Games For Rehabilitation Research Articles

Convolutional Neural Networks Based Motion Data Optimization Networks forLeap Motion

<p indent=0mm>It is necessary to improve the capture accuracy and precision of Leap Motion equipment, and solve its inherent problems such as finger self-occlusion and instable sampling frequency, firstly, a multi-modal synchronous hand motion capture scheme is proposed based on Leap Motion and motion capture devices, and the dataset is captured correspondingly. Secondly, a convolutional-neural-network-based hand motion data optimization method for Leap Motion is presented. The proposed network is trained to learn the mapping from Leap Motion data domain to motion capture data domain with the synchronous dataset. Finally, a coplanar constraint for human fingers is proposed, which makes the outputs maintain stable hand skeleton structure. The 967 550 frames of synchronous hand motion data are captured in 6 categories from 15 volunteers. Experiments are designed for validating of the finger coplanar constraint, testing the consistency of the optimized motion data, and the comparison with BRA (bidirectional recurrent autoencoder) and EBD (encoder-bidirectional-decoder) methods. Experiments indicate that proposed method supports for capturing hand motion data with fixed sample frequency and MoCap-like precision using a Leap Motion. Furthermore, the proposed method can obtain smoother and more stable results than BRA and EBD. The method is also applied in rehabilitation games, which significantly reduces the number of errors of hand interaction motion recognition.

VR Serious Games for Neuro-cognitive Rehabilitation of Patients with Severe Memory Loss

Computer-Aided Design and Applications is an international journal on the applications of CAD and CAM. It publishes papers in the general domain of CAD plus in emerging fields like bio-CAD, nano-CAD, soft-CAD, garment-CAD, PLM, PDM, CAD data mining, CAD and the internet, CAD education, genetic algorithms and CAD engines. The journal is aimed at all developers and users of CAD technology to ptovide CAD solutions for various stages of design and manufacturing. The journal publishes all about Computer-Aided Design and Computer-Aided technologies.

A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting

BackgroundNeuroscience and neurotechnology are transforming stroke rehabilitation. Robotic devices, in addition to telerehabilitation, are increasingly being used to train the upper limbs after stroke, and their use at home allows us to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of the MERLIN robotic system based on serious games for upper limb rehabilitation in people with stroke in the home environment.Methods9 participants with a stroke in three different stages of recovery (subacute, short-term chronic and long-term chronic) with impaired arm/hand function, were recruited to use the MERLIN system for 3 weeks: 1 week training at the Maimonides Biomedical Research Institute of Cordoba (IMIBIC), and 2 weeks at the patients’ homes. To evaluate usability, the System Usability Scale (SUS), Adapted Intrinsic Motivation Inventory (IMI), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), and the ArmAssist Usability Assessment Questionnaire were used in the post-intervention. Clinical outcomes for upper limb motor function were assessed pre- and post-intervention.Results9 patients participated in and completed the study. The usability assessment reported a high level of satisfaction: mean SUS score 71.94 % (SD = 16.38), mean QUEST scale 3.81 (SD = 0.38), and mean Adapted IMI score 6.12 (SD = 1.36). The results of the ArmAssist Questionnaire showed an average of 6 out of 7, which indicates that MERLIN is extremely intuitive, easy to learn and easy to use. Regarding clinical assessment, the Fugl-Meyer scores showed moderate improvements from pre- to post-intervention in the total score of motor function (p = 0.002). There were no significant changes in the Modified Ashworth scale outcomes (p = 0.169).ConclusionsThis usability study indicates that home-based rehabilitation for upper limbs with the MERLIN system is safe, useful, feasible and motivating. Telerehabilitation constitutes a major step forward in the use of intensive rehabilitation at home.Trial registration ClinicalTrials.gov, NCT04405609. Registered 06 January 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04405609

Perception of Game-Based Rehabilitation in Upper Limb Prosthetic Training: Survey of Users and Researchers.

