Virtual Reality Gaming for Treadmill Training: Improving Functional
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Transcript Virtual Reality Gaming for Treadmill Training: Improving Functional
Virtual Reality Gaming for
Treadmill Training:
Improving Functional Ambulation
in Children with Cerebral Palsy
Karen Kott
School of Physical Therapy, Old Dominion University
Gianluca De Leo
Virginia Modeling Analysis and Simulation Center, Old Dominion University
Katrina Lesher
Physical Medicine and Rehabilitation, Eastern Virginia Medical School
Eleonora Brivio
Virginia Modeling Analysis and Simulation Center, Old Dominion University
Steven Morrison
School of Physical Therapy, Old Dominion University
Background
Cerebral Palsy1
Describes
group of permanent disorders that
are non-progressive (2-3/1,000)
Occur in the fetal or infant brain
Impact development of movement and
posture
Causing activity limitation
Background
Different clinical presentations
Abnormal
muscle tone (hypertonia & hypotonia)
Abnormal coordination (ataxia)
Movement abnormality (dystonia & athetosis)
Accompanying impairments
Sensation,
perception, cognition, communication,
behavior, seizures
Secondary musculoskeletal system i.e. weakness and
limited range of motion
Background
Functional mobility or activity limitation
Means
to classify severity of movement disability
Key function of ambulation
Ambulation is the basis for standardized system of
classification
Gross Motor Function Classification System (GMFCS)2
Loss or limited ambulation
Impacts the lifetime costs for care3
Limits the quality of life
Can lead to an early death4
Literature Review
Rehabilitation
Ambulation
training
“Best practices” for motor learning movements5
Self-initiated and useful
Able to adapt to the environment
Practiced repetitively
Goal driven related to functional tasks
Treadmill feasible tool for CP6
How to make it interesting?
Integrate with play and Virtual Reality (VR)7,8
VR + gait training can change spatiotemporal
parameters9
Research Pilot Study
Purpose: Design, develop, and test the use of
a virtual game to improve ambulation in children
Participants:
CP
ages
5-15 years
ability to walk with no assistive devices except
orthoses
no cardiopulmonary limitations
Research Study
Methods:
One
group:
pre-test/post-test design
Measurement tool:
Standardized Walking
Obstacle Course
(SWOC)10
Research Study
Treatment Protocol
Watch
VR DVD (5,10,15 minutes segments)
Walk on treadmill (completing 9 hours of training)
Initial speed calculated from walk hands free condition of the
SWOC
Monitor HR via pulse
Increased speed as tolerated by .1 mph
Safety and rest
Receive
reinforcement via coins, diamonds and
verbal prompting
VR Game Solution
Toys do not have rules or goals
Puzzles have goals
Games have rules and goals
A game must include
Play activity
Pretended reality
A nontrivial goal
Rules
VR Game Solution
1) design of the virtual environments,
2) render of the virtual environments,
3) edit of the final video.
Lightwave application software
Rendered on a cluster
Solution available on DVD
VR Game Solution
Positive reinforcements by:
Receiving verbal feedbacks from VR characters (“keep
walking we have to save the princess”)
Earning points. Points accumulated in the concrete form
of diamonds, coins, magic shield, staff and glue (used to
fight the dragon at the end) that adhered to a magic shirt
that the child wore.
The use of the magic shirt helped the child feel more
immersed in the game.
VR Game Solution
QuickTime™ and a
Sorenson Video 3 decompressor
are needed to see this picture.
Results
35
60
30
50
20
15
40
35
40
Time in Seconds
25
Time in Seconds
Time in Seconds
Average (SD) time all children pre-test to post-test condition of:
30
20
10
10
30
25
20
15
10
5
5
0
0
1
0
Pre and Post Tests
walk with hands free
2
Pre and Post Tests
walk with tray
1
2
Pre and Post Tests
walk with glasses
Results
-) Positive feedback from subjects, their brothers and sisters and their parents
-) All of the subjects completed the training (ca. 9 hours of walking)
References
1.Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N (2007)
Proposed definition and classification of Cerebral Palsy. Developmental
Medicine & Child Neurology, 109, 49: 571-576.
2. Palisano, R.J., Hanna, S.E., Rosenbaum, P.E., Russell, D.J., Walter, S.D.,
Wood, E.P, Raina, P.S., Galuppi, B.E. (1997). Development and reliability of
a system to classify gross motor function of children with cerebral palsy.
Developmental Medicine & Child Neurology, 39, 214-223.
3. Economic Costs Associated with Mental Retardation, Cerebral Palsy,
Hearing Loss, and Vision Impairment --- United States, 2003 Morbidity and
Mortality Weekly Report (2004), 53, 03, Jan 30.
4. Day, S.M., Wu Y.W., Strauss, D.J., Shavelle, R.M., Reynolds, R.J. (2007)
Change in ambulatory ability of adolescents and young adults with cerebral
palsy. Developmental Medicine & Child Neurology, 49, 647-653.
References
5.
Valvano, J. (2005). Neuromuscular systems: the plan of care. In S. Effgen
(Ed), Meeting the physical therapy needs of children. Philadelphia: FA
Davis. 258-266.
6. Richards, C.L., Malouin, F., Dumas, F., Marcoux, S., Lepage, C.,Menier, C.
(1997). Early and intensive treadmill locomotor training for young children
with cerebral palsy: a feasibility study. Pediatric Physical Therapy, 9,4, 158165.
7. Rodgers, S., Ziviani, J. (1999) Play based occupational therapy. International
Journal of Developmental Disability Education, 46, 337-365.
8. Grealy, M.A., & Heffernan, D. (2000). The rehabilitation of brain injured
children: the case for including physical exercise and virtual reality. Pediatric
Rehabilitation, 4, 2, 41-9.
9. Deutsch, J.E., Merians, A.S., Adamovich, S., Poizner, H.,Burdea, G.C.
(2004). Development and application of virtual reality technology to improve
hand use and gait of individuals post-stroke. Restorative Neurology and
Neuroscience, 22, 3-5, 371-86.
References
10. Held, S.L., Kott, K.M.,Young, B. (2006). Standardized Walking Obstacle
Course (SWOC): reliability and validity of a functional measurement tool in
children who are developing typically and atypically. Pediatric Physical
Therapy, 18, 1, 23-30.