Games For Upper Limb Rehabilitation Research Articles

Brain-computer interface prototype to support upper limb rehabilitation processes in the human body

The high potential for creating brain-computer interfaces (BCIs) and video games for upper limb rehabilitation has been demonstrated in recent years. In this work, we describe the implementation of a prototype BCI with feedback based on a virtual environment to control the lateral movement of a character by predicting the subject’s motor intention. The electroencephalographic signals were processed employing a Finite Impulse Response (FIR) filter, Common Spatial Patterns (CSP), and Linear Discriminant Analysis (LDA). Also, a video game was used as a virtual environment, which was written in C# on the Unity3D platform. The test results showed that the prototype implemented based on electroencephalographic signal acquisition has the potential to take on real-time applications such as avatar control or assistive devices, obtaining a maximum control time of 65 s. In addition, it was noticed that the feedback in an interface plays a crucial role, since it helps the person not only to feel motivated, but also to learn how to have a more consistent motor intention and when little calibration data is recorded, the probability that the system makes erroneous predictions increases. These results demonstrate the usefulness of the development as support for people who require some treatment in the form of upper limb motor rehabilitation, and that the use of virtual environments, such as video games, can motivate such people during the rehabilitation processes.

An analysis of clinical outcomes and essential parameters for designing effective games for upper limb rehabilitation: A scoping review.

Upper limb disabilities are one of the most common disabilities among different groups of people who always need rehabilitation. One of the important methods in helping to carry out efficient rehabilitation processes and exercises is the use of games. The aim of this study is to identify the parameters necessary to design a successful rehabilitation game and the outcomes of using these games in upper limb disabilities rehabilitation. This scoping review was conducted by searching the Web of Science, PubMed, and Scopus. The eligibility criteria were: any form of game-based upper limb rehabilitation, published in a peer-reviewed journal, published in English, and not include articles that did not focus upper limb disabilities rehabilitation games, review, meta-analysis, or conference papers. Analysis of collected data was done using descriptive statistics (frequency and percentage). The search strategy retrieved 537 relevant articles. Finally, after removing irrelevant and repetitive articles, 21 articles were included in this study. Among the six categories of diseases or complications of upper limb disabilities, games were mostly designed for stroke patients. Smart wearables, robots and telerehabilitation were three technologies that were used for rehabilitation along with games. Sports and shooters were the most used games for upper limb disability rehabilitation. Among 99 necessary parameters for designing and implementing a successful rehabilitation game in ten categories. "Increasing the patient's motivation to perform rehabilitation exercises", "Game difficulty levels", "Enjoying and the attractiveness of the game for patients", and "Providing positive or negative audiovisual feedback" were the most important parameters. "Improvement in musculoskeletal performance" and "Increasing users' enjoyment/joy of therapeutic exercises and their motivation to perform these exercises" were the most important positive outcomes, and "Mild discomfort such as nausea and dizziness when using games" was the only negative outcome. The successful design of a game according to the parameters identified in the present study can lead to an increase in the positive outcomes of using games in the rehabilitation of disabilities. The study results indicate that upper limb therapeutic exercise augmented with virtual reality games may be highly effective in enhancing motor rehabilitation outcomes.

Feasibility and Performance Validation of a Leap Motion Controller for Upper Limb Rehabilitation

The leap motion controller is a commercial low-cost marker-less optical sensor that can track the motion of a human hand by recording various parameters. Upper limb rehabilitation therapy is the treatment of people having upper limb impairments, whose recovery is achieved through continuous motion exercises. However, the repetitive nature of these exercises can be interpreted as boring or discouraging while patient motivation plays a key role in their recovery. Thus, serious games have been widely used in therapies for motivating patients and making the therapeutic process more enjoyable. This paper explores the feasibility, accuracy, and repeatability of a leap motion controller (LMC) to be applied in combination with a serious game for upper limb rehabilitation. Experimental feasibility tests are carried out by using an industrial robot that replicates the upper limb motions and is tracked by using an LMC. The results suggest a satisfactory performance in terms of tracking accuracy although some limitations are identified and discussed in terms of measurable workspace.

Realisation of a Virtual Reality based Remedial Module for Cognition and Hand Function Rehabilitation

Hand function disorders of an individual hinders them from performing activities of daily living with ease and sometimes limit their cognitive growth. As a remedial treatment, nowadays virtual reality (VR) emerged as a gaming platform that has been employed for the rehabilitation of such individuals. User motivation and engagement has risen with the development of VR technology. The developed remedial module is based on a VR platform using two games for upper limb rehabilitation with a hand motion sensing device (HMSD) to provide a solution for sensing hands and fingers movements. The movement was measured with the development of the games based on bilateral hand coordination and manual dexterity, the subset of Bruininks-Oseretsky Test (BOT2) of Motor Proficiency. However, the result of the system considered here is based on the system usability scale (SUS) for healthy individuals. Thus, the system is simple, economical, portable, user-friendly, and does not require intruding external hardware to wear. Hence, over the time these engaging VR rehabilitation games can provide an effective rehabilitation training process for upper limb hemiparesis children.

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

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.

