Kinecting the moves: the kinematic potential of rehabilitation-specific gaming to inform treatment for hemiplegia

IntroductionThe use of commercial gaming systems is gaining momentum in the field of rehabilitation (1). Virtual reality and active video games can increase user engagement and enjoyment in rehabilitation, increasing the potential for enhancing patient outcomes (2, 3). Therapeutic gaming may be one treatment tool selected by therapists for individuals with hemiparesis as a means of providing motivating opportunities for repetitive motor practice that encourages specific movement patterns and use of the impaired limb (4, 5). Bimanual therapy is an effective approach to reduce impairment and to improve functional ability of the paretic arm (6). However, commercial video games are not designed to consistently optimize the use of both arms simultaneously. Challenges exist, therefore, in the application of these systems to meet the therapeutic needs and physical capacities of different patient populations (7). Accordingly, the development of novel game applications and user interfaces for commercial gaming systems is expanding the potential for the technology to be adapted and integrated for these purposes, both in clinics and in the home.Motion tracking technology is being used increasingly both as a movement interface in these gaming systems, and as a means of capturing data about participants' kinematic movements during rehabilitation (8,9). The Vicon system (Oxford, UK) (10), the FASTRAK system (League City, TX) (11), and the Microsoft Kinect(TM) (Redmond, WA) (12) are three examples of this technology. The marker-based Vicon and FASTRAK systems provide higher accuracy compared to the Kinect, however at a higher cost and required expertise, making them unsuitable for most rehabilitation applications. Conversely, the Kinect has demonstrated centimetre-level accuracy, yet high correlations of tracked data with those obtained by marker-based systems (13). These findings, along with its commercial availability, make the Kinect a potential candidate for use in a clinical or home setting for rehabilitation. Furthermore, at this time, no documented guidance exists to translate the Kinect's kinematic data into clinically relevant information that is useful to therapists prescribing gaming interventions.The FEATHERS (Functional Engagement in Assisted Therapy through Exercise Robotics) project focuses on the development, testing and implementation of rehabilitation-specific interfaces for bimanual therapy, and the extraction of kinematic data to inform therapists monitoring patients' performance and progress. By applying custom algorithms to data collected from the Sony PlayStation Move (Tokyo, Japan) and the Kinect systems, it is possible to determine the total distance moved by the participant, their range of motion (ROM), and the vertical hand offsets for different directional movements. Moreover, the Kinect system is capable of providing data about excessive trunk movements.The purposes of this paper are therefore: (i) to describe the adaptation of two commercial interfaces (PlayStation Move and Microsoft Kinect) to promote bilateral arm use during social media-based game play; and (ii) to share preliminary kinematic data from two participants with hemiparesis using the systems. The analysis of the kinematic data offered by the systems allows for the extraction of clinically relevant information that can be shared with therapists to inform their treatment decisions.MethodsIn order to use the two motion capture interfaces for the upper limb rehabilitation of individuals with hemiparesis, a computer application called "FEATHERS Motion" was developed. The FEATHERS Motion application relies on the use of bimanual motions in the frontal plane to control the mouse cursor on a Windows® 7 personal computer. Two motion modes (Visual Symmetry and Point Mirror Symmetry) are available for mapping the hand with the least movement into cursor motion. In Visual Symmetry mode, users are required to move both hands at the same time in the same direction, while in Point Mirror Symmetry Mode, users must move both hands around the circumference of a circle, similar to turning a steering wheel. …