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Games For Health - Spirometer Game Talk
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Playing With BreathP.M. Bingham,* T. Ashikaga, T. Lahiri
University of Vermont
*Disclosure: co-inventor, UVM’s Breath Biofeedback System and Method (US Patent # 7,618,378)
Spirometer Game Applications
• Training Breathing Muscles (exercise)
• Reinforce breath technique(s)
• Breath Awareness (“symptom detection” proprioception training)
Somatization
www.tonysteelemorgan.co.uk/gallery.php?sort=f...
Respiratory Interoception –can it be learned?
Game Technology
Digital spirometer, Software plots air flow on vertical axis
Points added every second the player keeps the ball on target
… … learning an eye-breath control game …learning an eye-breath control game …
Training “eye-breath” coordination in CF patients:
Distance to target:
0
75
150
225
300
375
1 2 3 4 5
Session
Mea
n R
MS
Val
ue
Bingham et al Clin Peds 2010 49:337
What I’m Playing...What I’m Playing...
www.myspace.com/lokummusic
Neural Processing- Primary Breathing Sensors
• Mechanoreceptors
• Nociceptors
• chemoreceptors
Neural Processing of Breath–High Roads and Low Roads
• Cognitive—spatial, temporal and intensity components (medullary nuclei, pons, thalamus, somatosensory, motor cortex)
• Emotional—dyspnea (amygdala, anterior cingulate, insular cortex)
Convergent:
• Thalamus, insular cortex, anterior cingulate cortex, amygdala
Anterior Insula mediates ‘sense of self’Craig, Nat Neurosci Rev 10 2009
Fink JB, RESPIRATORY CARE • 2007 VOL 52
http://www.nhlbi.nih.gov/health/dci/Diseases/cf/cf_signs.html
Why Forced Expirations?
Fink JB, RESPIRATORY CARE • 2007 VOL 52
Hypothesis: game playing increases forced expirations & alters PFTs
Design: within-subjects randomized crossover trial [A (game) -B (control) or B – A]
• 13 subjects, 7-12 yo• repeated measures analysis (days used)Outcomes: average FEs per day usedChange in pulmonary function measures (FEV1, VC)
Reinforcing Breath Technique – CF
Study Procedures
• subjects received spirometer, computer (games vs control setup)
• both games and control software incite the player to perform forced exhalation maneuvers
• weekly phone contact; “no nagging” policy
Software Usage, FEs, and %PFT Changes
Game Control P(t test)
Days Available 38.6 + 20.2 26.4 + 11.3 0.02
Days Used 10.0 + 11.2 8.5 + 7.2 0.59
Total Minutes Used/Days Used 4.8 ± 4.4 1.6 ± 1.8 0.02
Total HFEs/Days Used 10.2 ± 5.2 11.6 ± 8.2 0.65
% FEV1 Change 4.1 + 16.1 -0.8 + 17.3 0.16
% FEV1 Change/Days Used 0.3 ± 2.4 -2.5 ± 5.2 0.01
% VC Change 4.3+ 10.6 -2.1 + 12.6 0.05
% VC Change/Days Used 0.4 ± 1.7 -2.6 ± 5.3 0.03
Summary
• FE count did not differ (10-12/day) but apparently exceeded baseline
• Players were more engaged with the game than the control software (minutes/day used ~5 vs. ~2)
• Game days increased Vital Capacity (p=.03) and FEV1 (0.01)
Conclusions
• Visual breath biofeedback can engage CF patients with FEs in a research setting
…but for how long?
• Game based visual feedback may improve PFTs
… improved test technique?
… formal clinical trial planned
Acknowledgements
• Families and Subjects with Cystic Fibrosis
• Jason Bates
• Sarah Waterman, Amanda Woods, Gwen Fitz-Gerald, Jackie Swartz
• Vermont Children’s Hospital – Nurses/Staff
• R.W. Johnson Foundation
• NIH SBIR 103370
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