BackgroundSerious games have been investigated for their use in multiple forms of rehabilitation for decades. The rising trend to use games for physical fitness in more recent years has also provided more options and garnered more interest for their use in physical rehabilitation and motor learning. In this study, we report the results of an opinion survey of serious games in upper limb prosthetic training.ObjectiveThis study investigates and contrasts the expectations and preferences for game-based prosthetic rehabilitation of people with limb difference and researchers.MethodsBoth participant groups answered open and closed questions as well as a questionnaire to assess their user types. The distribution of the user types was compared with a Pearson chi-square test against a sample population. The data were analyzed using the thematic framework method; answers fell within the themes of usability, training, and game design. Researchers shared their views on current challenges and what could be done to tackle these.ResultsA total of 14 people with limb difference and 12 researchers participated in this survey. The open questions resulted in an overview of the different views on prosthetic training games between the groups. The user types of people with limb difference and researchers were both significantly different from the sample population, with χ25=12.3 and χ25=26.5, respectively.ConclusionsWe found that the respondents not only showed a general willingness and tentative optimism toward the topic but also acknowledged hurdles limiting the adoption of these games by both clinics and users. The results indicate a noteworthy difference between researchers and people with limb difference in their game preferences, which could lead to design choices that do not represent the target audience. Furthermore, focus on long-term in-home experiments is expected to shed more light on the validity of games in upper limb prosthetic rehabilitation.

Multiclass emotion prediction using heart rate and virtual reality stimuli

BackgroundEmotion prediction is a method that recognizes the human emotion derived from the subject’s psychological data. The problem in question is the limited use of heart rate (HR) as the prediction feature through the use of common classifiers such as Support Vector Machine (SVM), K-Nearest Neighbor (KNN) and Random Forest (RF) in emotion prediction. This paper aims to investigate whether HR signals can be utilized to classify four-class emotions using the emotion model from Russell’s in a virtual reality (VR) environment using machine learning.MethodAn experiment was conducted using the Empatica E4 wristband to acquire the participant’s HR, a VR headset as the display device for participants to view the 360° emotional videos, and the Empatica E4 real-time application was used during the experiment to extract and process the participant's recorded heart rate.FindingsFor intra-subject classification, all three classifiers SVM, KNN, and RF achieved 100% as the highest accuracy while inter-subject classification achieved 46.7% for SVM, 42.9% for KNN and 43.3% for RF.ConclusionThe results demonstrate the potential of SVM, KNN and RF classifiers to classify HR as a feature to be used in emotion prediction in four distinct emotion classes in a virtual reality environment. The potential applications include interactive gaming, affective entertainment, and VR health rehabilitation.

RehabHand: Oriented-tasks serious games for upper limb rehabilitation by using Leap Motion Controller and target population in spinal cord injury

There is a growing interest in the use of technology in the field of neurorehabilitation in order to quantify and generate knowledge about sensorimotor disorders after neurological diseases, understanding that the technology has a high potential for its use as therapeutic tools. Taking into account that the rehabilitative process of motor disorders should extend beyond the inpatient condition, it's necessary to involve low-cost technology, in order to have technological solutions that can approach the outpatient period at home. to present the virtual applications-based RehabHand prototype for the rehabilitation of manipulative skills of the upper limbs in patients with neurological conditions and to determine the target population with respect to spinal cord injured patients. Seven virtual reality applications have been designed and developed with a therapeutic sense, manipulated by means of Leap Motion Controller. The target population was determined from a sample of 40 people, healthy and patients, analyzing hand movements and gestures. The hand movements and gestures were estimated with a fitting rate between the range 0.607-0.953, determining the target population by cervical levels and upper extremity motor score. Leap Motion is suitable for a determined sample of cervical patients with a rehabilitation purpose.

Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation.

PurposeDesign and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension.MethodsA robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant’s game play performance was sampled and analyzed, and system modifications made between sessions.ResultsParticipants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable.ConclusionsThe novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.

