Gaming Technology in Neurological Rehabilitation

Introduction

A growing population presents new challenges for healthcare systems. People are living longer than ever before due to disease and disability, putting increasing pressure on the healthcare system. In theory, by incorporating more telemedicine into traditional rehabilitation, Chronic disease therapists should be able to handle more cases and manage more patients. Using a console to supplement therapy is a cost-effective way to increase practice opportunities for patients during non-treatment specific times. [1]

Another key factor to consider when considering incorporating console-based gaming into practice is patient engagement. Studies have shown that patient motivation is overall improved when using consoles and virtual reality for therapy sessions [2]. A study by Deutsch et al. [3] found that, Individuals have increased compliance, fun, and stamina, and are better able to handle the repetitive nature of rehabilitation. [3][4]

The console has been found to be an appropriate way to meet the ongoing needs of people of all ages in need of neurorehabilitation. [5][4][3][6][7] By using the console as an aid to traditional rehabilitation, patients are able to augment and self-direct their steps Recover at home. This is critical for anyone with a neurological condition that necessitates long-term disability. The rehabilitation process can take months to years to allow the patient to develop to his or her full capabilities. Treatment may be required during the patient’s lifetime If their condition is chronic. [7][8] With advances in technology and medicine, people who previously lived shorter lives can now live longer and with a better quality of life. [9][2]

A common problem in rehabilitation from neurological disorders is not only providing treatment of sufficient intensity to restore muscle function and strength in a limb or joint, but also to allow for skill transfer. [10] A study by Deutsch et al. [11] found that the patient population did have Some skill transfer when using the Wii as a means of rehabilitation. Different games require different physical activations. Those tasks that required bilateral tasks were found to improve upper limb function in children with hemiplegic cerebral palsy. [5] Importantly, patients not only Enjoy all aspects of being involved in the recovery process, but also feel safe doing so. [3] found that some groups of patients required supervision when using the console during rehabilitation. Also note that patients themselves say they Feel safe and able to practice in a home setting.

What is a Console-Based Therapy?

Console-based therapy is an area of study concerned with the use of technology within the field of physical therapy. Regardless of the cause of the injury, the primary goal of most neurorehabilitation is to facilitate the learning or relearning of motor skills. The process of acquiring motor skills involves Repeat the same movement hundreds or even thousands of times. Traditional rehabilitation is time-consuming and requires lengthy sessions with therapists, which place high demands on staff and healthcare budgets. Patients often tire of recovery, finding it frustrating or tedious. it has been Patient adherence to long-term rehabilitation programs involving exercise regimens has been reported to be as low as 23% [12].

Integrating console-based gaming into rehabilitation programs has the potential to change the current rehabilitation structure. Appropriate use of play-based rehabilitation can be challenging and fun. Patients no longer need to repeatedly flex and extend their elbows using a computer They can tame a lion stirring cake batter or shoot colorful balloons in the game. Instead of asking the patient to balance while reaching up to touch a physical therapy assistant’s hand, the patient can practice their balance while playing a virtual golf ball Bowling alleys or driving go-karts at a racetrack on a deserted island.

Console-based rehabilitation does not seek to replace therapists with computers; rather, it is a useful tool that therapists can use to interact with patients, making rehabilitation fun and exciting, and potentially increasing adherence rates, thereby improving these patient functional outcome patient.

The need for therapists to integrate play into therapy is further explored in this Ted talk:

Consoles generally involve:

• A box or device attached to a television or other medium to transmit information
• Can be used with a variety of commercially available and rehabilitation-specific games
• May be considered a luxury or just for fun
• Tablets may have a different interface, require input to a TV or other media, and add portability where consoles don’t

Consoles for Rehabilitation

Wii

The “Wii” is a computer game console designed to put players in motion. The player stands in front of the screen with the Wii Remote in his hand. Sensors located above or below the screen monitor the player’s hand position (by reading signals sent from the remote) player’s hand) and translates these signals into motion. It shows the player their progress on the screen.

The Wii was designed for able-bodied users, but Joo et al. [13] found that stroke patients with moderately severe UL impairment could operate the Wii with proper strapping and supervision. The therapist may need to provide encouragement and guidance to compensate Availability limitations for Wii.

Since the launch of Henry and Barrett 2010 in November 2006, the role of the Nintendo Wii gaming system in patient rehabilitation has grown. Rehab for Wii combines the Wii and its components to help patients achieve their recovery goals. Over 75 million units sold Worldwide, it is becoming a popular rehabilitation tool around the world Taylor et al. [14]. The increasing use of Wii for rehabilitation can be attributed to: versatility of treatment goals, affordability and increased treatment engagement.

