PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
Lucia Bonzi, Gloria Vergara-Diaz, Alan Dunne, Michelle Coldwell,
Giacomo Severini, Donna Nimec, Jim Niemi, Paolo Bonato
Department of Physical Medicine and Rehabilitation
Harvard Medical School, Spaulding Rehabilitation Hospital
Wyss Institute for Biologically Inspired Engineering
Harvard Medical School
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
We have no relevant financial disclosure
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Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
Cerebral Palsy (CP) and Rehabilitation
Gaming Technology
Group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain
(
Rosenbaum et al. 2007)
Different treatments for improving functional performance, range of motion and coordination of upper limb in children with CP
Therapy involves a child performing repeated movements of their arms, hands and fingers
(
Sakzewski et al. 2014)
Children can be motivated and interested making this movements into videogames Rehabilitation Gaming Technology
( Zocolillo et al. 2015; Valdes et al. 2014; Preston et al. 2014; Chiu et al. 2014)
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
Rehabilitation Multitouch Technology
(Leitner et al. 2007; Annett et al. 2009;
Alcañiz et al. 2009;
Dunne et al. 2010)
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
OBJECTIVE
This study aims to assess the usability of a multi-touch table as a therapeutic tool toward a more effective and quantifiable rehabilitation of the upper limb by engaging children in task-specific exercises while playing interactive games
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
SYSTEM
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
STUDY PROTOCOL
 Design: Cross-sectional study

Setting: Pediatric rehabilitation hospital (outpatient)
 Inclusion/Exclusion Criteria: 6-12 y.o. with an upper extremity dysfunction due to
Cerebral Palsy able to fulfill directions in English, without severe vision impairments
 Written parental consent and child assent
Fun Boring
 Main Outcome Measures:

Compensatory trunk movements
 Compensatory motions with the unaffected arm
Easy
 Visual Analog Scale (VAS) of satisfaction
 Number of movement repetitions using the affected arm
Comfortable
Difficult
Uncomf.
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
STUDY PROTOCOL
Interventions:
 Demographic and clinical data
 Box and Blocks Test
 Sensors:
7 wireless sensors
 5 interactive games
 Video recordings:
Quality of movements
 Subjects ’ feedback
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
SAMPLE DESCRIPTION

Population:10 Subjects
 Median Age: 9 [7-12] years old
 Gender: 60% males
 Spastic: 80% hemiparesis, 20% tetraparesis
 Box and Block test:

Dominant arm 34.1
±12.9; Non dominant 18.7±17.80 (p=0.009)
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
QUALITY OF MOVEMENT AND SATISFACTION

Compensatory Movements: 30% trunk and 60% unaffected hand

Satisfaction: High rates measured with a VAS
 100% would like to play the games again, either during regular therapy or like home therapy
 90% would like to do it instead of regular therapy
Fruits
Boats
Butterflies
Puzzle
Hockey
Fun
90.5 [82-95]
94 [89-95]
88.5 [86-95]
91.5 [89-97]
93.5 [90-95]
Easy
53.5 [7-94]
93.5 [29-96]
58.5 [7-81]
87 [65-95]
72 [13-88]
Comfortable
90.5 [85-95]
95 [85-97]
85 [78-95]
90 [80-96]
90 [89-931]
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
SENSOR DATA

No significant differences
 Number of repetition
 Number of repetition in 1 minute

