The present study covers a new experimental system, designed to improve the balance and postural control of adults with cerebral palsy. This system is based on a serious game for balance rehabilitation therapy, designed using the prototype development paradigm and features for rehabilitation with serious games: feedback, adaptability, motivational elements, and monitoring. In addition, the employed interaction technology is based on computer vision because motor rehabilitation consists of body movements that can be recorded, and because vision capture technology is noninvasive and can be used for clients who have difficulties in holding physical devices. Previous research has indicated that serious games help to motivate clients in therapy sessions; however, there remains a paucity of clinical evidence involving functionality. We rigorously evaluated the effects of physiotherapy treatment on balance and gait function of adult subjects with cerebral palsy undergoing our experimental system. A 24-week physiotherapy intervention program was conducted with nine adults from a cerebral palsy center who exercised weekly in 20-min sessions. Findings demonstrated a significant increase in balance and gait function scores resulting in indicators of greater independence for our participating adults. Scores improved from 16 to 21 points in a scale of 28, according to the Tinetti Scale for risk of falls, moving from high fall risk to moderate fall risk. Our promising results indicate that our experimental system is feasible for balance rehabilitation therapy.
Serious game development for rehabilitation therapy is becoming increasingly popular because of the motivational advantages that these types of applications provide. Consequently, the need for a common process framework for this category of software development has become increasingly evident. The goal is to guarantee that products are developed and validated by following a coherent and systematic method that leads to high-quality serious games. This paper introduces a new process framework for the development of serious games for motor rehabilitation therapy. We introduce the new model and demonstrate its application for the development of a serious game for the improvement of the balance and postural control of adults with cerebral palsy. The development of this application has been facilitated by two technological transfer contracts and is being exploited by two different organizations. According to clinical measurements, patients using the application improved from high fall risk to moderate fall risk. We believe that our development strategy can be useful not only for motor rehabilitation therapy, but also for the development of serious games in many other rehabilitation areas.
When rehabilitation sessions are for maintaining capacities, the demotivation of patients is common due to the difficulty in improving their situation. Recent experiments show that rehabilitation results are better when users are motivated and serious games can help to motivate patients in rehabilitation processes. We developed a rehabilitation serious-game for a set of patients who had abandoned therapy due to demotivation in the previous years. The serious-game was developed following desirable features for rehabilitation serious-games presented in the related research works. From this development, we present implementations guidelines for developing serious-games as motivational tool for rehabilitation therapies. The experiments performed in previous works validate that the interacting design issues defined help motivation in therapy and that they are adequate in rehabilitation therapy.
Observation is recommended in motor rehabilitation. For this reason, the aim of this study was to experimentally test the feasibility and benefit of including mirror feedback in vision-based rehabilitation systems: we projected the user on the screen. We conducted a user study by using a previously evaluated system that improved the balance and postural control of adults with cerebral palsy. We used a within-subjects design with the two defined feedback conditions (mirror and no-mirror) with two different groups of users (8 with disabilities and 32 without disabilities) using usability measures (time-to-start (T s) and time-to-complete (T c)). A two-tailed paired samples t-test confirmed that in case of disabilities the mirror feedback facilitated the interaction in vision-based systems for rehabilitation. The measured times were significantly worse in the absence of the user's own visual feedback (T s = 7.09 (P < 0.001) and T c = 4.48 (P < 0.005)). In vision-based interaction systems, the input device is the user's own body; therefore, it makes sense that feedback should be related to the body of the user. In case of disabilities the mirror feedback mechanisms facilitated the interaction in vision-based systems for rehabilitation. Results recommends developers and researchers use this improvement in vision-based motor rehabilitation interactive systems.
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