Nintendo has introduced a new type of VR by offering wireless controllers that interact with players through a motion detection system. An avatar named Mii[15] (pronounced “me”) represents the player in the game.

Initial interest in the Wii as an upper body rehabilitation tool stemmed from the console’s unique wireless controller allowing games to respond to the player’s body movements rather than the “joystick” movements of traditional gaming systems Halton et al etc. [16]. Movement is monitored by components including the Wii Remote “nunchuck” or balance board.

• Utilizes a three-axis accelerometer to translate body motion into on-screen motion.
• Accelerometers respond to changes in directional velocity and acceleration, enabling participants to interact with the game while performing wrist-arm and hand movements.
• Provide basic audio and visual feedback.
• The nunchuck also incorporates motion-sensing technology and provides additional control.

The advantages of incorporating the Wii into neurorehabilitation are many, including:

• User-friendly interface for use and setup[17]
• Use secure commercial systems [18]
• Systems that do not require large areas and allow patients to use them at home[19][20]
• A system that reduces contact time and promotes patient participation in recovery [21]
• Attractive graphics with audio feedback create an enjoyable experience[22]
• Increased adherence and motivation due to the entertaining and engaging nature of the game[19][22]
• Provide positive feedback through rewards and badges programmed into the game [13]
• Reduces incidence of depression by allowing patients to socialize with peers and family

It is important to note that the Wii may not be suitable for all patient populations, some disadvantages include:

• Patients may require assistance and supervision while using the Wii [22].
• Wii-related injuries
• “Witus” supraspinatus acute pain [14]
• Hand lacerations were commonly reported
• Nearly half (46%) of all reported injuries were caused by Wii tennis balls[14]
• Excessive gaming can lead to a variety of injuries, including musculoskeletal injuries and repetitive strain injuries [14]
• Patients with increased seizure activity may be sensitive to seizure-inducing stimuli [16].
• Patients with pacemakers should hold the Wii Remote at least 9 inches from the chest [16].

What dos the research say:

• Wii games can be used as an adjunct to conventional therapy [13]
• The Wii Can’t Replace Traditional Rehab
• Further research is needed to assess whether the Wii is effective on its own compared to conventional rehabilitation
• Wii games were found to improve UL motor function after stroke [13][19][23].

Saposnik et al. [24] concluded that post-stroke participants in the Wii group showed significant improvements in motor function compared to recreational group therapy (card bingo “Jenga”) up to six months after the intervention. A study by McNulty et al. [19] Patients aged 2-46 months Post-stroke found that Wii therapy was as effective as modified restraint-induced exercise therapy in improving movement of affected ULs and increasing independence in activities of daily living. All patients in the Wii treatment group reported increased independence for self-care.

A recent systematic review by Thomson et al. [20] highlighted that despite a trend toward improvement in UL function and movement, there is insufficient high-quality evidence to draw definitive conclusions about the benefits of activities of daily living or UL function and movement. Larger randomized controlled trials are now needed. No studies have shown that commercial gaming has a negative effect on treatment. Therefore, the Wii is likely to be used as a supplement to conventional therapy.

One limitation of current Wii technology is that it is not sensitive enough to measure certain levels of functional capability. One therapist noted: “Whether it’s a game for a low-functioning individual…we’re just doing a basic exercise that might take 6 Among the different options…” [17]. Feedback on:

• Quality of the user’s arm movement
• Parameters such as speed and range of motion are not adjustable [25]
• Perceived lack of ability to observe and track client progress Tatla et al. research[17]
• Could not measure changes or improvements Tatla et al. research[17]
• Unlike rehabilitation specific units, the game cannot detect small movements or muscle activity
• Allowance of Compensatory Action “Cheating”

Halton et al. [16] found that the Wii may be too difficult for some patients because it requires a certain degree of motor control to progress in the game. A more sensitive system might be able to overcome these compensating movements, using sensors or vibrations to give feedback to the patient when they need it compensate. However, a handful of studies have modified the Wii hardware, turning the Wii into a more useful recovery tool. Matamoros et al. [26] customized the Wii Remote and Nunchuk to transmit physiological data such as grip strength and finger strength while performing treat. More research is needed to design Wii games with a more sensitive rehabilitation focus.