Serious Gaming Technology in Upper Extremity Rehabilitation: Scoping Review

BackgroundSerious gaming has increasingly gained attention as a potential new component in clinical practice. Specifically, its use in the rehabilitation of motor dysfunctions has been intensively researched during the past three decades.ObjectiveThe aim of this scoping review was to evaluate the current role of serious games in upper extremity rehabilitation, and to identify common methods and practice as well as technology patterns. This objective was approached via the exploration of published research efforts over time.MethodsThe literature search, using the PubMed and Scopus databases, included articles published from 1999 to 2019. The eligibility criteria were (i) any form of game-based arm rehabilitation; (ii) published in a peer-reviewed journal or conference; (iii) introduce a game in an electronic format; (iv) published in English; and (v) not a review, meta-analysis, or conference abstract. The search strategy identified 169 relevant articles.ResultsThe results indicated an increasing research trend in the domain of serious gaming deployment in upper extremity rehabilitation. Furthermore, differences regarding the number of publications and the game approach were noted between studies that used commercial devices in their rehabilitation systems and those that proposed a custom-made robotic arm, glove, or other devices for the connection and interaction with the game platform. A particularly relevant observation concerns the evaluation of the introduced systems. Although one-third of the studies evaluated their implementations with patients, in most cases, there is the need for a larger number of participants and better testing of the rehabilitation scheme efficiency over time. Most of the studies that included some form of assessment for the introduced rehabilitation game mentioned user experience as one of the factors considered for evaluation of the system. Besides user experience assessment, the most common evaluation method involving patients was the use of standard medical tests. Finally, a few studies attempted to extract game features to introduce quantitative measurements for the evaluation of patient improvement.ConclusionsThis paper presents an overview of a significant research topic and highlights the current state of the field. Despite extensive attempts for the development of gamified rehabilitation systems, there is no definite answer as to whether a serious game is a favorable means for upper extremity functionality improvement; however, this certainly constitutes a supplementary means for motivation. The development of a unified performance quantification framework and more extensive experiments could generate richer evidence and contribute toward this direction.

Superior Facilitation of an Action Observation Network by Congruent Character Movements in Brain-Computer Interface Action-Observation Games.

Action observation (AO) is a promising strategy for promoting motor function in neural rehabilitation. Recently, brain-computer interface (BCI)-AO game rehabilitation, which combines AO therapy with BCI technology, has been introduced to improve the effectiveness of rehabilitation. This approach can improve motor learning by providing feedback, which can be interactive in an observation task, and the game contents of the BCI-AO game paradigm can affect rehabilitation. In this study, the effects of congruent rather than incongruent feedback in a BCI-AO game on mirror neurons were investigated. Specifically, the mu suppression with congruent and incongruent BCI-AO games was measured in 17 healthy adults. The mu suppression in the central motor cortex was significantly higher with the congruent BCI-AO game than with the incongruent one. In addition, the satisfaction evaluation results were excellent for the congruent case. These results support the fact that providing feedback congruent with the motion of an action video facilitates mirror neuron activity and can offer useful guidelines for the design of BCI-AO games for rehabilitation.

Effects of three different rehabilitation games’ interaction on brain activation using functional near-infrared spectroscopy

Objective: This study reveals the changes in brain activation due to different game interaction states based on functional near-infrared spectroscopy signals and discusses their significance for stroke rehabilitation. Approach: The oxygenated hemoglobin concentration (Delta [HbO2]) signals and the deoxygenated hemoglobin (Delta [HbR]) signals were recorded from the prefrontal cortex (PFC), the motor cortex (MC), the occipital lobe (OL) and the temporal lobe of 21 subjects (mean age: 24.6 ± 1.9 years old) in three game interaction states: physical, motion-sensing, and button-push training. The subjects were also asked to complete user-satisfaction survey scales after the experiment. Main results: Compared with the button-training state, several channels in the PFC and MC region of the physical-training state were significantly altered as were several channels in the RMC region of the motion-sensing training state (P < 0.05 after adjustment). The motion-sensing state of the PFC had a significant correlation with that of the MC and the OL. The subjective scale results show that the acceptability of the physical and motion-sensing states was greater than the acceptability of the button-push training state. Significance: The results show that the brain regions responded more strongly when activated by the physical and motion-sensing states compared with the button-push training state, and the physical and motion-sensing states are more conducive to the rehabilitation of the nervous system. The design of rehabilitation products for stroke patients is discussed and valuable insights are offered to support the selection of better interactive training methods.

