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Telerehabilitation Gaming Therapy Development for Children with Cerebral Palsy

Telerehabilitation Gaming Therapy Development for Children with Cerebral Palsy. Team #: 15 Team members: Jayce Holley Fan (Peter) Zhu (Presenter) Kevin Lind Mentor: Dr. Jack Engsberg.

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Telerehabilitation Gaming Therapy Development for Children with Cerebral Palsy

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  1. Telerehabilitation Gaming Therapy Development for Children with Cerebral Palsy Team #: 15 Team members: Jayce Holley Fan (Peter) Zhu (Presenter) Kevin Lind Mentor: Dr. Jack Engsberg Birkenmeier RL, Prager EM, Lang CE. (2010) Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study. Neurorehabil Neural Repair. 24(7):620-35.

  2. Background Cerebral Palsy Permanent muscle and movement disorders[1] Lesions in the developing brain[1] Affecting 2 to 2.5 children per 1000 births[2] No relation between muscle strength and spasticity [4] Rehabilitation is benefit to both [5,6] http://www.google.com/imgres?q=cerebral+palsy+patient&um=1&hl=en&sa=N&biw=1536&bih=720&tbm=isch&tbnid=bP2YeBFaLT3J4M:&imgrefurl=http://cerebralpalsyhelp.org/&docid=baAQzV7InNv_M&imgurl=http://cerebralpalsyhelp.org/images/Cerebral%252520Palsy%252520Help.jpg&w=340&h=378&ei=lylhUI3aBZOc8wTs3IHwCA&zoom=1&iact=hc&vpx=428&vpy=182&dur=324&hovh=237&hovw=213&tx=137&ty=104&sig=104437745059302163758&page=1&tbnh=162&tbnw=153&start=0&ndsp=20&ved=1t:429,r:1,s:0,i:78

  3. Background Current practice Patients and therapists must be physically together Low compliance http://www.google.com/imgres?q=cerebral+palsy+training&um=1&hl=en&biw=1536&bih=720&tbm=isch&tbnid=PuZujr7Y2BM3oM:&imgrefurl=http://www.neurodiagnosticdevices.com/treadmilltraininginchildrenwithcerebralpalsy.htm&docid=AHIuN5X5FpOsLM&imgurl=http://s1.hubimg.com/u/288764_f260.jpg&w=260&h=347&ei=TixhUNuWE4Lc8ATfqoGYBg&zoom=1&iact=hc&vpx=181&vpy=131&dur=2975&hovh=259&hovw=194&tx=119&ty=85&sig=104437745059302163758&page=1&tbnh=167&tbnw=119&start=0&ndsp=19&ved=1t:429,r:0,s:0,i:70

  4. Background Goal Telerehabilitation and virtual gaming Wii More motivation 97% of all American adolescents (12-17) play video games[10] http://www.google.com/imgres?q=play+video+games&um=1&hl=en&biw=1536&bih=720&tbm=isch&tbnid=xLu1nIU9ZnGTaM:&imgrefurl=http://tavrosperseveres.tumblr.com/post/3719884737&docid=g9lbu0KR7JR3ZM&imgurl=http://25.media.tumblr.com/tumblr_lhqfowFMYY1qhdse7o1_400.jpg&w=333&h=221&ei=fT1hUIWZKvP7yAGp-IDYCw&zoom=1&iact=hc&vpx=571&vpy=204&dur=153&hovh=176&hovw=266&tx=127&ty=106&sig=104437745059302163758&page=1&tbnh=158&tbnw=205&start=0&ndsp=21&ved=1t:429,r:2,s:0,i:103

  5. Need Knee joint Shock absorption during stance Foot clearance during swing Range of motion Cheap, safe and interactive tasks Therapist Home http://www.google.com/imgres?q=knee+rehabilitation&um=1&hl=en&sa=N&biw=1536&bih=720&tbm=isch&tbnid=OB9BRT1C1TWQLM:&imgrefurl=http://www.nasa.gov/topics/nasalife/knee_brace.html&docid=jpX58Blh9fua_M&imgurl=http://www.nasa.gov/images/content/293783main_knee_brace1_lg.jpg&w=639&h=501&ei=zy1hUOnWKILo8gTLjoCIDg&zoom=1&iact=hc&vpx=365&vpy=333&dur=247&hovh=199&hovw=254&tx=169&ty=147&sig=104437745059302163758&page=1&tbnh=154&tbnw=209&start=0&ndsp=22&ved=1t:429,r:8,s:0,i:98

  6. Project ScopeSummary Three fold A “Telekit” A “Teleprocess” A knee strengthening device

  7. Project Scope “Telekit” Laptop Webcam Wifi Wii remote Knee rehabilitation device http://www.google.com/imgres?q=laptop&um=1&hl=en&sa=N&biw=1536&bih=720&tbm=isch&tbnid=GLwjrHoaUgUSDM:&imgrefurl http://www.google.com/imgres?q=wii+remote&num=10&hl=en&biw=1536&bih=720&tbm=isch&tbnid=9_0w48zli2aBnM:&imgrefurl=http://en.wikipedia.org/wiki/Wii_Remote&docid=cTxgRkmIFqpPWM&imgurl=