Despite the increasing popularity of Wii, current research shows that Wii is not a suitable substitute for traditional treatments. Some studies have found that Wii exercises can confer UL functional movement and ADL benefits, but there is not enough evidence to draw general conclusions. However business Games can provide 180 minutes of safely tolerated high-intensity UL practice per week [20]. Stroke rehabilitation is a complex field with gaps in the evidence base on how to promote motor recovery. Some interventions show promise; especially studies focused on high-intensity repetitive training Task-specific practice [20].

The Nintendo Wii encourages high-intensity repetitive arm movements. Over time, patients may find traditional task-specific exercises tedious. As discussed earlier, the Wii can potentially motivate patients to spend more time participating in active UL sports because of its fun and Interactive method. The therapist obviously plays a key role in selecting and adapting games and activities to meet the needs of the patient during the rehabilitation process.

Despite the evidence, some of the benefits of using the Wii console in UL rehabilitation for Wii-playing patients are more complex than in traditional physical therapy programs [25]. This may interfere with standard treatment planning for patients because patients Different movements of different intensities will be used.

Further research on the effect and experience of Wii gaming on rehabilitation in UL is needed to assess the efficacy of Wii therapy compared to usual rehabilitation in UL. the problem still exists:

• How can we increase the sensitivity of the Wii console and tailor games to different patient populations?
• How can we improve safety and usability issues for long-term use at home?

Games

Wii Sports – UL Rehab

Nintendo Wii fitness games such as Wii Sports and Wii Fit are gaining popularity in rehab settings. The handheld wireless pointing device for the Wii game console has embedded sensors that detect changes in three-dimensional orientation and velocity. Games provide instant audio and visual feedback About progress. These games may be beneficial for:

• Providing encouraging commentaries
• Use of medals and badges
• Allowing bonuses
• Use music to help improve workouts and repeatedly improve performance
• Allow patient to sit or stand while participating
• Providing different levels of difficulty
• Extent options for how limbs are used to accomplish tasks (such as swinging a virtual tennis racket or throwing and virtual bowling)

Games available for UL Rehab’s Wii Sports software include:

• Boxing
• Bowling
• Tennis
• Golf
• Baseball

The therapist will pre-select games based on personal preference and UL functional ability. Different games or portions of games will be used for different patients. It is the therapist’s role to monitor appropriate responses to play, ensuring correct Muscle use, and note fatigue or pain. If the patient’s grip is insufficient, the therapist can provide verbal encouragement, use the cuff to support the patient’s hand to hold the Wii Remote, and even offer hands-on assistance or play with the patient.

A breakdown of how Wii games are used for specific therapeutic goals [16]

The Wii games described so far were sold with the Wii console. While they can be used to help with recovery goals, Wii games are not designed to do so. Therefore, specially designed games are needed to complement rehabilitation. A game designed for burn diabetics Asthma and bladder and bowel dysfunction. Future research should focus on designing specific games that better suit patients’ rehabilitation needs. The Wii’s potential could be improved if games and accessories were designed with rehabilitation in mind.

Kinect

Released in 2010, Kinect is considered a breakthrough in gaming technology. Players no longer need to hold a remote control, cameras and motion capture sensors can recognize players and track their movements and display them on the screen.

Kinect started out as a revolutionary gaming platform. It uses an infrared depth-sensing camera [27] made by PrimeSense [28]. The camera captures the user’s full-body motion in 3D space for gaming activities [29]. PrimeSense is used in Microsoft Kinect [28]. The Microsoft Kinect sensor can be Connection to a PC via USB allows uploading or downloading of data from the server [28].

Kinect enables users to control and interact with the gaming console by using gestures instead of a game controller [29][30][27], as the Kinect PrimeSense body sensor is not required as in a laboratory setting [31]. Game 20000 leaks let participants use their hands and feet and go head to toe Or stab to plug various leaks created by fish or sharks hitting virtual glass bubbles [32]. PrimeSense detects the player’s movements and provides feedback on the quality of the movements, determining whether the player has successfully completed each task.

PrimeSense utilizes an RGB camera and a depth sensor, the combination of which provides full-body 3D motion capture [29]. The Kinect One is reported to have a 1080p HD camera that can capture video at 30 frames per second [33]. New Active Infrared feature improves accuracy, allowing Kinect One works in all lighting conditions and has a wider field of view. Microsoft’s proprietary “time-of-flight” technology measures the time it takes for a single photon to bounce off the player to create unprecedented accuracy and precision. new noise isolation A multi-microphone array filters ambient sounds to identify natural speaking voices. The camera is more sensitive than its predecessor, able to detect additional joint data points, including the player’s heartbeat.