Computerized Neuropsychological Test Battery CogniSoft for Assessment of Cognition in Patients with Multiple Sclerosis

Cognitive dysfunction is a leading cause of disability in multiple sclerosis (MS) and is associated with unemployment, need of assistance with daily activities and poor quality of life. The introduction of neuropsychological testing and monitoring of cognitive status as part of the overall evaluation of MS patients in parallel with clinical and paraclinical parameters is highly recommended. Recent studies have demonstrated a better perception and preference for computerized cognitive tests than classic variants, with no significant difference in results. In accordance with global trends, a bilingual computer system CogniSoft for assessment and rehabilitation of cognitive status in persons with MS has been developed, including: 1) a set of diagnostic tests for evaluation of memory and executive functions based on the nature of Brief International Cognitive Assessment for MS (BICAMS); 2) a set of games for cognitive rehabilitation. Questionnaire for depression (Beck Depression Inventory – BDI-II) will be filled before conduction of the neuropsychological tests for differentiation of possible depression which could interfere with the results. The CogniSoft information system will incorporate two approaches for evaluation of neuropsychological results which will allow early detection of cognitive impairments in these patients, which will initiate timely cognitive rehabilitation.

CogniSoft: A Platform for the Automation of Cognitive Assessment and Rehabilitation of Multiple Sclerosis

Cognitive disorders remain a major cause of disability in Multiple Sclerosis (MS). They lead to unemployment, the need for daily assistance, and a poor quality of life. The understanding of the origin, factors, processes, and consequences of cognitive disfunction is key to its prevention, early diagnosis, and rehabilitation. The neuropsychological testing and continuous monitoring of cognitive status as part of the overall evaluation of patients with MS in parallel with clinical and paraclinical examinations are highly recommended. In order to improve health and disease understanding, a close linkage between fundamental, clinical, epidemiological, and socio-economic research is required. The effective sharing of data, standardized data processing, and the linkage of such data with large-scale cohort studies is a prerequisite for the translation of research findings into the clinical setting. In this context, this paper proposes a software platform for the cognitive assessment and rehabilitation of patients with MS called CogniSoft. The platform automates the Beck Depression Inventory (BDI-II) test and diagnostic tests for the evaluation of memory and executive functions based on the nature of Brief International Cognitive Assessment for MS (BICAMS), as well as implementing a set of games for cognitive rehabilitation based on BICAMS. The software architecture, core modules, and technologies used for their implementation are presented. Special attention is given to the development of cognitive tests for diagnostics and rehabilitation. Their automation enables better perception, avoids bias as a result of conducting the classic paper tests of various neurophysiologists, provides easy administration, and allows data collection in a uniform manner, which further enables analysis using statistical and machine learning algorithms. The CogniSoft platform is registered as medical software by the Bulgarian Drug Agency and it is currently deployed in the Neurological Clinic of the National Hospital of Cardiology in Sofia, Bulgaria. The first experiments prove the feasibility of the platform, showing that it saves time and financial resources while providing subjectivity in the interpretation of the cognitive test results.

Rehabilitation Games in Real-World Clinical Settings

Upper-limb impairments due to stroke can severely affect the quality of life in patients. Scientific evidence supports that repetitive rehabilitation exercises can improve motor ability in stroke patients. Rehabilitation games gained tremendous interest among researchers and clinicians because of their potential to make the seemingly mundane, enduring rehabilitation therapies more engaging. However, routine and longitudinal use of rehabilitation games in real-world clinical settings has not been investigated in depth. Particularly, we know little about current practices, challenges, and their potential impacts on therapeutic outcomes. To address this gap, we established a partnership with a rehabilitation hospital where game-assisted rehabilitation was routinely employed over a 2-year period. We then conducted an observational study, in which we observed 11 game-assisted therapy sessions and interviewed 15 therapists who moderated the therapy. Significant findings include (1) different engagement patterns of stroke patients in game-assisted therapy, (2) imperative roles of therapists in moderating games and challenges that therapists face during game-assisted therapy, and (3) lack of support for therapists in delivering patient-centered, personalized therapy to individual stroke patients. Furthermore, we discuss design implications for more effective rehabilitation game therapies that take into consideration both patients and therapists and their specific needs.

