Upper extremity rehabilitation of children with cerebral palsy using accelerometer feedback on a multitouch display

Cerebral palsy is a non-progressive neurological disorder caused by disturbances to the developing brain. Physical and occupational therapy, if started at a young age, can help minimizing complications such as joint contractures, and can improve limb range of motion and coordination. While current forms of therapy for children with cerebral palsy are effective in minimizing symptoms, many children find them boring or repetitive. We have designed a system for use in upper-extremity rehabilitation sessions, making use of a multitouch display. The system allows children to be engaged in interactive gaming scenarios, while intensively performing desired exercises. It supports games which require completion of specific stretching or coordination exercises using one or both hands, as well as games which use physical, or “tangible” input mechanisms. To encourage correct posture during therapeutic exercises, we use a wireless kinematic sensor, worn on the patient's trunk, as a feedback channel for the games. The system went through several phases of design, incorporating input from observations of therapy and clinical sessions, as well as feedback from medical professionals. This paper describes the hardware platform, presents the design objectives derived from our iterative design phases and meetings with clinical personnel, discusses our current game designs and identifies areas of future work.

[1]  Thomas Grechenig,et al.  Designing Tangible Table-top Interfaces for Patients in Rehabilitation , 2007, CVHI.

[2]  B. Thomas,et al.  The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: A randomized controlled trial [ISRCTN87413556] , 2005, BMC pediatrics.

[3]  Josien C van den Noort,et al.  Evaluation of clinical spasticity assessment in cerebral palsy using inertial sensors. , 2009, Gait & posture.

[4]  Shyamal Patel,et al.  A Novel Approach to Monitor Rehabilitation Outcomes in Stroke Survivors Using Wearable Technology , 2010, Proceedings of the IEEE.

[5]  D. Patel,et al.  Therapeutic interventions in cerebral palsy , 2005, Indian journal of pediatrics.

[6]  Bruce H. Thomas,et al.  Virtual Reality as a Pediatric Pain Modulation Technique: A Case Study , 2003, Cyberpsychology Behav. Soc. Netw..

[7]  Walter F. Bischof,et al.  Using a multi-touch tabletop for upper extremity motor rehabilitation , 2009, OZCHI '09.

[8]  Jonathan Duckworth,et al.  A virtual tabletop workspace for the assessment of upper limb function in Traumatic Brain Injury (TBI) , 2007, 2007 Virtual Rehabilitation.

[9]  M. Tonkin,et al.  The upper limb in cerebral palsy , 2003 .

[10]  B. Dan,et al.  A report: the definition and classification of cerebral palsy April 2006 , 2007, Developmental medicine and child neurology. Supplement.

[11]  M. Guglielmetti,et al.  A virtual tabletop workspace for upper-limb rehabilitation in Traumatic Brain Injury (TBI): A multiple case study evaluation , 2008, 2008 Virtual Rehabilitation.

[12]  H. Hoffman,et al.  Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. , 2000, The Clinical journal of pain.

[13]  Eric J. Perreault,et al.  Side of lesion influences bilateral activation in chronic, post-stroke hemiparesis , 2007, Clinical Neurophysiology.

[14]  Elspeth Froude,et al.  An Investigation of Bilateral Isokinematic Training and Neurodevelopmental Therapy in Improving Use of the Affected Hand in Children with Hemiplegia , 2007, Physical & occupational therapy in pediatrics.

[15]  J Crosbie,et al.  Inter-limb coordination in bimanual reach-to-grasp following stroke , 2006, Disability and rehabilitation.

[16]  Gavin Williams,et al.  Upper limb virtual rehabilitation for traumatic brain injury: Initial evaluation of the elements system , 2010, Brain injury.

[17]  Ann Johnson Prevalence and characteristics of children with cerebral palsy in Europe. , 2002, Developmental medicine and child neurology.

[18]  M. Tonkin,et al.  ii) The upper limb in cerebral palsy , 1995 .