Advantages

• Kinect strengths include its hands-free 3D motion capture capabilities [27]
• Kinect is available for individuals with various impairments and diseases [30][34][31][35][28][29].
• Patients can complete game-based tasks while standing or sitting [35], thereby providing greater convenience for people with disabilities, including wheelchair users [28][34].
• Kinect is commercially available to allow patients to self-administer and complete additional physical therapy exercises at home. [35][36][28][37][34]
• Current research provides therapists with the flexibility to develop a customized rehabilitation plan [32]
• Kinect will provide feedback on patient performance [27].
• Kinect measures three degrees of freedom of the upper limb, one at the elbow and two at the shoulder [30][37][28].
• The system includes an interactive interface with audio and visual feedback to enhance motivation to participate in physical activity [31][32][38][30][34] interest and perseverance[35][29].

Disadvantages

• Kinect can’t differentiate between supination and pronation of upper limb
• Players may not achieve sufficient intensity to make adequate progress [39].
• Game scores do not correspond to exercise recovery [36]
• Healthcare professionals may not be aware of the use of Kinect as an adjunct to traditional physical therapy [32].

Patients report that the Kinect and physical therapy designed protocols are easy to use and safe to use in both home and clinical settings. [31]) No adverse events were reported during the tests performed by Palacios-Navarro et al. [31]. Who thought Kinect games were safe and feasible means of rehabilitation. VGBT has also been recommended as a complementary strategy to the routine care of children with CP [40]. Patent for recovering from neurological injuries including stroke and spinal cord injury finds use of Kinect prototype valuable Rehabilitation tools [28].

When using the Kinect in the clinic, the rehabilitation area needs to be cleaned up under supervision. Initial assessment should be performed in a home setting to ensure patient safety (HCPC Code of Conduct). PT paramedics and pts should review all exercises before starting Recovery; patients should have nursing staff present when appropriate. Seated exercises are associated with fewer risks than standing exercises in people with impaired balance and coordination.

The rapidly developing field of VR offers great promise for rehabilitation [38]. VR systems create interactive simulations. MIRA (Medical Interactive Recovery Assistant) developed software using the Kinect interface [27]. Their game helps healthcare professionals by providing data Regarding patient performance [29].

The validity reliability and feasibility of Kinect have been evaluated in Table 3. Kinect is recommended by current research as an appropriate addition to rehabilitation. Kinect has been found to have acceptable reliability and sensitivity in both recovered and healthy populations [35].

Improvements in neuroplasticity and subsequent recovery of motor function after nervous system injury or disease have been observed with high-intensity skilled practice [35][28]. MRI results showed activation of the contralateral primary sensorimotor cortex in Kinect-based training for stroke patients [29]. Individuals who have access to an intensive multidisciplinary rehabilitation program show earlier and faster gains on measures of functional independence [30]. This shows that Kinect provides the strength needed to study neuroplasticity Changes in the recovery period of hemiplegia in patients with subacute stroke [29].

Furthermore, a large systematic review found that the gains of VRBR were attributed to the multisensory feedback provided by Kinect, while affecting the motivational aspect of motor performance [38]. Sensory information enables the central nervous system to control body position and orientation, allowing Adapt to the complex external environment [38]. The effects of VRBR were found at one-month and three-month follow-up in the study.

The low cost and ease of use of Kinect make it suitable for home environment [36][31][40][35][38][37][29]. Due to the small sample size, more studies are needed, some studies had no control group, and others lacked follow-up.

Thanks to Kinect’s unique interface, many software companies have been able to develop their own games to target specific clinical outcomes. For this reason, a lot of research has been done without using any XBox games. This section will first outline some common XBox games Rehabilitation-specific software for rehabilitation and discussed in the following section.

Kinect Games

Kinect Adventure Pack[32]:20000 Water Leak: The player uses his arms, legs and head to block the water leak in the glass bubble to prevent water from splashing into the bubble. This game requires trunk stabilization movements of upper body lower body trunk and head. Players must make purposeful actions Accurate plugging.

Space Pop: Players must sidestep, squat, slap and raise their arms to move in outer space. They have to wander around to pop bubbles and get rewards. Athletes need torso stability and sufficient upper and lower extremity strength to hover. The accuracy of upper body movement is Required because the target is specific.

Rally Ball: Using the upper body and head, the player must sidestep to hit a moving ball that hits various targets. Positioning of the upper body is important for hitting specific targets. During these processes it is also important to stabilize the trunk musculature sports.