Correlation
‘Fun‘ and ‘easy‘ rating of
- Hockey and Butterflies and the number of repetition r = 0.37; r = 0.37
- Butterflies and number of repetitions in 1 minute r = 0.30
GAMES
Fruits Repetition
Rep in 1 minute
Repetition Boats
Rep in 1 minute
Butterflies Repetition
Rep in 1 minute
Repetition
Puzzle
Repetition
Rep in 1 minute
Rep in 1 minute
Hockey
Repetition
Repetition
Rep in 1 minute
Rep in 1 minute
* Median [P25-P75] p Value > 0.05
Lateral
Lateral
Vertical
Vertical
Vertical
Vertical
Lateral
Vertical
Lateral
Vertical
Lateral
Vertical
Lateral
Vertical
MOVEMENT
AFFECTED
ARM *
19 [16,29]
5.15 [ 4.2-7.3]
41 [23,80]
7 [ 4.4-10.3]
17.5[8,32]
5.25 [ 3.5-6.7]
22.5 [15,27]
17.5[ 9-57]
5.15 [4,7.1]
5.2 [ 1.9-8.2]
18.5 [14,21]
21 [ 16-36]
3.1 [2.7,5.6]
3.95 [ 3.2-7.9]
NON AFFECTED
ARM *
24 [20,28]
5.35 [4.2-7.9]
83.5 [27,138]
11.2 [8.9-713.1]
34 [18,52]
11.3 [9.7-13.7
37 [29,47]
38 [19-94]
8.8 [7.9,9.6]
9.55 [5.3-15.3]
24 [20,25]
59 [17-101]
5.75 [3.4,8.5]
9.05 [4.8-14.5]
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
The Multi-Touch Table appears to be a helpful tool to engage children with CP in therapy, allowing a more effective treatment and therefore improving outcomes for upper extremity rehabilitation

Level of Evidence : Level IV
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
Acknowledgments
Clinicians at Spaulding Rehabilitation Hospital and Children’s Hospital (Boston)
Peabody Foundation and the Wyss Institute
Thank you for your attention
Gloria Vergara-Diaz, MD gvergaradiaz@partners. org
Motion Analysis Laboratory

PM&R, Harvard Medical School
Spaulding Rehabilitation Hospital
Wyss Institute for
Biologically Inspired Engineering
Summary of Citations & Level of Evidence
1.
Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006.
Developmental medicine and child neurology. Supplement. 2007;109:8-14.
2.
Sakzewski L, Gordon A, Eliasson AC. The state of the evidence for intensive upper limb therapy approaches for children with unilateral cerebral palsy. J Child Neurol. 2014 Aug;29(8):1077-90; LOE – Level 1.
3.
Zoccolillo L, Morelli D, Cincotti F, Muzzioli L, Gobbetti T, Paolucci S, Iosa M. Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical activity. Eur J Phys Rehabil Med. 2015 Feb 5; LOE – Level 2-4.
4.
Valdés BA, Hilderman CG, Hung CT, Shirzad N, Van der Loos HF. Usability testing of gaming and social media applications for stroke and cerebral palsy upper limb rehabilitation. Conf Proc IEEE Eng Med Biol Soc.
2014;2014:3602-5; LOE – Level 4.
5.
Preston N, Weightman A, Gallagher J, Holt R, Clarke M, Mon-Williams M, Levesley M, Bhakta B. Feasibility of school-based computer-assisted robotic gaming technology for upper limb rehabilitation of children with cerebral palsy. Disabil Rehabil Assist Technol. 2014 Jun 25:1-8; LOE – Level 4.
6.
Chiu HC, Ada L, Lee HM. Upper limb training using Wii Sports Resort for children with hemiplegic cerebral palsy: a randomized, single-blind trial. Clin Rehabil. 2014 Oct;28(10):1015-24; LOE – Level 2.
7.
Dunne A, Do-Lenh S, O' Laighin G, Shen C, Bonato. Upper extremity rehabilitation of children with cerebral palsy using accelerometer feedback on a multitouch display. Conf Proc IEEE Eng Med Biol Soc.
2010;2010:1751-4.
8.
Annett M et al. Using a Multi-touch Tabletop for Upper Extremity Motor Rehabilitation. OZCHI 2009, November
23-27, 2009, Melbourne, Australia.
9.
Leitner M et al. Designing tangible tabletop interfaces for patients in rehabilitation. Conference & Workshop on
Assistive Technologies for People with Vision & Hearing Impairments Assistive Technology for All Ages CVHI
2007, M.A. Hersh (ed.).
10. Alcañiz M, Abarca V, Lozano JA, Herrero N. Analysis of multitouch technology for neurorehabilitation. Journal of
Cybertherapy & Rehabilitation. Fall 2009, Volume 2, Issue 3.
Motion Analysis Laboratory