20,28]

Rep in 1 minute Lateral 5.15 [ 4.2-7.3] 5.35 [4.2-7.9]

Boats Repetition Vertical 41 [23,80] 83.5 [27,138]

Rep in 1 minute Vertical 7 [ 4.4-10.3] 11.2 [8.9-713.1]

Butterflies Repetition Vertical 17.5[8,32] 34 [18,52]

Rep in 1 minute Vertical 5.25 [ 3.5-6.7] 11.3 [9.7-13.7

Puzzle

Repetition Lateral 22.5 [15,27] 37 [29,47]

Repetition Vertical 17.5[ 9-57] 38 [19-94]

Rep in 1 minute Lateral 5.15 [4,7.1] 8.8 [7.9,9.6]

Rep in 1 minute Vertical 5.2 [ 1.9-8.2] 9.55 [5.3-15.3]

Hockey

Repetition Lateral 18.5 [14,21] 24 [20,25]

Repetition Vertical 21 [ 16-36] 59 [17-101]

Rep in 1 minute Lateral 3.1 [2.7,5.6] 5.75 [3.4,8.5]

Rep in 1 minute Vertical 3.95 [ 3.2-7.9] 9.05 [4.8-14.5]

* Median [P25-P75]p Value > 0.05

r = 0.37; r = 0.37

r = 0.30

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CONCLUSIONS

The Multi-Touch Table appears to be a helpful tool to engage children with CP in therapy, allowing a more effective treatment and therefore improving outcomes for upper extremity rehabilitation

Level of Evidence : Level IV

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Acknowledgments

Clinicians at Spaulding Rehabilitation Hospital and Children’s Hospital (Boston)

Peabody Foundation and the Wyss Institute

Gloria Vergara-Diaz, MDgvergaradiaz@partners. org

Thank you for your attention

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Summary of Citations & Level of Evidence1. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral

palsy April 2006. Developmental medicine and child neurology. Supplement. 2007;109:8-14.2. Sakzewski L, Gordon A, Eliasson AC. The state of the evidence for intensive upper limb therapy

approaches for children with unilateral cerebral palsy. J Child Neurol. 2014 Aug;29(8):1077-90; LOE – Level 1.

3. Zoccolillo L, Morelli D, Cincotti F, Muzzioli L, Gobbetti T, Paolucci S, Iosa M. Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical activity. Eur J Phys Rehabil Med. 2015 Feb 5; LOE – Level 2-4.

4. Valdés BA, Hilderman CG, Hung CT, Shirzad N, Van der Loos HF. Usability testing of gaming and social media applications for stroke and cerebral palsy upper limb rehabilitation. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:3602-5; LOE – Level 4.

5. Preston N, Weightman A, Gallagher J, Holt R, Clarke M, Mon-Williams M, Levesley M, Bhakta B. Feasibility of school-based computer-assisted robotic gaming technology for upper limb rehabilitation of children with cerebral palsy. Disabil Rehabil Assist Technol. 2014 Jun 25:1-8; LOE – Level 4.

6. Chiu HC, Ada L, Lee HM. Upper limb training using Wii Sports Resort for children with hemiplegic cerebral palsy: a randomized, single-blind trial. Clin Rehabil. 2014 Oct;28(10):1015-24; LOE – Level 2.

7. Dunne A, Do-Lenh S, O' Laighin G, Shen C, Bonato. Upper extremity rehabilitation of children with cerebral palsy using accelerometer feedback on a multitouch display. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:1751-4.

8. Annett M et al. Using a Multi-touch Tabletop for Upper Extremity Motor Rehabilitation. OZCHI 2009, November 23-27, 2009, Melbourne, Australia.

9. Leitner M et al. Designing tangible tabletop interfaces for patients in rehabilitation. Conference & Workshop on Assistive Technologies for People with Vision & Hearing Impairments Assistive Technology for All Ages CVHI 2007, M.A. Hersh (ed.).

10. Alcañiz M, Abarca V, Lozano JA, Herrero N. Analysis of multitouch technology for neurorehabilitation. Journal of Cybertherapy & Rehabilitation. Fall 2009, Volume 2, Issue 3.

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PB2014 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering UPPER