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game.reha.lviv.ua
International Clinic of Rehabilitation
WEB-BASED HOME REHABILITATION GAMING SYSTEM
game.reha.lviv.ua
International Clinic of Rehabilitation
• Prof. Volodymyr Kozyavkin, MD, Director of International Clinic of Rehabilitation,
• Dr. Oleh Kachmar, MD, Head of Innovative Technologies Department,
• Dr. Taras Voloshyn, MD, child neurologist,
• Mr. Vadym Markelov, software developer,
• Mrs. Iryna Ablikova, Physical Therapist,
• Mr. Bohdan Kachmar, software developer
Research and Development Team
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• Provides Intensive treatment for patients with Cerebral Palsy and other neurological diseases
• More than 4.000 patients came for treatment each year
game.reha.lviv.ua
Background• Virtual reality (VR) have great potential in the neurological rehabilitation of patients with movement disorders
• Most VR systems for motor training are quite expensive and could be used only in clinical setting
• Low-cost, commercially available gaming systems are widely used, but:• typical games are too difficult for disabled
children• no means for distant supervision by therapists
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game.reha.lviv.ua
Our Experience• Using Computer Games in Motor Rehabilitation for more than 12 years
• Now gaming rehabilitation is used on regular daily basis
• Custom Made Gaming Hardware• Hand training device• Training chair• Universal gaming device
Special Rehabilitation Gaming Software
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game.reha.lviv.ua
Objective
• Develop a low-cost rehabilitation game training system • for patients with movement disorders, • suitable for home use,• with supervision of a therapist
• Preliminary assessment of its benefits for training balance in patients with Cerebral Palsy
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game.reha.lviv.ua
System Description
application installed on a home computer
Tasks:• connect gaming hardware
through USB or Bluetooth: • convert data from different
hardware to one format, • send the game controlling data
to the games and receive feedback
Hosted in the Internet
Tasks:• user management • repository for rehabilitation
games with training guidelines
• usage statistics • messaging
Game Device Controller VR Game Server
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Internet
Therapist
Rehabilitation Game
Browser
Patient
Game
Developer
GDC
Game Server
game.reha.lviv.ua
Rehabilitation Gaming Hardware
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Nintendo Balance Board
Nintendo Wii Remote
MS Kinect
Universal Gaming Device
game.reha.lviv.ua
Rehabilitation Games
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• Could be played with different gaming hardware• Appropriate for people with movement disorders • Calibrated according to patient’s possibilities• 5 difficulty levels • Unified scoring system (max score 100)• Multilingual – game messages are separate
game.reha.lviv.ua
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with Rehabilitation Gaming System
BALANCE TRAINING
game.reha.lviv.ua
Training Positions
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Standing, left-right bending
Standing, front- back bending
Standing with supportStanding one foot in
front
Kneeling on the board Sitting on the board
game.reha.lviv.ua
Supervision by physical therapist
• Physical therapist evaluates the patient and draws up a training program, indicating recommended games, training positions, frequency and duration of sessions.
• Duration, timing and score of gaming sessions are stored on the server
• Using this information therapist may adjust the program, if necessary
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game.reha.lviv.ua
Stabilometry, a diagnostic game
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• Child stands still on the balance board for 15 sec
• Mean velocity of center of pressure (CoP) displacement and area of CoP displacement are calculated
• Higher velocities and larger areas indicate poor balance
game.reha.lviv.ua
PRELIMINARY OUTCOME ASSESSMENT
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game.reha.lviv.ua
Patients
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• Two weeks Daily home training sessions (30 min duration)
PatientAge
(years)Gender (M/F)
Diagnosis GMFCS level
A 5 MCP, spastic right-sided hemiplegia
І
B 5 FCP, spastic right-sided hemiplegia
ІІ
C 7 F CP, spastic right diplegia І
D 7 MCP, spastic right-sided hemiplegia
І
E 11 MCP, spastic left-sided hemiplegia
І
F 8 F CP, spastic tetraplegia ІІІ
game.reha.lviv.ua
Evaluation tools
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• Gross Motor Function Classification System - a five level classification system that describes the gross motor function of children with Cerebral Palsy
(Level I can walk without limitations, Level V – transported in wheelchair)
• Pediatric Balance Scale a scale with proven reliability and validity, designed to evaluate the child’s balance function.
(14 tasks, each from 0 to 4 points, 56 max)
• Stabilometry a specials diagnostic game measuring Velocity and Area of Center of Pressure (CoP) displacement while staying still on the board
game.reha.lviv.ua
Results
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Patient, age
GMFCS level
diagnosis,
Before training After training
Balance Scale
CoP Velocity
CoP Area Balance Scale
CoP Velocity
CoP Area
A, 5 years Level I, hemiplegia
52 25 8 53 23 8
B, 5 years Level II, hemiplegia
45 50 8 46 46 7
C, 7 years Level I, diplegia 47 29 14 48 25 9
D, 7 years Level I, hemiplegia
48 22 3 50 26 4
E, 11 years
Level I, hemiplegia
49 31 8 51 24 7
F, 8 years Level III, tetraplegia
7 48 (with
support)
7 (with
support)
7 44 (with
support)
5 (with
support)
game.reha.lviv.ua
Results
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before after0
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A
B
C
D
E
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Cen
ter
of
pre
ssu
re v
elo
cit
y
before after0
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4
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AB
C
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Cen
ter
of
pre
ssu
re A
rea
before after0
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A
BC
DE
F
Ped
iatr
ic B
ala
nce S
cale
Balance scale Center of Pressure (CoP) Velocity
CoP Area
game.reha.lviv.ua
Conclusions• A Home Rehabilitation Gaming System was developed in order to transfer the virtual rehabilitation of patients with motor disorders from clinical to home settings.
• Preliminary results suggest that home gaming training is beneficial for improving balance function in patients with Cerebral Palsy
Limitations of the study• a small number of patients • without control group • evaluation performed by a therapist working with them, so his assessments may have been biased
• important to determine how balancing skills, obtained during training sessions, can be adapted to everyday life
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game.reha.lviv.ua
Acknowledgements• The authors express their gratitude to the administration of the International Clinic of Rehabilitation for their support in developing the system,
• as well as to doctors and therapists for testing the system and offering critical and constructive suggestions
Home Rehabilitation Gaming System is available free-of-charge to both therapists and patients at http://game.reha.lviv.ua.
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game.reha.lviv.ua
Visit our demo at ***
THANK YOU
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