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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.

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BackgroundCerebral 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

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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

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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

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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

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Project ScopeSummary

Three foldA “Telekit”A “Teleprocess”A knee strengthening device

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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=

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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

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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

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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

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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

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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

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Specific Design RequirementsSoftware

Troubleshooting Content management system

Therapist Patient Calendar Blog

data

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Existing solutionsSolution #1

JAS Knee

The JAS Knee system with the user operating the angle control device.

(http://www.jointactivesystems.com/

JAS-Systems/1/5/JAS-Knee.aspx)

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

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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

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Existing solutionsSolution #3

http://www.google.com/imgres?q=Telerehabilitation&um=1&hl=en&sa&biw=1536&bih=720&tbm=isch&tbnid=GxoVMRQfe3LBM:&imgrefurl=htp://www.njinfotech.com/index2.html&docid=qIYk_YPrx0rJ2M&imgurl=htp://www.njinfotech.com/images/portfolio/ru_ti_large.jpg&w=750&h=63&ei=0zxhUJDiCdH8yAG_5YDIDA&zoom=1&iact=rc&dur=331&sig=10443775059302163758&page=3&tbnh=156&tbnw=186&start=42&ndsp=25&ved1t:429,r:13,s:42,i:253&tx=128&ty=89

Directed by Dr. Jack Engsberg last year

Interface

Wii & ankle rehabilitation device

Video games

Base plate

Telerehabilitation

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Preliminary analysesGeneral device introduction

Setup of our device

Patient knee

Resistance component

Base

Rotating arm

Pivotθ

Patient calf

Patient footCushion

Wii

Fixed arm

Chair

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Preliminary analysesMathematical calculations

θ

Mk

M1g

Tb

a

lMp

Axis of rotation 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)

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Preliminary analysesMathematical calculations

Lever arm of T

a

b

A (Knee)

B

H

θ

θ

Mk

M1g

Tb

a

lMp

Axis of rotation

T

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Preliminary analysesMathematical calculations

a

b

A (Knee)

B

H

θ

sin**2

1sin**

2

1)( baACABABCArea

AHBCheightbaseABCArea *2

1*

2

1)(

AHBCba *2

1sin**

2

1

Therefore:

BC

abAH

sin

So:

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Preliminary analysesMathematical calculations

a

b

A (Knee)

B

C

H

θ

)cos(2)cos(***2 2222 abbaACABACABBC

Law of cosine:

)cos(2

sin22

abba

abAH

Lever arm of T:

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Preliminary analysesMathematical calculations

Tension T calculation

)0)cos(2(*)0(** 22 labbaklBCkxkT

T

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Preliminary analysesMathematical calculations

Torque equation:

θ

Mk

M1g

Tb

a

lMp

Axis of rotation

cos2

sin*))0cos2(*(sin1

22

22

abba

ablabbakMpglMMk

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Preliminary Design Schedule

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Current Organization of team responsibilities

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Questions?

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References[1] Morris, Christopher. "Definition and Classification of Cerebral Palsy: AHistorical Perspective." University of Oxford (n.d.): 1-7. Web. 17 Sept. 2012.[2] Graham, H. Kerr, and P. Selber. "MUSCULOSKELETAL ASPECTS OFCEREBRAL PALSY." Royal Children's Hospital (n.d.): n. page. Print.[3] Aisen, Mindy Lipson, Danielle Kerkovich, Joelle Mast, Sara Mulroy, TishyaAL Wren, Robert M. Kay, and Susan A. Rethlefsen. "Cerebral Palsy: ClinicalCare and Neurological Rehabilitation." The Lancet Neurology 10.9 (2011):844-52. Print.[4] Engsberg, Jack R., and Sandy A. Ross. "Relation between Spasticity andStrength in Individuals with Spastic Diplegic Cerebral Palsy." DevelopmentalMedicine & Child Neurology (2002): 149-57. Web.[5] Damiano, D., and M. F. Abel. "Functional Outcomes of Strength Training inSpastic 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 theEffectiveness of Strength-training Programs for People with CerebralPalsy." Archives of Physical Medicine and Rehabilitation 83.8 (2002): 1157164. Print.[7] Nudo, R.J., Milliken, G.W., & Merzenich, M.M., (1996). Use-dependentalterations of movement representations in primary motor cortex of adultsquirrel monkeys, Journal of Neuroscience,16 785-807.

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References

[8] Vliet, Paulette M., and Nicola R. Heneghan. "Motorcontrol and the Management of MusculoskeletalDysfunction." 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 LowCost, 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 Civicshttp://pewresearch.org/pubs/953/September 16, 2008[11] Gage, James R. "Surgical Treatment of Knee Dysfunction in Cerebral Palsy." Clinical Orthopaedics andRelated Research&NA;.253 (1990): Print.[12] DeVita, Paul. "Obesity Is Not Associated with Increased Knee Joint Torque and Power during LevelWalking." 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. WashingtonUniversity in St. Louis Senior Design Project. 2010. [16] Hill, Kelly, Amanda Mepplelink, and Liz Phillips. Flex2Play: An Ankle Strength Training Device with VirtualReality Interface for Children with Cerebral Palsy. Washington University in St. Louis Senior Design Project.2011.