C. Stephanidis (Ed.): Posters, Part II, HCII 2013, CCIS 374, pp. 130–134, 2013.
© Springer-Verlag Berlin Heidelberg 2013
Developing an Interactive Game System for Upper Limb Stroke Rehabilitation
Chun-Ching Chen
Graduate Institute of Interactive Media Design, National Taipei University of Technology [email protected]
Abstract. The number of cases of stroke has been increasing in Taiwan.
Movement disorders such as hemiplegia occur commonly after stroke. Hemip- legic stroke patients are not able to control one side of their body, particularly upper limb. To help stroke patients recovery their lifestyles, rehabilitation plays an important role. This paper introduces the development of a digital system---a personalized interactive game, to help upper limb in hemiplegic stroke patients.
Taking patients’ needs and emotion into account, the system makes rehabilita- tion therapy more enjoyable. The results show that the system could help stroke patients alleviate mental fatigue and allow doctors to control and monitor the rehabilitation process of patients easily. Incorporating interactive game to stroke rehabilitation could be a feasible and acceptable way.
Keywords: Stroke rehabilitation, Upper limb hemiplegia, Human-computer interaction, Digital game, Interaction design.
1 Introduction
With the population aging, stroke becomes a major cause of disability in the elderly in Taiwan. The neurological symptoms of stroke differs from types of pathological le- sion and severity of brain impairments, however, hemiplegia is the most typical symptom that can be found. Hemiplegia means the pathological region of brain causes one side of the extremity decay or disability on motor function. This will make the limb lack of strength and get out of control to lose functional ability of daily living.
Among the stroke patients, upper limb hemiplegia is the most common – at a propor- tion of two-third (Gowland, deBruin, Basmajian, Plews, Burcea, 1992). Because brain impairment affects motoring skill, patients can only move their limbs in slow pace and unusually discontinuous way to execute goal-oriented tasks (Trombly, 1992). The patient always suffers weakness of muscle, abnormal tension of muscle, abnormal motor coordination, shoulder girdle and hip joint activity diminishing, and losing coordination of joints (Trombly & Radomski, 2002).
Different upper limb impairments might have various functional effects on move- ment control, particular for hands reaching, a basic movement for grasping objects, operating devices, even performing an action that requires some special skill and doing leisure activities. Therefore, this movement is frequently used to evaluate stroke
patients’ prognosis. In the daily life, many tasks require skillful operation and two hands working together. With normal central nervous system, individual muscle and joints can be well organized to lead to coordinate movement, and accomplish func- tional motion through normal motoring ability (Shumway-Cook & Woollacott, 2000).
Hence it is crucial to effectively assess the patients and give treatment to recover stroke patients’ upper limb function.
The rehabilitation for stroke patients aims to stimulate brain to recover the plastici- ty and reorganization. Therefore, the treatment will focus on motion training of paret- ic side extremity, e.g., the constraint-induced techniques proposed in past decade (Bonifer & Anderson, 2003, Taub, Uswatte, Morris, 2003). The constraint-induced technique is to restrain the activity of nonparetic side and constrain paretic side to make movement so as to activate the function of paretic extremity. This rehabilitation way has been frequently applied and studied; however, is more adaptive for cases with minor impairment, i.e., paretic side is still capable of basic motoring skill. For cases with severe impairment, scholars suggests bilateral movement training , which is to activate neural network by nonparetic side or produce interlimb coupling to stimulate the activity of paretic side (Mudie & Matyas, 2000, Cunningham, Stoykov, Walter, 2002).
Rehabilitation is a time consuming and boring process, either for patients or physi- cal therapist. Stroke rehabilitation therapy mostly includes initial assessment of the doctor and therapist, planning of patients’ activity and loadings, repetitive and conti- nuous observation to record and adjust their tasks. Systematic, objective and reliable evaluation methods is critical for therapist to monitor and control patients’ rehabilita- tion. For patients, it is important to ensure they are able to follow the therapy and continue the rehabilitation with patience so as to recover their ability to be back to normal daily life. Based on these requirements, digital technology may provide con- ventional rehabilitation new approach to enhancing the performance. Current state-of- the-art technology can provide more flexible, effective and efficient way for rehabili- tation, through designer’s efforts. Therefore, this study is to develop a tangible inter- active game for upper limb hemiplegia patients’ rehabilitation. The prototyping was finally evaluated by physical therapist and patients to identify its potential for future stroke rehabilitation.
2 Methods
Three critical steps to this study are: identifying system design requirements, proto- typing and usability inspection and user’s evaluation.
2.1 System Design Requirements
The system is divided into two parts, a digital game and an upper limb bilateral movement mechanism. The work to be done is to develop the content of the digital game and allow the patients to operate the mechanism to play the game, without using mouse and keyboard. The mechanism, developed by the Industrial Research Limited
Fig. 1. Bilate
(IRL) of New Zealand, wo upper limb stroke rehabili paretic side (Fig. 1).