River Rush: A drifting sim that requires navigating by leaning forward and sideways and using upper body aiming bonuses on the river. Players avoid obstacles by jumping and sidestepping. Trunk and lower body stability are required throughout the game. this is It’s also important to have accurate upper body movement and timing for the bonus.

Reflex Ridge: The player is on a rail car and must avoid obstacles by bending and sidestepping. The upper body is used to collect bonuses. Arm action does not require a specific position, as the bonus size is larger and easier to obtain.

Kinect Sports Pack: Soccer: The player has to walk left and right to act as a defender, kick the ball to act as an attack, move left and right and raise his arms to act as a goalkeeper.

Volleyball: To serve, the player must use one arm in an upward motion and the other arm in a swinging motion. The game must also mimic the action of pool and smash.

Bowling: Asks the player to reach out with the left or right arm to catch the ball, then swing the arm forward in a bowling motion while maintaining balance.

Athletics: Includes sprint, javelin, long jump, discus and hurdles. Competitors must jog and jump in place and use arm movements to throw the discus and javelin.

Boxing: Players must punch and block with their arms at different heights in response to visual stimuli.

Table Tennis: Players must reach left or right to grab the racket and swing their arms forward to create topspin, backspin and smash. The game also has a “Paddle Panic” setting that hits as many balls as possible with both arms.

A study by Zoccolillo et al. [40] combined the games 20000 Leaks Space Pop and Rally Ball (as well as boxing volleyball and bowling games in the Kinect Sports Pack) with the rehabilitation of children with cerebral palsy. They found a significant improvement in the quality of exercise The upper body is particularly well suited for grasping and free movement.

Fruit Ninja Players who use their arms as “blades” must slice through fruits of various sizes to collect points. This may include shoulder abduction, adduction, flexion, extension and rotation. The game requires crude dexterity synchronized with the falling fruit. Increased game difficulty More fruits fall at a faster rate. Players are in the center of the action, so need to use their arms to slice as much fruit as possible that falls on either side of them. The study by Bao et al. [29] found that the use of Fruit Ninja for one hour in subacute stroke patients 5 Improve scores on the Fugl-Meyer assessment and the Wolf test of motor function several times a week.

DoctorKinetic [41] aims to improve motor-intensity coordination activities of daily living and cognition through fun and engaging games. Games and exercises can be modified to work the upper body, lower body core and/or back. The therapist is able to prescribe specific Exercise should be included in the patient’s program.

The system provides in-game feedback as well as therapist-selected biofeedback. A report was generated after each session covering gait balance range of motion and motor control data. Therapists are able to review reports of patient performance and make progress Report to detect trends over time.

The system is able to identify individual patients. This allows the therapist to see the camera without entering the game’s virtual reality. This feature also enables a quick start by identifying patients and bringing up their specifications in-game. this system Effects on neuromusculoskeletal connective tissue circulatory and respiratory system lesions.

MIRA: Medical Interactive Recovery Assistant [42] MIRA involves participatory games aimed at upper extremity rehabilitation. Originally developed to aid in the rehabilitation of orthopedic injuries, the system has branched out to involve neurological injuries. Mainly focused on hemiparesis Tetraparesis Parkinson’s Dystonia Autism and Stroke.

Upper extremity movements of the shoulder (flexion abduction frontal plane rotation internal and external rotation and arms elevation) are used to encourage the athlete and achieve therapeutic goals. These movements involve reflexes, upper body coordination, flexibility, and range of motion Posture Arm Coordination Hand-Eye Coordination Reach and Velocity Limited Movement.

SeeMe Rehab [43] aims to improve coordination, balance, muscle strength, range of motion, reaction time and memory. These games are easily modifiable to meet therapeutic needs defined as “deep customization”. The system generates reports in real time for therapists to analyze Compensatory Movement The relative angle between the timing and range of motion of a limb. These reports also allow for the analysis and quantification of long-term progress.

The developers say they are targeting people with strokes MS CP Parkinson’s disease, extrapyramidal syndromes, brain tumor surgery, spinal cord injuries, muscle wasting and many orthopedic problems. Descriptions of the modules are listed on their website, allowing The therapist chooses the appropriate game based on the patient’s goals. There is also a real-life module that enables players to perform everyday activities in the virtual world. The developer also released some games for home use (using PC and webcam) Costs under $20.

