Quantifying selective elbow movements during an exergame in children with neurological disorders: a pilot study

Sensitivity to Vibrotactile Stimulation in the Hand and Wrist: Effects of Motion, Temporal Patterns, and Biological Sex

OBJECTIVE

We investigated the impact of low-tempo, repetitive hand movements on vibrotactile sensitivity by employing various temporal and spatial patterns in the hand and wrist area.

BACKGROUND

The investigation of a human's ability to perceive vibrotactile stimuli during dynamic hand movements remains understudied, despite the prevalence of slow to mild hand motions in applications such as hand navigation or gesture control using haptic gloves in Virtual Reality (VR) and Augmented Reality (AR).

METHOD

We investigated vibrotactile sensitivity, analyzing the impact of various factors, including Motion (static and low-tempo repetitive hand movements), Temporal Patterns (Single or Double vibrations with varying onset times), Tactor Placements (hand and wrist), Spatial Patterns, and Biological Sex.

RESULTS

Our study revealed that Motion significantly influences vibrotactile sensitivity in the hand and wrist areas, leading to reduced accuracy rates during dynamic conditions. Additionally, as the stimulus onset approached in Double vibrations, accuracy rates markedly decreased. Notably, Hand Placement resulted in significantly higher accuracy rates compared to the Wrist Placement.

CONCLUSION

Our findings underscore the impact of motion in reducing vibrotactile sensitivity on the back of the hand and around the wrist.

APPLICATION

This research has wide-ranging practical applications, particularly in the field of VR/AR experiences, rehabilitation programs, and accessibility solutions through the use of haptic gloves. Insights from our study can be harnessed to enhance the efficacy of haptic gloves in conveying vibrotactile cues within these contexts.

The use of virtual reality in the stimulation of manual function in children with cerebral palsy: a systematic review

OBJECTIVE

To identify in national and international literature the use of virtual reality to develop manual skills of children with cerebral palsy.

METHODS

This is a systematic review carried out in the PubMed database, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and the Online System for Search and Analysis of Medical Literature (Ovid Medline) using the keywords "cerebral palsy", "virtual reality", "occupational therapy", "child", "daily activities/activities of daily living", in English and in Portuguese. The selected articles had their methodological quality evaluated through the Physiotherapy Evidence Database (PEDro scale).

RESULTS

228 studies were selected, as they included children with cerebral palsy undergoing treatment with exposure to virtual reality to improve manual function in daily activities. Studies on other themes, incomplete, and duplicated reviews were excluded. Three evaluators conducted the study selection process and included 14 articles in the analysis.

CONCLUSIONS

The findings suggest that virtual reality therapy has contributed to an improvement in the manual function of children with cerebral palsy, constituting a useful resource for a supporting intervention to enhance traditional therapies.

Eylem Gözlem Terapisi ile Unilateral Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin Geliştirilmesi

Eylem Gözlem Terapisi (EGT) hareketlerin izlenmesi sonrası aynı hareketlerin taklit edilmesi ile merkezi sinir sistemi restorasyonunu destekleyen nörorehabilitasyon temelli bir tedavi yaklaşımıdır. Serebral palsi, parkinson, inme, ortopedik yaralanmalar, alzheimer ve konuşma bozuklukları gibi pek çok hastalıkta, fonksiyonu gerçekleştiren nöral yapıları aktive etmek için nörofizyolojik mekanizmadan yararlanan yeni bir rehabilitasyon yaklaşımı olarak bilinir. Sağlıklı bireylerde ve nörolojik veya ortopedik etkilenimi olan bireylerde yapılan araştırmalar; EGT uygulamasının gözlemcinin motor sisteminde kolaylaştırmayı indüklediği ve eylem-algı eşleştirme mekanizmasını desteklediği bilinir. Bu derleme, Serebral Palsi (SP) tanılı çocuklarda üst ekstremiteye yönelik uygulanan EGT programlarının kullanımı ve etkinliği ile ilgili mevcut bilgileri gözden geçirmek amacıyla planlanmıştır. EGT kullanımının farklı koşullara kolayca adapte edilebilmesi, nöral plasitisiteyi destekleyerek motor öğrenmeyi fasilite etmesi ve ekonomik olması nedeniyle, SP’li çocukların üst ekstremite rehabilitasyonunda kullanımının uygun olduğu; ancak protokol, süre ve uygulama şekli açısından optimal uygulama prensiplerinin belirlenebilmesi için daha detaylı çalışmalara ihtiyaç olduğu düşünülmektedir.

Playfully Assessing Lower Extremity Selective Voluntary Motor Control in Children With Cerebral Palsy: Psychometric Study

BACKGROUND

Objective measures specifically assessing selective voluntary motor control are scarce. Therefore, we have developed an interval-scaled assessment based on accelerometers.

OBJECTIVE

This study provided a preliminary evaluation of the validity and reliability of this novel gamelike assessment measuring lower limb selective voluntary motor control in children with cerebral palsy (CP).

