virtual reality gaming for treadmill training: karen kott school of physical therapy, old dominion...
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Virtual Reality Gaming for Treadmill Training:
Karen KottSchool of Physical Therapy, Old Dominion University
Gianluca De LeoVirginia Modeling Analysis and Simulation Center, Old Dominion University
Katrina LesherPhysical Medicine and Rehabilitation, Eastern Virginia Medical School
Eleonora BrivioVirginia Modeling Analysis and Simulation Center, Old Dominion University
Steven MorrisonSchool of Physical Therapy, Old Dominion University
Improving Functional Ambulation in Children with Cerebral Palsy
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
postureCausing 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
orthosesno 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
Results
0
5
10
15
20
25
30
35
Pre and Post Tests
Time in Seconds
0
10
20
30
40
50
60
1 2
Pre and Post Tests
Time in Seconds
0
5
10
15
20
25
30
35
40
1 2
Pre and Post Tests
Time in Seconds
walk with hands free walk with tray
Average (SD) time all children pre-test to post-test condition of:
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, 158-165.
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.