1. game.reha.lviv.ua International Clinic of Rehabilitation WEB-BASED HOME REHABILITATION GAMING SYSTEM

2. game.reha.lviv.ua International Clinic of Rehabilitation Prof. Volodymyr Kozyavkin, MD, Director of International Clinic of Rehabilitation, Dr. Oleh Kachmar, MD, Head of Innovative Technologies Department, Dr. Taras Voloshyn, MD, child neurologist, Mr. Vadym Markelov, software developer, Mrs. Iryna Ablikova, Physical Therapist, Mr. Bohdan Kachmar, software developer Research and Development Team 2 Provides Intensive treatment for patients with Cerebral Palsy and other neurological diseases More than 4.000 patients came for treatment each year

3. game.reha.lviv.ua Background Virtual reality (VR) have great potential in the neurological rehabilitation of patients with movement disorders Most VR systems for motor training are quite expensive and could be used only in clinical setting Low-cost, commercially available gaming systems are widely used, but: typical games are too difficult for disabled children no means for distant supervision by therapists 3

4. game.reha.lviv.ua Our Experience Using Computer Games in Motor Rehabilitation for more than 12 years Now gaming rehabilitation is used on regular daily basis Custom Made Gaming Hardware Hand training device Training chair Universal gaming device Special Rehabilitation Gaming Software 4

5. game.reha.lviv.ua Objective Develop a low-cost rehabilitation game training system for patients with movement disorders, suitable for home use, with supervision of a therapist Preliminary assessment of its benefits for training balance in patients with Cerebral Palsy 5

6. game.reha.lviv.ua System Description application installed on a home computer Tasks: connect gaming hardware through USB or Bluetooth: convert data from different hardware to one format, send the game controlling data to the games and receive feedback Hosted in the Internet Tasks: user management repository for rehabilitation games with training guidelines usage statistics messaging Game Device ControllerVR Game Server 6

7. game.reha.lviv.ua Rehabilitation Gaming Hardware 7 Nintendo Balance Board Nintendo Wii Remote MS Kinect Universal Gaming Device

8. game.reha.lviv.ua Rehabilitation Games 8 Could be played with different gaming hardware Appropriate for people with movement disorders Calibrated according to patient’s possibilities 5 difficulty levels Unified scoring system (max score 100) Multilingual – game messages are separate

9. game.reha.lviv.ua 9 with Rehabilitation Gaming System BALANCE TRAINING

10. game.reha.lviv.ua Training Positions 10 Standing, left-right bendingStanding, front- back bending Standing with support Standing one foot in front Kneeling on the board Sitting on the board

11. game.reha.lviv.ua Supervision by physical therapist Physical therapist evaluates the patient and draws up a training program, indicating recommended games, training positions, frequency and duration of sessions. Duration, timing and score of gaming sessions are stored on the server Using this information therapist may adjust the program, if necessary 11

12. game.reha.lviv.ua Stabilometry, a diagnostic game 12 Child stands still on the balance board for 15 sec Mean velocity of center of pressure (CoP) displacement and area of CoP displacement are calculated Higher velocities and larger areas indicate poor balance

13. game.reha.lviv.ua PRELIMINARY OUTCOME ASSESSMENT 13

14. game.reha.lviv.ua Patients 14 Two weeks Daily home training sessions (30 min duration) Patient Age (years) Gender (M/F) DiagnosisGMFCS level A5MCP, spastic right-sided hemiplegiaІ B5F ІІ C7FCP, spastic right diplegiaІ D7MCP, spastic right-sided hemiplegiaІ E11MCP, spastic left-sided hemiplegiaІ F8FCP, spastic tetraplegiaІІІ

15. game.reha.lviv.ua Evaluation tools 15 Gross Motor Function Classification System - a five level classification system that describes the gross motor function of children with Cerebral Palsy (Level I can walk without limitations, Level V – transported in wheelchair) Pediatric Balance Scale a scale with proven reliability and validity, designed to evaluate the child’s balance function. (14 tasks, each from 0 to 4 points, 56 max) Stabilometry a specials diagnostic game measuring Velocity and Area of Center of Pressure (CoP) displacement while staying still on the board

16. game.reha.lviv.ua Results 16 Patient, ageGMFCS level diagnosis, Before trainingAfter training Balance Scale CoP VelocityCoP AreaBalance Scale CoP VelocityCoP Area A, 5 yearsLevel I, hemiplegia 5225853238 B, 5 yearsLevel II, hemiplegia 4550846 7 C, 7 yearsLevel I, diplegia 47291448259 D, 7 yearsLevel I, hemiplegia 4822350264 E, 11 yearsLevel I, hemiplegia 4931851247 F, 8 yearsLevel III, tetraplegia 748 (with support) 7 (with support) 744 (with support) 5 (with support)

17. game.reha.lviv.ua Results 17 Balance scaleCenter of Pressure (CoP) Velocity CoP Area

18. game.reha.lviv.ua Conclusions A Home Rehabilitation Gaming System was developed in order to transfer the virtual rehabilitation of patients with motor disorders from clinical to home settings. Preliminary results suggest that home gaming training is beneficial for improving balance function in patients with Cerebral Palsy Limitations of the study a small number of patients without control group evaluation performed by a therapist working with them, so his assessments may have been biased important to determine how balancing skills, obtained during training sessions, can be adapted to everyday life 18

19. game.reha.lviv.ua Acknowledgements The authors express their gratitude to the administration of the International Clinic of Rehabilitation for their support in developing the system, as well as to doctors and therapists for testing the system and offering critical and constructive suggestions Home Rehabilitation Gaming System is available free-of-charge to both therapists and patients at http://game.reha.lviv.ua. 19

20. game.reha.lviv.ua Visit our demo at *** THANK YOU 20