Abstract
BackgroundTraumatic brain injury (TBI) disrupts the central and executive mechanisms of arm(s) and postural (trunk and legs) coordination. To address these issues, we developed a 3D immersive videogame-- Octopus. The game was developed using the basic principles of videogame design and previous experience of using videogames for rehabilitation of patients with acquired brain injuries. Unlike many other custom-designed virtual environments, Octopus included an actual gaming component with a system of multiple rewards, making the game challenging, competitive, motivating and fun. Effect of a short-term practice with the Octopus game on arm-postural coordination in patients with TBI was tested.MethodsThe game was developed using WorldViz Vizard software, integrated with the Qualysis system for motion analysis. Avatars of the participant's hands precisely reproducing the real-time kinematic patterns were synchronized with the simulated environment, presented in the first person 3D view on an 82-inch DLP screen. 13 individuals with mild-to-moderate manifestations of TBI participated in the study. While standing in front of the screen, the participants interacted with a computer-generated environment by popping bubbles blown by the Octopus. The bubbles followed a specific trajectory. Interception of the bubbles with the left or right hand avatar allowed flexible use of the postural segments for balance maintenance and arm transport. All participants practiced ten 90-s gaming trials during a single session, followed by a retention test. Arm-postural coordination was analysed using principal component analysis.ResultsAs a result of the short-term practice, the participants improved in game performance, arm movement time, and precision. Improvements were achieved mostly by adapting efficient arm-postural coordination strategies. Of the 13 participants, 10 showed an immediate increase in arm forward reach and single-leg stance time.ConclusionThese results support the feasibility of using the custom-made 3D game for retraining of arm-postural coordination disrupted as a result of TBI.
Highlights
Traumatic brain injury (TBI) disrupts the central and executive mechanisms of arm(s) and postural coordination
Approximately 3.2 million Americans live with long-term disability following traumatic brain injury (TBI) [1]
Most positive evidence has been collected in patients with stroke [6,8,11,12], several studies reported the feasibility of virtual reality (VR) practice in patients with TBI [13,14]
Summary
Traumatic brain injury (TBI) disrupts the central and executive mechanisms of arm(s) and postural (trunk and legs) coordination. To address these issues, we developed a 3D immersive videogame– Octopus. Effect of a short-term practice with the Octopus game on armpostural coordination in patients with TBI was tested. The majority of TBI survivors present with disrupted central and executive mechanisms underlying arm and postural (trunk and legs) coordination [2]. Such disruption limits postural stability when performing arm of TBI survivors. To date numerous custom-made VR applications have been tested and shown to be effective in restoring sensorimotor abilities in patients with acquired brain injuries. The potential of VR gaming applications has been verified in this population when assessing cognitive functions [14,15], or retraining functional skills [16,17] and balance [9,18,19]
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