1. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Microsoft Surface Project

2. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Cerebral Palsy Permanent, non-progressive physical disorders Caused by disturbances to fetal/infant brain Affects 1 in 303 children Causes impairments in: movement hearing vision Learning No cure Treatment: alleviation and maintenance of symptoms; Occupational and Physical Therapy.

3. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Therapy Services Help minimize contractures Improve: range of motion coordination quality of movement Provide tasks that engage and motivate We have designed a system based on Microsoft interactive touch screen surface to address these limitations in therapy sessions.

4. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering The Platform Five interactive games that encourage repetitive motions Similar to iPad touch screen Eight sensors on upper limbs Record joint angles of shoulders and elbows Accelerometer embedded in vest worn by the participant Provides postural and positional data

5. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Unique Features of the Tabletop Videogames allow for repeated practice Participants can move on their own…can lead to motor recovery Immediate auditory and visual feedback Progress shown in a concrete way Pain free range of motion

6. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Children with auditory processing impairments often only learn through visual system. Mechanics of hi/lo table allow for adaptability: Gravity eliminated shoulder and elbow control Easel allows for help with visual scanning, wrist extension and holding head in neutral Offers ability to play in sitting and standing Adjust height for functional body mechanics Games keep accurate record of performance and progress. Unique Features of the Tabletop

7. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering What Motor Skills do the Games Target? Active range of motion in gravity eliminated, against gravity and weight bearing (standing). Fine motor skills: Speed Pre-writing: finger isolation Object use: sustaining hold of adaptive tool (adaptive stylus, ball, paddle with Butterfly game)

8. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering What Motor Skills do the Games Target? Bi-manual skills: Sub-divided into 4 categories: Use of involved arm as stabilizer (hold paper while writing) Ability to use involved arm symmetrically or simultaneously (pushing/pulling) Ability to differentiate function (both arms can move to specific target) Ability to alternate use from left to right reciprocally (playing musical instruments)

9. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Study Design Pilot study Usability and feasibility of the device Novel games: Engaging and motivating children to perform upper extremity motions

10. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Hypothesis Patients will be more motivated to perform therapeutic motions. Movements to those performed in traditional therapy Compensatory motions will be minimized by feedback from the wearable accelerometer. Minimize failure to complete tasks. Structure required motions that they slowly increase in difficulty and allowing interaction by patients with reduced function.

11. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Inclusion and Exclusion Criteria Inclusion Criteria 6-12 years old Upper extremity dysfunction due to cerebral palsy Able to understand, read and write in English Able to understand and comprehend directions from occupational therapist Exclusion Criteria: Participants may be excluded if they have severe vision impairments

12. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Study Setting Recruitment procedures: Spaulding Rehabilitation Hospital (SRH) and Boston Children’s Hospital. Data collection: Wyss Institute. Data analysis: Wyss Institute and SRH. Enroll 20 children.

13. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Study Setting Study session will last no longer than 90 minutes (including consent and assent) Each session will be videotaped, allowing critical analysis of child's interaction with system. Games have been divided by four motor skills: Gross movements Coordinated movements Distal control Fine motor control

14. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Risk and Benefits We do not anticipate any physical risks to the participants from participating in this research study. There are no direct benefits for participating in this study.

15. PB2015 PM&R, Harvard Medical School Spaulding Rehabilitation Hospital Motion Analysis Laboratory Wyss Institute for Biologically Inspired Engineering Conclusion Could benefit children with Cerebral Palsy by providing new treatment/rehabilitation option for those with impaired upper extremities.