Automated functional upper limb evaluation of patients with Friedreich ataxia using serious games rehabilitation exercises

Abstract

BackgroundFriedreich ataxia (FRDA) is a disease with neurological and systemic involvement. Clinical assessment tools commonly used for FRDA become less effective in evaluating decay in patients with advanced FRDA, particularly when they are in a wheelchair. Further motor worsening mainly impairs upper limb function. In this study, we tested if serious games (SG) developed for rehabilitation can be used as an assessment tool for upper limb function even in patients with advanced FRDA.MethodsA specific SG has been developed for physical rehabilitation of patients suffering from neurologic diseases. The use of this SG, coupled with Kinect sensor, has been validated to perform functional evaluation of the upper limbs with healthy subjects across lifespan. Twenty-seven FRDA patients were included in the study. Patients were invited to perform upper limb rehabilitation exercises embedded in SG. Motions were recorded by the Kinect and clinically relevant parameters were extracted from the collected motions. We tested if the existence of correlations between the scores from the serious games and the severity of the disease using clinical assessment tools commonly used for FRDA. Results of patients were compared with a group a healthy subjects of similar age.ResultsVery highly significant differences were found for time required to perform the exercise (increase of 76%, t(68) = 7.22, P < 0.001) and for accuracy (decrease of 6%, t(68) = − 3.69, P < 0.001) between patients and healthy subjects. Concerning the patients significant correlations were found between age and time (R = 0.65, p = 0.015), accuracy (R = − 0.75, p = 0.004) and the total displacement of upper limbs. (R = 0.55, p = 0.031). Statistically significant correlations were found between the age of diagnosis and speed related parameters.ConclusionsThe results of this study indicate that SG reliably captures motor impairment of FRDA patients due to cerebellar and pyramidal involvement. Results also show that functional evaluation of FRDA patients can be performed during rehabilitation therapy embedded in games with the patient seated in a wheelchair.Trial registrationThe study was approved as a component of the EFACTS study (Clinicaltrials.gov identifier NCT02069509, registered May 2010) by the local institutional Ethics Committee (ref. P2010/132).

Hand Dexterity and Pyramidal Dysfunction in Friedreich Ataxia, A Finger Tapping Study

“…No site effect was detected in the overall analysis of the EFACTS cohort 20,21 and our sample is similar in terms of age, disease duration, SARA score, and size of GAA1 expansion to the average characteristics of the EFACTS cohort. On average, FT rate was 50% lower in FRDA patients than in matched healthy individuals, in general agreement with previous studies in which FRDA patients were slower than healthy subjects in a number of tasks, such as the repeated pronation/ supination item of the SARA, 17 "serious games," 24 and the items used to calculate the cerebellar composite functional severity (CCFS) score 19 (ie, a mathematical computation of the sum of pondered Z scores of the time to realize a 9HPT and a 10-s clicks tasks). 25 Like in this study, slower rate of alternation in the CCSF was associated to longer disease duration and higher SARA score.…”

Neurologic outcomes in Friedreich ataxia

“…Serious Games, another upper limb coordination test reflecting cerebellar function, is also more sensitive in this group. 25 Additional upper limb function tests using computer-assisted analyses, particularly in the context of ADL, are the object of ongoing studies.…”

The Use of New Mobile and Gaming Technologies for the Assessment and Rehabilitation of People with Ataxia: a Systematic Review and Meta-analysis

“…Four studies were experimental studies, with 1 controlled trial [26] and 3 single-group trials [27][28][29]. Two studies were categorized as diagnostic studies [30,31]. All included experimental studies investigated the effectiveness of either available video games for both Nintendo Wii and Microsoft Xbox Kinect [27][28][29] or specifically developed exergames adopting the Kinect sensor in both children and adults with different ataxias [26].…”

“…The 2 diagnostic studies evaluated the accuracy of either an already available serious game coupled with the Kinect sensor [30] or a specifically developed app for tablet and smartphone [31] to assess motor symptoms in patients with ataxias, and to discriminate between healthy subjects and patients with ataxias.…”

“…The study by Bonnechere et al, the smaller study classified as diagnostic [30], enrolled 27 patients with FA and 43 healthy subjects. All subjects participated in 3 sessions of a specifically designed mini-game (Wipe Out game), with spatial displacement recorded by a Kinect sensor.…”