Virtual reality games for rehabilitation of upper extremities in stroke patients

IntroductionStroke is one of the main causes of physical disability in which doing frequent and early exercise is imperative for rehabilitation. Virtual reality gaming has a high potential in rehabilitation leading to increased performance of patients. This study aimed to develop, validate and examine virtual reality games in chronic stroke patients. MethodsThis was a single before-after study. To determine the movements and content of games, 9 physiotherapists and 11 game designers were asked to participate in a questionnaire-based survey. Then, to evaluate the impact of games on rehabilitation, patients (N = 10; mean age = 52 ± 4.38) with chronic stroke were asked to play the games three times a week for four weeks. Outcomes included measurement of the ability to perform shoulder, elbow and wrist movements was performed using goniometric instrument, Modified Motor Assessment Scale (MMAS) was used to assess the functional ability of patients and muscle spasticity, and brunnstrom's stages of recovery test was also used to assess spastic and involuntary muscle movement. ResultsGames have positive effects on the horizontal abduction of shoulder (16.26 ± 23.94, P = 0.02), horizontal adduction of shoulder (59.24 ± 74.76, P = 0.00), supination of wrist (10.68 ± 53.52, P = 0.02), elbow flexion (0.1 ± 1.5, P = 0.00), and wrist flexion (0.06 ± 1.34, P = 0.03). However, they had no effects on the flexion of shoulder, flexion of elbow, extension of elbow, and extension of wrist (p-value> 0.05). ConclusionsThe results showed that games improve the range of motion of the participants in terms of horizontal abduction and abduction of the shoulder, elbow flexion, and supination and flexion of the wrist. Due to the small sample size in this study, we recommend more studies with larger samples and a control group.

IMU sensor-based data glove for finger joint measurement

&lt;p&gt;The methods used to quantify finger range of motion significantly influence how hand disability is reported. To date, the accuracy of sensors being utilized in data gloves from the literature has been ascertained yet need further analysis. This paper presents an inertial measurement unit sensor-based data glove for finger joint measurement developed for collecting a range of motion data of distal interphalangeal, proximal interphalangeal and metacarpophalangeal finger joints of an index finger. In this study, three inertial measurement sensors, MPU-6050 and two flexible bend sensors which are capable to detect angle displacement were attached to the distal interphalangeal, proximal interphalangeal and metacarpophalangeal finger joint points on the glove. The data taken from inertial measurement unit sensors and flexible bend sensors were acquired using Arduino and MATLAB software interface. The data obtained were compared with the reference data measured from goniometer to allow for accurate comparative measurement. The percentage of error resulted from MPU-6050 sensor unit were ranged from 0.81 % to 5.41 % were very low which indicates high accuracy when compared with the measurements obtained using goniometer. On the other hand, flexible bend sensor shows low accuracy (11.11 % to 19.35 % error). In conclusion, the inertial measurement unit sensor-based data glove using MPU-6050 sensors can be a reliable solution for tracking the progress of finger rehabilitation exercises. In order to motivate patients to adhere to the therapy exercises, interactive rehabilitation game will be developed in the future incorporating MPU-6050 sensors on all five fingers.&lt;/p&gt;

A Game-Based Rehabilitation Therapy for Post-Stroke Patients: An Approach for Improving Patient Motivation and Engagement

A brain stroke could result in the loss of neuromotor and cognitive functions. Poststroke rehabilitation therapy is used to enable patients to regain some of their lost functionalities. However, traditional rehabilitation faces problems related to the availability of physiotherapists and specific equipment. In home therapy is more convenient for poststroke patients, but their motivation and adherence to their medical regime must be addressed properly. This article presents a game-based in-home rehabilitation system based on two different design approaches. The first design approach (A1) consists of selecting games or ludic activities and adapting them to meet the treatment object ives, the second design approach (A2) consists of selecting and virtualizing the physiotherapy exercises being used at the hospital. The results of the usability study showed that the system is usable. The game difficulty levels were similar for both approaches. The perception of fun was greater for A1 than for A2. Additionally, both approaches were considered motivating for the subjects. The usability study showed that the rehabilitation games reported in this research are usable and motivating. In future research, these games will be integrated into a neuromotor rehabilitation program for poststroke patients.