Effects of virtual reality associated with serious games for upper limb rehabilitation in patients with multiple sclerosis: randomized controlled trial

BackgroundDexterity and activities of daily living limitations on the upper limb (UL) represent one of the most common problems in patients with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of the specially developed Serious Games that make use of the Leap Motion Controller (LMC) as main user interface for improving UL grip muscle strength, dexterity, fatigue, quality of life, satisfaction and compliance.MethodsA single-blinded randomized controlled trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on serious games designed by the research team using the developed LMC based Serious Games for the UL plus conventional rehabilitation, and a control group who received the same conventional rehabilitation for the UL. Both groups received two 60 min sessions per week over a ten-week period. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, fatigue, quality of life, satisfaction and compliance were assessed in both groups pre-treatment, post-treatment and in a follow-up period of 1 month without receiving any treatment.ResultsIn the experimental group compared to the control group, significant improvements were observed in the post-treatment assessment for coordination, speed of movements, fine and gross UL dexterity. Also, significant results were found in the follow-up in coordination, speed of movements, fine and gross for the more affected side.ConclusionsAn experimental protocol using an LMC based Serious Games designed for UL rehabilitation showed improvements for unilateral gross manual dexterity, fine manual dexterity, and coordination in MS patients with high satisfaction and excellent compliance.Trial registrationThis randomized controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908, Nov 2019.

Serious Game Platform with Haptic Feedback and EMG Monitoring for Upper Limb Rehabilitation and Smoothness Quantification on Spinal Cord Injury Patients

Cervical Spinal Cord injury (SCI) is a neurological disease that produces, as a consequence, impairments of the upper limb function. This paper illustrates a virtual reality platform based on three serious games for upper limb rehabilitation with electromyography monitoring, providing force feedback to the patient. In the rehabilitation process proposed, haptic feedback was provided to the patients to strength the arm muscles by means of the Novint Falcon device. This end-effector device was used to manipulate the serious games. During the therapy performance, the system recorded electromyography signals from the patient’s arm muscles, which may be used to monitor muscle contraction. The work presented a virtual reality system developed for spinal cord-injured patients. Each virtual reality environment could be modified in strength and duration according to the patients’ needs and was implemented for recording quantitative data about the motor performance. The platform was validated as a proof of concept in cervical spinal cord-injured patients. Results showed that this rehabilitation platform could be used for obtaining objective information in relation to motor control characteristics.

Impact of game mode in multi-user serious games for upper limb rehabilitation: a within-person randomized trial on engagement and social involvement

BackgroundSerious games have been increasingly used for motor rehabilitation. However, it is not well known how different game features can be used to impact specific skills properly. Here, we study how the mode (competitive, co-active, collaborative) in which a multi-user game is presented impacts engagement and social involvement.MethodsWe collected data from 20 pairs of community-dwelling older adults (71.5 ± 8.7 years) in a study following a within-persons design. The participants performed a two-player upper limb rehabilitation game with three conditions (Competitive, Co-active, and Collaborative modes). Engagement and social involvement were assessed through the Core Module and Social Presence Module, respectively, from the Game Experience Questionnaire. To infer the impact of personality and cognitive function, users answered the International Personality Item Pool (short version) and the Montreal Cognitive Assessment, respectively.ResultsResults show that the Collaborative game mode promotes more social involvement when compared to Competitive and Co-active modes. This result is mostly explained by those participants with higher cognitive skills, and those that are more extrovert. Extrovert participants feel more empathy and are behaviorally more involved when playing the Collaborative mode. Also, the Collaborative mode is shown to be appropriate to promote interaction with participants that previously had a distant relationship, while the Competitive mode seems to be more beneficial to promote empathy between players with a closer relationship.ConclusionsThe Collaborative game mode elicited significantly higher social involvement in terms of Empathy, Positive Affect, and Behavioral Involvement. Hence, this game mode seems to be the most adequate choice to be used in multiplayer rehabilitation settings, where social interaction is intended.

Interaction Modalities Used on Serious Games for Upper Limb Rehabilitation: A Systematic Review.

This systematic review aims to analyze the state-of-the-art regarding interaction modalities used on serious games for upper limb rehabilitation. A systematic search was performed in IEEE Xplore and Web of Science databases. PRISMA and QualSyst protocols were used to filter and assess the articles. Articles must meet the following inclusion criteria: they must be written in English; be at least four pages in length; use or develop serious games; focus on upper limb rehabilitation; and be published between 2007 and 2017. Of 121 articles initially retrieved, 33 articles met the inclusion criteria. Three interaction modalities were found: vision systems (42.4%), complementary vision systems (30.3%), and no-vision systems (27.2%). Vision systems and no-vision systems obtained a similar mean QualSyst (86%) followed by complementary vision systems (85.7%). Almost half of the studies used vision systems as the interaction modality (42.4%) and used the Kinect sensor to collect the body movements (48.48%). The shoulder was the most treated body part in the studies (19%). A key limitation of vision systems and complementary vision systems is that their device performances might be affected by lighting conditions. A main limitation of the no-vision systems is that the range-of-motion in angles of the body movement might not be measured accurately. Due to a limited number of studies, fruitful areas for further research could be the following: serious games focused on finger rehabilitation and trauma injuries, game difficulty adaptation based on user's muscle strength and posture, and multisensor data fusion on interaction modalities.

Adaptation in serious games for upper-limb rehabilitation: an approach to improve training outcomes

In this paper, we propose a game adaptation technique that seeks to improve the training outcomes of stroke patients during a therapeutic session. This technique involves the generation of customized game levels, which difficulty is dynamically adjusted to the patients’ abilities and performance. Our goal was to evaluate the effect of this adaptation strategy on the training outcomes of post-stroke patients during a therapeutic session. We hypothesized that a dynamic difficulty adaptation strategy would have a more positive effect on the training outcomes of patients than two control strategies, incremental difficulty adaptation and random difficulty adaptation. To test these strategies, we developed three versions of PRehab, a serious game for upper-limb rehabilitation. Seven stroke patients and three therapists participated in the experiment, and played all three versions of the game on a graphics tablet. The results of the experiment show that our dynamic adaptation technique increases movement amplitude during a therapeutic session. This finding may serve as a basis to improve patient recovery.