Jintronix [44] A system that uses clinically designed exercises to engage patients in rehabilitation. The system also measures and reports results to clinicians in real time. The report enables therapists to make adjustments to treatment and challenges patients to improve their scores. Currently, clinicians must monitor patient engagement, which is not commercially available. The main focus of the system is the rehabilitation of neurological disorders such as stroke and TBI.

ReflexionHealth-Vera [45] aims to guide and motivate patients to exercise. The company is currently focused on musculoskeletal rehabilitation (joint replacement surgery and falls prevention), but has potential use in broader contexts, including neurology recovery. Vera recently received FDA approval and will be used in many clinics to assist recovery. The system uses avatars to have patients perform prescribed exercises at home. The therapist is then able to review the results reported by the system and make adjustments Program as needed.

The KineRehab system was developed to help therapists rehabilitate students in public schools. The settings of the game can be adjusted to personalize the game to meet the rehabilitation needs of the students. The main purpose of the game is for students to measure the accuracy of their movements During recovery. The system provides visual and auditory feedback and records the student’s progress for review by the therapist. A pilot study [34][30] involving two students with cerebral palsy found improved accuracy of upper body movements. Students also said they enjoyed activities, and it facilitated their better participation in therapy, although this was not defined as ‘game’.

Virtual Occupational Therapy Assistant (VOTA): [Under development] VOTA is a virtual reality program that enables participants to practice virtual activities of daily living (ADL). It combines upper body movement “in an integrated multi-step activity.” participant exercise Around the virtual world and close to the ADL. Capture upper body movements during ADL. This makes it possible to engage both motor and cognitive abilities at the same time. Provide visual and verbal cues to participants. This system is not recommended for lower extremity rehabilitation.

A study of hemiplegic stroke patients [46] demonstrated a modest correlation between the game-embedded assessment of the VOTA system and the time-based assessment of the Wolf Motor Function Test (WMFT). Therefore, VOTA can potentially be used to track participants’ progress.

A randomized controlled clinical trial showed that a virtual reality intervention had a positive effect on children’s body sway and gross motor function. [47]

Tablets

A tablet, often called a tablet, is a portable computer with a touchscreen display. Whereas a traditional computer would have a separate keyboard, mouse, screen and speakers, a tablet combines all of these components into one. Touchscreen monitors reduce mouse and The tablet has a built-in camera speaker and battery.

Although tablet and smart screen technology has only been around since 2010, its popularity has exploded and continues to grow. The iPad was the first commercial tablet when it was released in 2010, and tablet ownership has grown steadily since then. Ofcom Report 2015 Communications Market reports that 54% of UK households now own a tablet. Verdonck and Maye[48], in their review of current practice in adult cervical spine injury rehabilitation, found that smartphones and tablets are playing an increasing role in daily activities live and interact. They recommend that occupational therapists integrate smart technology into rehabilitation practices for patients with c spinal injuries, giving patients greater autonomy.

The tablet is controlled by a touchscreen, which responds to the movement of your fingers across the screen. However, it has many other functions that allow the tablet to calculate and react to movement (for example, it can tell if it has been placed on its side and adjust the orientation of the screen therefore). The tablet components that allow it to do so include the following:

Accelerometer: Detects the physical motion and orientation of the device. This is used in games to allow the user to tilt the device in order to drive a car, for example. Gyroscope: Gyroscopes work together with accelerometers to calculate orientation and rotation. A device has both Accelerometers and gyroscopes will have greater accuracy in determining the position of the player’s hand. So this will allow the tablet to more accurately record work done. GPS (Global Positioning System): This tells where the user or other people are on the globe If the tablet is connected to the internet, the tablet can be accurate to a few meters. This can be used to measure walking distance or provide directions to guide people home or to the nearest bus stop hospital or shop. Camera: This can be used with Medical staff or record the patient’s recovery process for later playback.

Advantages

• The tablet is portable and battery-operated, allowing patients to complete their recovery remotely in the clinic. This feature also allows patients to start rehabilitation with the tablet in the hospital or clinic and continue with the same program after discharge.
• Tablets are relatively cheap. The only hardware required is the tablet itself, no additional equipment is required.
• Anyone can develop a game or application for the tablet and distribute it on the App Store for iPad or the Play Store for Android devices. When a game is released on these stores, anyone can download it and start playing with it in minutes.
• There’s a wide range of uses for this tablet beyond gaming. For example, if a patient brings home a tablet for upper extremity rehabilitation, they can also use the same device to:
• Keep record of their medication
• remind them when to take their medicine
• Communicate with departments via Skype or email
• Research their condition
• Join support groups online
• Patients with speech impairments can use tablets to help them communicate. [49]
• No help is required to set up the tablet; users can pick up the tablet and start gaming right away. This provides patients with a measure of independence and ownership of their recovery.
• Some of the games described below have features that allow therapists to set up accounts and monitor patient progress remotely. It can also be used to adjust the difficulty setting of a game, or provide feedback or motivation through messages or even short video clips.

