Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study

Journal of NeuroEngineering and Rehabilitation, Mar 2016

Background Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting. Methods Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31–69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged. Results The usability of the system was considered average to satisfying (mean 60.1–93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems. Conclusions Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system. Trial registration ClinicalTrials.gov NCT02368223

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Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study

Gerber et al. Journal of NeuroEngineering and Rehabilitation Preparing a neuropediatric upper limb exergame rehabilitation system for home- use: a feasibility study Corinna N. Gerber 0 1 2 3 4 Bettina Kunz 0 1 2 3 4 Hubertus J. A. van Hedel 1 2 4 0 Department of Health Sciences and Technology, ETH Zurich , Rämistrasse 101, CH-8092 Zurich , Switzerland 1 Pediatric Rehab Research Group, Rehabilitation Center for Children and Adolescents , Mühlebergstrasse 104, CH-8910 Affoltern am Albis , Switzerland 2 Children's Research Center, University Children's Hospital Zurich , Steinwiesstrasse 75, CH-8032 Zürich , Switzerland 3 Department of Health Sciences and Technology, ETH Zurich , Rämistrasse 101, CH-8092 Zurich , Switzerland 4 Pediatric Rehab Research Group, Rehabilitation Center for Children and Adolescents , Mühlebergstrasse 104, CH-8910 Affoltern am Albis , Switzerland Background: Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting. Methods: Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31-69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged. Results: The usability of the system was considered average to satisfying (mean 60.1-93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems. Conclusions: Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system. Trial registration: ClinicalTrials.gov NCT02368223 Data glove; Pediatrics; Neurorehabilitation; Upper extremities; YouGrabber; Tele-rehabilitation; Game-based; Cerebral palsy; Children and adolescents; Clinical utility; User satisfaction Background Cerebral Palsy (CP) is the most common cause for motor disabilities in children in Western Countries (prevalence in Europe: 1.77/1’000 per year) [ 1 ]. Traumatic brain injuries (TBI) in children and youths (worldwide incidence of hospitalizations: 74/100’000 per year) [ 2 ], and childhood stroke (worldwide incidence: 1.2-13/ 100’000 children per year) [ 3 ] are other common causes for hospitalization with consecutive rehabilitation. Many of these patients exhibit upper limb impairments such as reduced movement speed, finger dexterity, muscle strength, or interlimb coordination. As a consequence, these children might experience severe reductions in their independence in activities of daily living (ADL). In fact, one of the most important goals for these patients is to become more independent in their daily life [ 4 ]. Therefore, neuropediatric rehabilitation targets at reducing functional limitation and improving motor capacity and performance to achieve the best possible level of independence in daily life. For successful neurorehabilitation, it is important, amongst others, that patients participate actively in therapeutic sessions, are challenged, motivated and rewarded, and that treatment is tailored to the patient’s needs [ 5 ]. Furthermore, a higher therapy dosage seems to lead to better motor outcomes [ 5, 6 ]. To optimize pediatric neurorehabilitation and to complement conventional occupational therapies, computerbased therapies for upper limb rehabilitation have been developed or adapted for the pediatric fiel (...truncated)


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Corinna Gerber, Bettina Kunz, Hubertus van Hedel. Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study, Journal of NeuroEngineering and Rehabilitation, 2016, pp. 33, 13, DOI: 10.1186/s12984-016-0141-x