A series of interviews w ducted to define the system below.
─ Comfortable atmosphe warm, cozy, bright and Light background music vide a positive environm
─ Designing difficulty lev symptoms might respon designed according to re stand patients’ ability sim
─ Personal game trainin should provide training m game level, in which the
─ Providing system feedb parts: for the patient, the and remind them to cor report all the pathologic
─ Allowing the potential online database to save ist, patient and admin rehabilitation progress.
2.2 Prototyping and Us The system prototype was the patient operating the r webcam grabs images and game prototyping was then
eral movement stroke rehabilitation mechanism
orks bilaterally with two arm supports to provide sev itation, i.e., through nonparetic side movement to br
with technology experts and physical therapist were c m design requirements. The main issues were addres
ere to enhance patients’ motivation. The game should natural, which makes them feel relaxed and comfortab c and encouraging voice are needed in the system to p ment for patients.
vels based on rehabilitation progress. Different str nd differently to the game, so the level settings should ehabilitation progress which allows the therapist to und mply from the level they can achieve.
ng mode. Besides normal game level setting, the ga mode for patients to do training before they are able to s therapist should be able to define the training content.
back for both patients and therapists. This includes t e system should provide how they interact with the syst rrect their operation; for the therapist, the system sho data for them to monitor and evaluate patients’ progress of telemedicine development. The system should prov and retrieve different users’ profiles, including the ther nistrator. The therapist can remotely monitor patien
sability Inspection
developed using Adobe ActionScript Version 3.0. W rehabilitation mechanism to interact with the game, d provides system feedback on the monitor (Fig. 2). T
evaluated by experts to improve its usability.
vere ring
con- ssed
d be ble.
pro-
roke d be
der-
ame start
two tem ould
s.
vide rap-
nts’
When the The
Fig. 2. Prototyping structure
2.3 Evaluation
The system prototype was evaluated by the patient and physical therapist to examine the feasibility and potential for future application. The system was set up in a room of the hospital in Taiwan (Fig. 3). Three stroke patients with upper limb hemiplegia, accompanying with their therapist, participated in the experiment and provided their feedback for the system. The process was also observed by the experimenter to observe and record all the interaction.
Fig. 3. The participants was interacting with the system
3 Results and Conclusion
The final game prototype used “animals and their home” as a story scenario, which is comprised of seven different levels, a “Trace Mode” for training, a “loadcell” to detect and remind patient’s force, friendly user interface and the patient and therap- ist’s database linked with remote server (Table 1).
The result of the experiment showed that all participants were interested in the system, mostly on playing the game. They indicated that the rehabilitation time elaps- ing faster than before. From the observation, it can be seen that participants keep good mood whether they can accomplish the task or not. All cases did not show their impatience or any rejection to all tasks.
Consequently, this study provides a potential for future stroke rehabilitation, particularly for upper limb hemiplegia. This study demonstrates the importance of incorporating different profession, e.g. design and medicine, in such a cross-field
Webcam
Monitor
Rehab mechanism
Computer Patient
Table 1. Game content Image
Function A comfortable play at- mosphere for stroke reha- bilitation.
A “loadcell” indicator to detect and remind pa- tient’s force.
A user-friendly interface and information to pro- vide patients’ results.
Image
Function The therapist can access to the game from personal computer or outside.
Seven different levels can show patient’s progress.
“Trace Mode” for patient training, which can be set up by the therapist.
assisting technology system development. It can be also identified that interactive game provides emotional needs and can be applied to the rehabilitation.
References
1. Bonifer, N., Anderson, K.M.: Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia. Physical Therapy 83(4), 384–398 (2003)
2. Cunningham, C.L., Stoykov, M.E., Walter, C.B.: Bilateral facilitation of motor control in chronic hemiplegia. Acta Psychologica 110(2-3), 321–337 (2002)
3. Gowland, C., de Bruin, H., Basmajian, J.V., Plews, N., Burcea, I.: Agonist and antagonist activity during voluntary upper-limb movement in patients with stroke. Physical Therapy 72(9), 624–633 (1992)
4. Mudie, M.H., Matyas, T.A.: Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke. Disability and Rehabilitation 22(1-2), 23–37 (2000)
5. Shumway-Cook, A., Brauer, S., Woollacott, M.: Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical Therapy 80(9), 896–903 (2000)
6. Taub, E., Uswatte, G., Morris, D.M.: Improved motor recovery after stroke and massive cor- tical reorganization following Constraint-Induced Movement therapy. Physical Medicine and Rehabilitation Clinics of North America 14(suppl. 1), S77–S91 (2003)
7. Trombly, C.A.: Deficits of reaching in subjects with left hemiparesis: A pilot study.
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8. Trombly, A., Radomski, M.V.: Occupational therapy for physical dysfunction, 5th edn.
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