  8. Project Scope “Teleprocess” Remote prescription Prescriptions = different sets of games Evaluation Number of repetitions Range of motion Velocity User manual http://www.google.com/imgres?q=video+games&um=1&hl=en&sa=N&biw=1167&bih=530&tbm=isch&tbnid=BF_KAuszu8GfrM:&imgrefurl=http://www.biggtech.com/technology/hold-onto-your-seat-video-games-are-real_8545.html&docid=SDc850LOaKZfuM&imgurl=http://www.biggtech.com/wp-content/uploads/2011/08/Hold-onto-your-seat%2525E2%252580%2525A6Video-Games-are-Real.jpg&w=1024&h=768&ei=YMJhUPHzHqTuyAHohIHwCw&zoom=1&iact=hc&vpx=431&vpy=149&dur=3798&hovh=194&hovw=259&tx=125&ty=112&sig=104437745059302163758&page=2&tbnh=162&tbnw=214&start=18&ndsp=15&ved=1t:429,r:7,s:18,i:238

  9. Project Scope Knee strengthening device Variable resistance Wii remote to track the flexion and extension of the knee http://www.google.com/imgres?q=knee+extension&um=1&hl=en&sa=N&biw=1536&bih=720&tbm=isch&tbnid=vFw-maFB9PrWfM:&imgrefurl=http://jay-jee.blogspot.com/2012/05/new-extension-test-in-sitting.html&docid=Q7UODlB9rT-x-M&imgurl=http://4.bp.blogspot.com/-2mG7hglSIeQ/T7V-mzQEiFI/AAAAAAAAAas/aBmOnAAz_5I/s1600/knee.jpg&w=246&h=264&ei=6j1hUKHfL-rryAH_v4HoCg&zoom=1&iact=hc&vpx=581&vpy=182&dur=1156&hovh=211&hovw=196&tx=115&ty=110&sig=104437745059302163758&page=1&tbnh=149&tbnw=139&start=0&ndsp=21&ved=1t:429,r:2,s:0,i:119

  10. Specific Design RequirementsHardware Laptop Windows 7 32-bit, 2.66GHz dual core processor At least one USB 2.0 bus RAM of at least 2GB Webcam • Resolution: at least 640*480 pixel Wi-Fi hotspot • Fit in the palm of a hand • 3G internet http://www.google.com/imgres?q=640*480+pixel&um=1&hl=en&sa=N&biw=1167&bih=530&tbm=isch&tbnid=HQsKR0lqJwx4KM:&imgrefurl=http://www.eheart.com/SHASTA/wall.html&docid=KPsAVciV_XUcTM&imgurl=http://www.eheart.com/SHASTA/wallpaper/alpenglow-640x480.jpg&w=640&h=480&ei=csxhUJrMN6b9ygG9wIHwCQ&zoom=1&iact=rc&dur=70&sig=104437745059302163758&page=1&tbnh=140&tbnw=201&start=0&ndsp=10&ved=1t:429,r:5,s:0,i:91&tx=93&ty=106

  11. Knee rehabilitation device: Costs under $200 Weighs less than 30 pounds Fits within the 2ft*2ft*2ft box and Includes a carrier for a Wii remote Has variable resistances Has range of motion from 0< θ<90 Specific Design RequirementsHardware

  12. Specific Design RequirementsSoftware Face-time interactions Wii data keystroke commands online games Games Therapist patient, Patient maneuver Time: old, 2-3 min; new, less than 10 min

  13. Specific Design RequirementsSoftware Troubleshooting Content management system Therapist Patient Calendar Blog data

  14. Existing solutionsSolution #1 JAS Knee • Pros • Portable • Cheap • Easy to use at home • Doesn’t need excessive training or supervision • Cons • Not able to work on any dynamic movements • No data collection • No quantitative analysis The JAS Knee system with the user operating the angle control device. (http://www.jointactivesystems.com/JAS-Systems/1/5/JAS-Knee.aspx)

  15. Existing solutionsSolution #2 System 4 Pro • Pros • Force reading • Progress monitor • Adjustable resistances • Variety of exercises (Isokinetic, Isometric) • Cons • Big size • Not portable • Expensive • Specialist requirement http://www.google.com/imgres?q=System+4+Pro&um=1&hl=en&sa=N&biw=1536&bih=720&tbm=isch&tbnid=FqgUtt-rX5qDLM:&imgrefurl=http://m.biodex.com/physical-medicine/products/dynamometers/system-4-pro-0&docid=YpRqUtkfKmz6tM&imgurl=http://www.biodex.com/sites/default/files/imagecache/product_landing_large_mobile/products/images/850-000_1_knee_extension_flexion.jpg&w=335&h=250&ei=FDthUM2gIIHo8gSAy4HQDQ&zoom=1&iact=rc&dur=122&sig=104437745059302163758&page=1&tbnh=162&tbnw=219&start=0&ndsp=19&ved=1t:429,r:11,s:0,i:107&tx=100&ty=68

