Dr. Tony Szturm,

Physical Therapist

Ph.D.Neuroscience

Adjunct Engineering

University of Manitoba

Computer aided, Game-Based

Telerehabilitation Platform with

Telemonitoring ApplicationsBlending of fine/gross motor skill training

with cognitive / educational Activities

TELEREHABILITATION

Most children with neuro-muscular disabilities clearly benefit from

intensive inpatient and well-resourced outpatient care.

While one-to-one, supervised therapy is preferred, due to access and

financial barriers, many children do not have this option.

When Rehab regimens are prescribed for toddlers/children to do at home,

adherence is low due to the fact that rehab exercises are tedious and

boring, and there is little long-term support or follow-up.

Access to Physical & Occupational Therapy in rural areas is limited.

Telerehabilitation is a simplified platform of high quality therapies of

ccombined fine/gross motor exercise and cognitive/educational activities

which address the above problems.

Elements of the Telerehabilitation Platform (TRP)

1. Wireless motion detecting computer mouse of high fidelity & responsiveness..

This mouse allows physical motion to be translated and interpreted as a standard

USB mouse. This allows common and modern computer games to be used and

enjoyed as part of a clinical and home rehabilitation program.

2. A designed software-based Assessment Game - includes advanced data

logging and data analysis methods. Electronic records are generated and are

stored digitally, which can then be manipulated into meaningful graphs and tables

for clinicians to review. With Internet capability, therapist can monitor patients’

performance and rehabilitation progress.

3. The many inexpensive off the shelf computer games having a broad range of

physical, and cognitive therapeutic values, as well as educational content.

The TRP is designed to provide affordable, engaging client-centered programs of

rehabilitation, and importantly the progression from supervised to unsupervised

monitored in-school and home programs.

Organize space of game interactions into

two interrelated categories

Physical Space: howdifferent bodymovements / forces

and natural object movements can be readily

transformed into “therapeutic” input devices with high

fidelityandresponsiveness.–ThusQualityTherapies

Cognitive Space:- based on nature and the

complexity of knowledge structures &

information processing, distractors, (choices

which player is engaged.

Core

balance

Dual-task

Walking

hand-arm

function

Gaze

Control

Multi-Tasking

2. Mouse button

Select unit

USB- RF

Receiver

1. Motion detecting unit

2cm by 3cm

Prototype- separate motion mouse into 2 smaller functional units

Upper Extremity Fine/Gross Motor Skill Telerehabilitation

Because the Air Mouse™ can be easily attached with Velcro to many “therapeutic”

objects this approach provides a highly flexible and personalized clinical or home-

based treatment tool applied to fine or gross upper extremity motor skills.

Multiple objects with varied sizes, shapes, weights, surface properties and functional

demands for precision can be used for exercise and to practice a variety of gross or fine

motor skills, and importantly, while playing fun computer games.

Critically to incorporate graded levels of “movement precision & combined with

common/modern education or “brain-fitness” computer games

Many common objects have Ergonomic properties

which afford ease of manipulation (control)

These are readily available to meet needs of even the

most involved and severely disabled client.

Good starting point for emerging skills

Reduce need for robotic devices.

importantly can be done at home.

Building Framework for Task-Specific therapy

Assessment Rehabilitation Game

Electronic monitoring is a critical feature embedded into the

Telerehabilitation platform.

This addresses the challenge of quantitative and objective outcomes

measurement and gave us a means to obtain electronic records for

Telerehabilitation.

Specifically Assessment Games were developed to:

1. objectively measure compliance.

2. produce outcomes & electronic records to detect problems

related to targeted and integrated aspects of movement, vision,

and cognitive performance.

3. means to provide timely feedback and support

4. Conduct trend analysis and identify drivers of change

5. Database: as electronic records are collected, the database,

and exploratory and confirmatory data mining

procedures can be established.

Assessment Game Module 1Analysis of clients movements as compared to

Standardized computer -controlled target motion

Quantify - Movement quality & efficiency

- Temporal accuracy

- amplitude consistency

- Movement endurance (repetition)

Testing Recording

- circle object labeled “T” is game target.

- triangle & rectangle labeled “D” are distracters

- GOAL MOVE PADDLE TO CATCH TARGETS

Automated Outcomes

- Success rate

- Response time

- Execution time

- Absolute error

- Response variation

- Movement efficiency

Treatment Rehabilitation Games

For all age’s computer games can provide an engaging forum in which learning arises as a result of tasks

stimulated by the content of the games, knowledge is developed through the content of the game and

skills are developed as a result of playing the game when using appropriate input devices (physical

requirements of therapy/learning)

There is also the realization of the need to capture existing commercial hardware and computer games so

as to keep price point low enough for home markets.

Not only do the physical movements & exercise have specific therapeutic value, but so does the

choice of computer game. Many common and modern video games require different levels of

movement amplitude, speeds, accuracy, repetition, cognitive demands (mental processing),. Also different

computer games appeal to individual preferences.

Using inexpensive off the shelf games the TRP provides engaging game-based rehabilitation applied to a

broad spectrum of disorders across the life span

- Fine motor skills finger-hand function and arm function

- Gaze stability, visual-vestibular interaction

- Executive cognitive function

- Balance-Mobility, walking, fall risk

- Dual-tasking

NOTE: There will also be the need to produce “designed” “rehabilitation "games with gameplay levels to

match the limited, emerging skills of the more involved and severely disabled clients.

Recent Publication

An In-School Based Program of Combined Fine-Motor

Exercise and Educational Activities for Children with Neuro-

Developmental Disorders.

Tony Szturm1 Eleoussa Polyzoi Jonathan Marotta Cynthia

Swarnalatha.

Games for Health journal in press October 2014

BRAIN HEALTHKeep your neurons fit & have fun doing It

Designing the Telerehabilitation Platform (TRP)

Extensive field testing and worked with knowledge users has been done to shape and

develop the TRP and training programs based on several key principles:

1. Functional: “activity-dependant” and takes advantage of available technologies and

modern concepts of brain plasticity

2. Maximizing motivation and engagement through interactive digital media and gaming is

seen as a main goal of interventions “especially for long-term and intensive therapies

3. Flexible: applied to diverse rehabilitation programs designed to improve: (a) core balance,

(b) mobility, c) gaze control and visual attention, (d) executive cognitive functions, (f) dual-

task functions (blending of a-d, (g) hand function (fine/gross motor skills). All ages toddlers,

children, adolescents, adults, older population

4. Cost Effective: treatment with embedded assessment : (a) objectively measure

compliance, (b) Feedback and support, c) outcomes & electronic records, (d) Trend analysis

(drivers of change) and to establish dose-response relations.

5. Extend Clinical Practice: high quality therapy and cognitive enrichment programs with

monitoring and support) to function in schools, the home and community settings , schools

urban and rural locations.

6. Database and Registry : The developed data mining procedures can establish a basis for

sustained population health status information and for empirically motivated rehabilitation

research.

Assessment Game Module 1Automatic recording of Clients movements as compared

to Standardized computer “reference “ movements

Examples Interactive Rehab Gaming Controllers & Data recording System

Gyration

Head mouse

-Game

Interaction

Motion recording

Pressure-matt

Game Interaction

COP Recording

Treadmill

Unobtrusive

Pressure Mapping

COP/gait variables

Wearable Wireless

Inertial Motion Monitors

Trunk/leg kinematics

Dual-Task “Neural Fitness” Exercise Blending of Balance & Walking & Gaze & Cognition

Dual-Task

Treadmill walking

Treadmill walking Treadmill walking

Dual-Task

Balance

Mental processing