Video Gaming as a Therapeutic Modality

Off-the-shelf video gaming is used increasingly as a therapeutic modality in physical and occupational therapy.  Systems such as the Kinect for Xbox 360 and Wii offer many of the advantages of custom, virtual-reality therapeutic systems at a much lower cost and much higher ease of accessibility.  There is growing evidence that off-the-shelf video games provide significant advantages including greater engagement and enjoyment, and more total practice.  They allow the therapist to incorporate many more personal, task, environmental, and cognitive parameters simultaneously than more traditional exercise modes, allowing much greater tailoring of the activity to the needs of the client.  

Dr. Reinthal has investigated upper extremity  rehab post stroke with video gaming, particularly from the standpoint of motor learning and engagement and practice repetitions.  Dr. Espy’s interest is in proactive balance training wit video gaming, particularly the ability to manipulate dosage parameters and to work at higher intensities.  Several other projects have grown out of our investigation of the effectiveness of gaming in rehabilitation: the use of simple sensors to count exercise repetitions, the Framework for Clinical Decision Making, the Rate of Perceived Stability, and the quantification of engagement.

 As evidence grows for the utility of gaming as a therapeutic tool, a need has been identified for information to assist clinicians in using this technology most effectively.  It is very difficult for practicing therapists to be familiar enough with the wide variety of games and platforms available to choose the most appropriate one to meet a client’s specific goals and needs.  Five therapist/researchers from around the country, including Dr. Espy, are collaborating to developing a resource to provide relevant information about games on a common off-the-shelf video gaming console (Kinect). This online resource will support therapists in choosing the most therapeutically appropriate games given a particular patient’s needs and goals.  The project is being approached from a Knowledge Translation point of view and the resource is being developed in iterations with feedback and input from practicing clinicians. Publication of the first phase of the study was in PTJ.  



Pictures: Top) Games and surfaces combined to manipulate task parameters and exercise intensity.  Middle) Adaptation for Wii controller to allow bimanual upper extremity task practice with driving game.  Bottom Left) Motion capture of gaming to analyze kinematics of training.  Bottom Right) Use of gaming for balance training.



Publications
Levac D, Espy D, Fox E, Pradhan S, & Deutsch J.   ‘Kinect-ing’ with clinicians: A knowledge translation resource to support decision- making about video game use in rehabilitation. Phys Ther.  2015;95:426-440.


Presentations 
Reinthal A. Training Anticipatory Balance in Adults with Chronic Hemiparesis Using Repetitive Practice on a Mobile Mechanized Surface in Conjunction with Gaming. Poster presentation at APTA Combined Sections Meeting, San Diego, CA February 2010.

Reinthal A, Espy D. Changes in gait in adults with chronic hemiparesis after balance training on a mobile mechanized surface while gaming’, (Abstract ID 89838); accepted for presentation at the 2014 International Society of Posture and Gait Research World Congress, Vancouver, Canada, June 29 – July 3.


Funding
Reinthal A . $4078. Motion Analysis of Individuals Post Stroke Who Are Participating in the Video Gaming Multi-Site Study. 2010 Engaged Learning Proposals: CSU Undergraduate Research and Creative Achievement. April 2010.

Patterson S, Reinthal A, Sparks K. $4642. Assessing Balance Improvement in Post-Stroke Adults Using the Panasonic Core Trainer. 2010 Engaged Learning Proposals: CSU Undergraduate Research and Creative Achievement. April 2010.

Reinthal A, PI. $9443 Use of computer gaming as an adjunct during outpatient stroke rehabilitation to obtain task specific upper extremity practice repetitions. Faculty Research Development Grant, Cleveland State University, July 2009.

Reinthal A Linder S. $3540. Use of computer gaming to obtain task specific upper extremity practice in individuals with stroke who have completed traditional rehabilitation. 2009 Engaged Learning Proposals: CSU Undergraduate Research and Creative Achievement. April 2009.