Intelligent Rehabilitation Assistance Tools for Distal Radius Fracture: A Systematic Review Based on Literatures and Mobile Application Stores.

Objective To systematically analyze the existing intelligent rehabilitation mobile applications (APPs) related to distal radius fracture (DRF) and evaluate their features and characteristics, so as to help doctors and patients to make evidence-based choice for appropriate intelligent-assisted rehabilitation. Methods Literatures which in regard to the intelligent rehabilitation tools of DRF were systematic retrieved from the PubMed, the Cochrane library, Wan Fang, and VIP Data. The effective APPs were systematically screened out through the APP markets of iOS and Android mobile platform, and the functional characteristics of different APPs were evaluated and analyzed. Results A total of 8 literatures and 31 APPs were included, which were divided into four categories: intelligent intervention, angle measurement, intelligent monitoring, and auxiliary rehabilitation games. These APPs provide support for the patients' home rehabilitation guidance and training and make up for the high cost and space limitations of traditional rehabilitation methods. The intelligent intervention category has the largest download ratio in the APP market. Angle measurement tools help DRF patients to measure the joint angle autonomously to judge the degree of rehabilitation, which is the most concentrated type of literature research. Some of the APPs and tools have obtained good clinical verification. However, due to the restrictions of cost, geographic authority, and applicable population, a large number of APPs still lack effective evidence to support popularization. Conclusion Patients with DRF could draw support from different kinds of APPs in order to fulfill personal need and promote self-management. Intelligent rehabilitation APPs play a positive role in the rehabilitation of patients, but the acceptance of the utilization for intelligent rehabilitation APPs is relatively low, which might need follow-up research to address the conundrum.

An immersive virtual reality game to train spatial attention orientation after stroke: A feasibility study

Immersive virtual reality (IVR) may boost neglect recovery, as it can provide an engaging experience in a 3D environment. We designed an IVR rehabilitation game for neglect patients using the Oculus Rift. Multisensory cues were presented in the neglected visual field in a patient-tailored way. We acquired pilot data in 15 neurologically healthy controls and 7 stroke patients. First, we compared cybersickness before and after VR exposure. Second, we assessed the user experience through a questionnaire. Third, we tested whether neglect symptoms corresponded between the VR game and a computerized cancelation task. Fourth, we evaluated the effect of the multisensory cueing on target discrimination. Last, we tested two algorithms to tailor the game to the characteristics of the neglected visual field. Cybersickness significantly reduced after VR exposure in six stroke patients and was low in healthy controls. Patients rated the user experience neutral to positive. In addition, neglect symptoms were consistent between a computerized cancelation and VR rehabilitation task. The multisensory cue positively affected target discrimination in the game and we successfully presented sensory stimulation to the neglected visual field in a patient-tailored way. Our results show that it is promising to use gamified patient-tailored immersive VR for neglect rehabilitation.