Disadvantages

• Tablets don’t have the same level of sensitivity compared to Kinect and Wii, so don’t collect motion data very well
• While a tablet is very good at monitoring fine movements, which are currently important for improving flexibility, it’s not useful for restoring gross movements in the upper body other than as a virtual trainer.
• Currently, the evidence base supporting the use of tablets in rehabilitation is very limited.

As shown in Table 3, the evidence base for tablet-based therapy remains extremely limited. Several small pilot studies have been published, but to date, no large-scale studies have evaluated tablet-based rehabilitation compared to conventional or other rehabilitation technology. Therefore, we cannot definitively say whether integrating tablet games into neurorehabilitation is beneficial. However, several interesting trends emerged:

• All studies that looked at patient responses reported very positive feedback from patients. Elis et al. [50] reported that patients were very satisfied with the intervention (5.6/7 on the Likhert scale). [49] reported that patients were very satisfied with their treatment Tablet based home rehab program because they think their treatment is very modern and cutting edge.
• Adherence was high for all studies. [51][52][49]
• Participants enjoy therapy with play. Hocine et al. [52] reported that participants thought the sessions were shorter than they were, and one patient compared their game Prehab to “Mario.”
• Age did not appear to affect how participants interacted with the tablet, nor did it affect how participants scored in the game. Fizzotti et al. [51] and White et al. [49] discuss how older patients dislike computer use or have difficulty adjusting to new Technology as a potential barrier to its use. However, this has proven to be incorrect, with older participants scoring the same as younger participants [51], and stroke survivors adapting to the technique well with reassurance and education [49].

The 2013 NICE guideline [53] on post-stroke rehabilitation recommends repetitive task training for patients with movement disorders. On the rehabilitation unit, physical therapists typically focus on gross movement and muscle groups, which are critical to maintaining a patient’s high level of function. Flexibility and fine motor skills are often overlooked.

It’s possible that the addition of tablet-based games will help with that. If a ward has several tablets preloaded with several rehabilitation games that patients can use alone or with the help of family members, they can safely exercise hand movement and dexterity, with or without assistance from the medical team. In theory, the same tablet could also contain information (in written audio or video format) from medical team members with advice about their condition and programs to help with post-stroke communication issues. Tablets are also available Help bridge the gap between hospitals and homes by allowing patients to start treatment on the ward, then take the tablet home and continue the same familiar treatment at home. Patients often feel abandoned and alone after discharge from the hospital, and it has been determined that this needs to be addressed. (OK Guidelines for Stroke Rehabilitation). Offering a pill that improves continuity of care is one possible approach that could be used to try and prevent patients from feeling isolated when they are discharged.

Tablet Games

ReHoblet: An Android-based game that uses avatars to navigate the world, defeat enemies and collect rewards. This game requires gross movements of the upper limbs to complete the movements of lifting (up, down) and movement (left, right). Therapists can personalize Parameters such as avatar speed, enemy speed, world size, and the direction the player needs to move. These modifications allow the therapist to vary the difficulty of the game according to the patient’s abilities. e.g. increasing the size The world will need to increase total physical activity. Therapists are also able to log into the web server to track their patients’ data, game settings and a list of statistics from different sessions (i.e. levels played, scores, date and time, number of bonuses calculated and number of enemies hitting different locations in the level). This can be used to ensure adherence to treatment and to quantify where patients may be struggling.

A pilot study [54] of five MS patients showed good adherence and high levels of enjoyment and participation in the game.

Ball Strike and Pop Flux: Ball Strike: An iPad game where the player’s image is projected into the game. The goal of this game is to hit the moving colored balls and avoid the gray ones. This action engages the upper torso head and shoulders. As the player progresses through the level Game difficulty increased. The therapist can manipulate what level the patient can achieve.

An iPad game where the player’s image is projected into the game. The player has to blow soap bubbles and avoid hitting bombs rocket knives etc. This movement requires dynamic trunk balance selectivity and speed of movement.

The study by Fizzotti et al. [51] in patients with spinal cord injury showed significant gaming scores followed by improvements in the Trunk Recovery Scale, an indicator of trunk control. Self-reported trunk control also improved, and treatment satisfaction increased.