  16. Existing solutionsSolution #3 http://www.google.com/imgres?q=Telerehabilitation&um=1&hl=en&sa &biw=1536&bih=720&tbm=isch&tbnid=GxoVMRQfe3LBM:&imgrefurl=ht p://www.njinfotech.com/index2.html&docid=qIYk_YPrx0rJ2M&imgurl=ht p://www.njinfotech.com/images/portfolio/ru_ti_large.jpg&w=750&h=63 &ei=0zxhUJDiCdH8yAG_5YDIDA&zoom=1&iact=rc&dur=331&sig=1044377 5059302163758&page=3&tbnh=156&tbnw=186&start=42&ndsp=25&ved 1t:429,r:13,s:42,i:253&tx=128&ty=89 Telerehabilitation • Directed by Dr. Jack Engsberg last year • Interface • Wii & ankle rehabilitation device • Video games • Base plate

  17. Preliminary analysesGeneral device introduction Setup of our device

  18. Preliminary analysesMathematical calculations Four interactions acting on the yellow part 1. Torque from the knee of the CP patient (Mk) 2. Frictional torque from the pivot (MP) 3. Gravity from the patient’s calf, foot and the rotating arm (M1g) 4. Tension from the resistance component (T)

  19. Preliminary analysesMathematical calculations Lever arm of T T

  20. Preliminary analysesMathematical calculations Therefore: So:

  21. Preliminary analysesMathematical calculations Law of cosine: Lever arm of T:

  22. Preliminary analysesMathematical calculations Tension T calculation T

  23. Preliminary analysesMathematical calculations Torque equation:

  24. Preliminary Design Schedule

  25. Current Organization of team responsibilities

  26. Questions?

  27. References [1] Morris, Christopher. "Definition and Classification of Cerebral Palsy: A Historical Perspective." University of Oxford (n.d.): 1-7. Web. 17 Sept. 2012. [2] Graham, H. Kerr, and P. Selber. "MUSCULOSKELETAL ASPECTS OF CEREBRAL PALSY." Royal Children's Hospital (n.d.): n. page. Print. [3] Aisen, Mindy Lipson, Danielle Kerkovich, Joelle Mast, Sara Mulroy, Tishya AL Wren, Robert M. Kay, and Susan A. Rethlefsen. "Cerebral Palsy: Clinical Care and Neurological Rehabilitation." The Lancet Neurology 10.9 (2011): 844-52. Print. [4] Engsberg, Jack R., and Sandy A. Ross. "Relation between Spasticity and Strength in Individuals with Spastic Diplegic Cerebral Palsy." Developmental Medicine & Child Neurology (2002): 149-57. Web. [5] Damiano, D., and M. F. Abel. "Functional Outcomes of Strength Training in Spastic Cerebral Palsy." Archives of Physical Medicine and Rehabilitation 79.2 (1998): 119-25. Print. [6] Dodd, K. J., N. F. Taylor, and D. L. Damiano. "A Systematic Review of the Effectiveness of Strength-training Programs for People with Cerebral Palsy." Archives of Physical Medicine and Rehabilitation 83.8 (2002): 1157 164. Print. [7] Nudo, R.J., Milliken, G.W., & Merzenich, M.M., (1996). Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys, Journal of Neuroscience,16 785-807.

  28. References [8] Vliet, Paulette M., and Nicola R. Heneghan. "Motorcontrol and the Management of Musculoskeletal Dysfunction." Manual Therapy 11.3 (n.d.): 208-13. Print. [9] Deutsch, Judith E., Megan Borbely, Jenny Filler, Karen Huhn, and Phyllis Guarrera-Bowlby. "Use of a Low Cost, Commercially Available Gaming Console (Wii) for Rehabilitation of an Adolescent with Cerebral Palsy.“ Journal of the American Physcial Therapy Association 88.10 (2008): 1196-207. Web. <http://ptjournal.apta.org/content/88/10/1196.full.pdf+html>. [10] Pew Internet & American Life Project Teens, Video Games and Civics http://pewresearch.org/pubs/953/September 16, 2008 [11] Gage, James R. "Surgical Treatment of Knee Dysfunction in Cerebral Palsy." Clinical Orthopaedics and Related Research &NA;.253 (1990): Print. [12] DeVita, Paul. "Obesity Is Not Associated with Increased Knee Joint Torque and Power during Level Walking." Journal of Biomechanics 36.9 (2003): 1355-362. Print. [13] Owens, Charles. “Movement-Cure Apparatus.” Patent 721,737. 13 Dec 1901 [14] Burns, Jebodiah Mose. “Knee Rehabilitation Exercise Device.” U.S. Patent Application No. 12/799,456. Publication No. 2011/0207585 A1. 26 April, 2010. [15] Bolano, Andrew, Eric Boccio, and Tonya An. Wii Controlled Gaming for Physical Therapy. Washington University in St. Louis Senior Design Project. 2010. [16] Hill, Kelly, Amanda Mepplelink, and Liz Phillips. Flex2Play: An Ankle Strength Training Device with Virtual Reality Interface for Children with Cerebral Palsy. Washington University in St. Louis Senior Design Project. 2011.

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