Multisensory cueing facilitates naming in aphasia

BackgroundImpaired naming is a ubiquitous symptom in all types of aphasia, which often adversely impacts independence, quality of life, and recovery of affected individuals. Previous research has demonstrated that naming can be facilitated by phonological and semantic cueing strategies that are largely incorporated into the treatment of anomic disturbances. Beneficial effects of cueing, whereby naming becomes faster and more accurate, are often attributed to the priming mechanisms occurring within the distributed language network.ObjectiveWe proposed and explored two novel cueing techniques: (1) Silent Visuomotor Cues (SVC), which provided articulatory information of target words presented in the form of silent videos, and (2) Semantic Auditory Cues (SAC), which consisted of acoustic information semantically relevant to target words (ringing for “telephone”). Grounded in neurophysiological evidence, we hypothesized that both SVC and SAC might aid communicative effectiveness possibly by triggering activity in perceptual and semantic language regions, respectively.MethodsTen participants with chronic non-fluent aphasia were recruited for a longitudinal clinical intervention. Participants were split into dyads (i.e., five pairs of two participants) and required to engage in a turn-based peer-to-peer language game using the Rehabilitation Gaming System for aphasia (RGSa). The objective of the RGSa sessions was to practice communicative acts, such as making a request. We administered SVCs and SACs in a pseudorandomized manner at the moment when the active player selected the object to be requested from the interlocutor. For the analysis, we compared the times from selection to the reception of the desired object between cued and non-cued trials.ResultsNaming accuracy, as measured by a standard clinical scale, significantly improved for all stimuli at each evaluation point, including the follow-up. Moreover, the results yielded beneficial effects of both SVC and SAC cues on word naming, especially at the early intervention sessions when the exposure to the target lexicon was infrequent.ConclusionsThis study supports the efficacy of the proposed cueing strategies which could be integrated into the clinic or mobile technology to aid naming even at the chronic stages of aphasia. These findings are consistent with sensorimotor accounts of language processing, suggesting a coupling between language, motor, and semantic brain regions.Trial registrationNCT02928822. Registered 30 May 2016.

Acceptability of a Mobile Phone-Based Augmented Reality Game for Rehabilitation of Patients With Upper Limb Deficits from Stroke: Case Study.

BackgroundUpper limb functional deficits are common after stroke and result from motor weakness, ataxia, spasticity, spatial neglect, and poor stamina. Past studies employing a range of commercial gaming systems to deliver rehabilitation to stroke patients provided short-term efficacy but have not yet demonstrated whether or not those games are acceptable, that is, motivational, comfortable, and engaging, which are all necessary for potential adoption and use by patients.ObjectiveThe goal of the study was to assess the acceptability of a smartphone-based augmented reality game as a means of delivering stroke rehabilitation for patients with upper limb motor function loss.MethodsPatients aged 50 to 70 years, all of whom experienced motor deficits after acute ischemic stroke, participated in 3 optional therapy sessions using augmented reality therapeutic gaming over the course of 1 week, targeting deficits in upper extremity strength and range of motion. After completion of the game, we administered a 16-item questionnaire to the patients to assess the game’s acceptability; 8 questions were answered by rating on a scale from 1 (very negative experience) to 5 (very positive experience); 8 questions were qualitative.ResultsPatients (n=5) completed a total of 23 out of 45 scheduled augmented reality game sessions, with patient fatigue as the primary factor for uncompleted sessions. Each patient consented to 9 potential game sessions and completed a mean of 4.6 (SE 1.3) games. Of the 5 patients, 4 (80%) completed the questionnaire at the end of their final gaming session. Of note, patients were motivated to continue to the end of a given gaming session (mean 4.25, 95% CI 3.31-5.19), to try other game-based therapies (mean 3.75, 95% CI 2.81-4.69), to do another session (mean 3.50, 95% CI 2.93-4.07), and to perform other daily rehabilitation exercises (mean 3.25, 95% CI 2.76-3.74). In addition, participants gave mean scores of 4.00 (95% CI 2.87-5.13) for overall experience; 4.25 (95% CI 3.31-5.19) for comfort; 3.25 (95% CI 2.31-4.19) for finding the study fun, enjoyable, and engaging; and 3.50 (95% CI 2.52-4.48) for believing the technology could help them reach their rehabilitation goals. For each of the 4 patients, their reported scores were statistically significantly higher than those generated by a random sampling of values (patient 1: P=.04; patient 2: P=.04; patient 4: P=.004; patient 5: P=.04).ConclusionsBased on the questionnaire scores, the patients with upper limb motor deficits following stroke who participated in our case study found our augmented reality game motivating, comfortable, engaging, and tolerable. Improvements in augmented reality technology motivated by this case study may one day allow patients to work with improved versions of this therapy independently in their own home. We therefore anticipate that smartphone-based augmented reality gaming systems may eventually provide useful postdischarge self-treatment as a supplement to professional therapy for patients with upper limb deficiencies from stroke.