METHODS

Children with CP and their neurologically intact peers were recruited for this psychometric evaluation of the assessgame. The participants played the assessgame and steered an avatar by selective hip, knee, or ankle joint movements captured with accelerometers. The assessgame's scores provide information about the accuracy of the selective movement of the target joint and the amplitude and frequency of involuntary movements occurring in uninvolved joints. We established discriminative validity by comparing the assessgame scores of the children with CP with those of the neurologically intact children, concurrent validity by correlations with clinical scores and therapists' opinions, and relative and absolute test-retest reliability.

RESULTS

We included 20 children with CP (mean age 12 years and 5 months, SD 3 years and 4 months; Gross Motor Function Classification System levels I to IV) and 31 neurologically intact children (mean age 11 years and 1 month, SD 3 years and 6 months). The assessgame could distinguish between the children with CP and neurologically intact children. The correlations between the assessgame's involuntary movement score and the therapist's rating of the occurrence of involuntary movements during the game were moderate (Spearman ρ=0.56; P=.01), whereas the correlations of the assessgame outcomes with the Selective Control Assessment of the Lower Extremity and Gross Motor Function Classification System were low and not significant (|ρ|≤0.39). The intraclass correlation coefficients were >0.85 and indicated good relative test-retest reliability. Minimal detectable changes amounted to 25% (accuracy) and 44% (involuntary movement score) of the mean total scores. The percentage of children able to improve by the minimal detectable change without reaching the maximum score was 100% (17/17) for the accuracy score and 94% (16/17) for the involuntary movement score.

CONCLUSIONS

The assessgame proved reliable and showed discriminative validity in this preliminary evaluation. Concurrent validity was moderate with the therapist's opinion but relatively poor with the Selective Control Assessment of the Lower Extremity. We assume that the assessment's gamelike character demanded various other motor control aspects that are less considered in current clinical assessments.

Gaming Technology for Pediatric Neurorehabilitation: A Systematic Review

INTRODUCTION

The emergence of gaming technologies, such as videogames and virtual reality, provides a wide variety of possibilities in intensively and enjoyably performing rehabilitation for children with neurological disorders. Solid evidence-based results are however required to promote the use of different gaming technologies in pediatric neurorehabilitation, while simultaneously exploring new related directions concerning neuro-monitoring and rehabilitation in familiar settings.

AIM OF THE STUDY AND METHODS

In order to analyze the state of the art regarding the available gaming technologies for pediatric neurorehabilitation, Scopus and Pubmed Databases have been searched by following: PRISMA statements, PICOs classification, and PEDro scoring.

RESULTS

43 studies have been collected and classified as follows: 11 feasibility studies; six studies proposing home-system solutions; nine studies presenting gamified robotic devices; nine longitudinal intervention trials; and eight reviews. Most of them rely on feasibility or pilot trials characterized by small sample sizes and short durations; different methodologies, outcome assessments and terminologies are involved; the explored spectrum of neurological conditions turns out to be scanty, mainly including the most common and wider debilitating groups of conditions in pediatric neurology: cerebral palsy, brain injuries and autism.

CONCLUSION

Even though it highlights reduced possibilities of drawing evidence-based conclusions due to the above outlined biases, this systematic review raises awareness among pediatricians and other health professionals about gaming technologies. Such a review also points out a definite need of rigorous studies that clearly refer to the underlying neuroscientific principles.

First validation of a novel assessgame quantifying selective voluntary motor control in children with upper motor neuron lesions

The question whether novel rehabilitation interventions can exploit restorative rather than compensatory mechanisms has gained momentum in recent years. Assessments measuring selective voluntary motor control could answer this question. However, while current clinical assessments are ordinal-scaled, which could affect their sensitivity, lab-based assessments are costly and time-consuming. We propose a novel, interval-scaled, computer-based assessment game using low-cost accelerometers to evaluate selective voluntary motor control. Participants steer an avatar owl on a star-studded path by moving the targeted joint of the upper or lower extremities. We calculate a target joint accuracy metric, and an outcome score for the frequency and amplitude of involuntary movements of adjacent and contralateral joints as well as the trunk. We detail the methods and, as a first proof of concept, relate the results of select children with upper motor neuron lesions (n = 48) to reference groups of neurologically intact children (n = 62) and adults (n = 64). Linear mixed models indicated that the cumulative therapist score, rating the degree of selectivity, was a good predictor of the involuntary movements outcome score. This highlights the validity of this assessgame approach to quantify selective voluntary motor control and warrants a more thorough exploration to quantify changes induced by restorative interventions.

Current behavioral assessments of movement disorders in children

Pediatric movement disorders (PMDs) are common and have recently received increasing attention. As these disorders have special clinical features, the selection of appropriate behavioral assessment tools that can clearly distinguish movement disorders from other diseases (eg, epilepsy and neuromuscular disorders) is crucial for achieving an accurate diagnosis and treatment. However, few studies have focused on behavioral assessments in children. The present report attempts to provide a critical review of the available subjective and objective assessment tests for common PMDs. We believe that the principles of objectification, multi-purpose use, and simplification are also applicable to the selection and development of satisfactory pediatric behavioral assessment tools. We expect that the development of wearable sensors, virtual reality, and augmented reality will lead to the establishment of more reliable and simple tests. In addition, more rigorous randomized controlled trials that have been specifically designed to evaluate behavioral testing in children are also expected in the future.