A multisession evaluation of an adaptive competitive arm rehabilitation game

Abstract

BackgroundPeople with neurological injuries such as stroke should exercise frequently and intensely to regain their motor abilities, but are generally hindered by lack of motivation. One way to increase motivation in rehabilitation is through competitive exercises, but such exercises have only been tested in single brief sessions and usually did not adapt difficulty to the patient’s abilities.MethodsWe designed a competitive arm rehabilitation game for two players that dynamically adapts its difficulty to both players’ abilities. This game was evaluated by two participant groups: 15 participants with chronic arm impairment who exercised at home with an unimpaired friend or relative, and 20 participants in the acute or subacute phase of stroke who exercised in pairs (10 pairs) at a rehabilitation clinic. All participants first played the game against their human opponent for 3 sessions, then played alone (against a computer opponent) in the final, fourth session. In all sessions, participants’ subjective experiences were assessed with the Intrinsic Motivation Inventory questionnaire while exercise intensity was measured using inertial sensors built into the rehabilitation device. After the fourth session, a final brief questionnaire was used to compare competition and exercising alone.ResultsParticipants who played against an unimpaired friend or relative at home tended to prefer competition (only 1 preferred exercising alone), and exhibited higher enjoyment and exercise intensity when competing (first three sessions) than when exercising alone (last session).Participants who played against each other in the clinic, however, did not exhibit significant differences between competition and exercising alone. For both groups, there was no difference in enjoyment or exercise intensity between the first three sessions, indicating no negative effects of habituation or novelty.ConclusionsCompetitive exercises have high potential for unsupervised home rehabilitation, as they improve enjoyment and exercise intensity compared to exercising alone. Such exercises could thus improve rehabilitation outcome, but this needs to be tested in long-term clinical trials. It is not clear why participants who competed against each other at the clinic did not exhibit any advantages of competition, and further studies are needed to determine how different factors (environment, nature of opponent etc.) influence patients’ experiences with competitive exercises.Trial registrationThe study is not a clinical trial. While human subjects are involved, they do not participate in a full rehabilitation intervention, and no health outcomes are examined.Electronic supplementary materialThe online version of this article (10.1186/s12984-017-0336-9) contains supplementary material, which is available to authorized users.

Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke

“…This far exceeds the amount of hand displacement produced by the 54 movements observed during a typical occupational therapy session [ 50 ]. In accordance with previous multi-user training studies [ 26 , 29 , 30 ], the vast majority (14 of 15) participants indicated that they liked having a partner for therapy, despite not being in visual contact with this person.…”

“…There were limitations with the pilot study as well. While one of the potential benefits of the VERGE system is the inclusion of other players, we did not directly examine preferences for individual vs. partnered training, as previous studies have done [ 26 , 27 , 29 , 30 ]. In our study, the three training modalities were quite different from each other.…”

“…These efforts have proposed the inclusion of multiple users as a means to overcome resistance to home-based therapy that may result due to isolation or lack of engagement. Indeed, studies have observed a preference for multi-user vs, single-user therapy when utilizing these systems [ 26 , 29 ]. However, these systems have largely been limited to control of a one-dimensional or two-dimensional space and both users remain in the same physical location (e.g., side by side).…”

A SWOT Analysis of Virtual Reality for Seniors

“…While playing with VR, they were also seeking enjoyment, improved quality of life, and a sense of belonging. Goršič et al (2017) explored the role of competition while using VR. They concluded that stroke patients (including elderly) who exercise with a peer in an unsupervised situation (e.g.…”

Characterizing Human Box-Lifting Behavior Using Wearable Inertial Motion Sensors

“…For example, it is possible to assess the progress of arm rehabilitation [16] and to monitor the effectiveness of shoulder surgery [17]. Due to their form factor and cost-effectiveness, they can also be used as an input for rehabilitation games [18]. Recently, there has been increasing interest in using wearable sensors for analyzing human motion in athletics, such as swimming strokes [19] and the kicking of footballs [20].…”