Fruit Ninja: Game for Android and iPad. Goal-directed hand movements are required to “slice” the fruit that appears on the screen. The player must also avoid missing more than three fruits or cutting the bomb, as this will end the game. Khademi et al. [55] manipulated the game to get rid of The bomb and three fruits rule, but use a one-minute time limit. This results in a high correlation between the game’s score and the Fugl-Meyer Assessment (FMA) and Block Test (BBT). Stroke patients were able to improve their game scores throughout the study, which Leads to increased FMA and BBT scores. Dexteria: “An app that provides therapeutic hand exercises. Dexteria specifically states that this is not a game, whereas their kid-friendly app “Dexteria Jr.” has games for kids to do therapeutic hand exercises. This Exercises are designed to improve strength control and dexterity in the hands and fingers. Parents and therapists can track progress using the automated tracking and reporting features within the app. [56] found a strong correlation between Dexteria scores and the nine-hole nail test, and Tested with boxes and blocks.

Findex: An Android-based game that uses home- and work-related activities to engage players in finger-tapping, dragging, and stretching exercises. The goal is to improve finger control isolation and coordination as well as range of motion. The difficulty of the game increases with each level. Carabeo et al. [57] found that a small subset of stroke patients had improved mobility. Patients also feel that the game is effective and enjoys it. It is reported to be more attractive than standard physical therapy.

Prehab: Prehab (or rehab platform game) is a game designed for use on tablets aimed at upper arm rehabilitation through tasks such as reaching and pointing. Players enter a virtual world where they must collect coins to avoid detection by enemies and find gems to protect nature. It has several different settings, such as an underwater environment where the main character is a turtle, a forest, and a desert. Each environment was equally challenging, although all participants in the Hocine et al. [52] study preferred the underwater interface, considering it to be Easier and more adaptable for the player, it’s worth looking into further.

Stroke Rehab: The Stroke Rehab was designed by Saposnik et al. [24]. For their ongoing research, designed for patients with upper extremity fine motor weakness and/or neglect. It consists of six stages of increasing difficulty involving moving popping and stretching balloons Appear as a fixed item on the screen or move around the screen. [twenty four].

Decision Tree

Feeling a bit overwhelmed by all the information and research? We provide a decision tree to help you decide what is best for your patient

This tree strictly includes games that have reported well-studied and demonstrated improvements in their respective damages. This has no effect on the quality of games not included in the picture; the evidence was not strong enough at the time of development this wiki. Please refer to the “Games” section to make an informed decision.

The table below summarizes the resulting measures used to classify each subheading in the Decision Tree. It also outlines which outcome metrics are available for a particular game.

[24][58][13][59][60][19][61][50][56][55][62][63][64]

Conclusions

Current research shows the promise of using virtual reality as an adjunct to traditional rehabilitation for neurological patients. Consoles and tablets are commercially available, affordable and safe to use, making them a viable option for supplemental neurological rehabilitation situation. The variety of games available for different systems makes VR ideal for a plethora of neurological conditions, as it not only caters to specific parts of the body, but also appeals to audiences young and old.

Console-based rehabilitation does not seek to replace the therapist with a computer; rather, it is a useful tool that therapists can use as an adjunct to make rehabilitation engaging, thereby increasing adherence and thus improving the patient’s overall functioning result. console with Traditional therapy is an economically beneficial approach to ensure optimal recovery for neurological patients. This is especially important since neuropathology requires prolonged rehabilitation and a lot of repetition. These factors also address barriers, including Motivation is lowered by the mundane nature of the repetition.

More research is needed in the field of VR rehabilitation, as the data to date consist mainly of small sample groups and inappropriate use of outcome measures. Additional longitudinal studies with larger population samples to determine the long-term effects of VR would be beneficial About recovery. Greater use of control groups would also benefit the region, although there are ethical considerations in some cases. Additional follow-up studies will also improve the robustness of the collected data, providing clear benefits for therapists Acquired using VR during rehabilitation. More information is needed on the optimal prescription in hours per week to achieve neuroplasticity. Furthermore, there is a lack of data comparing and contrasting various commercially available systems. There are also deficiencies There is little data available specifically for people with disabilities, and few studies discuss the use of VR for people who are blind, deaf, or in wheelchairs.

The future of rehabilitation is moving towards incorporating VR into therapy. As technology continues to improve, the use of tablets in rehabilitation will increase. This would be ideal due to the portable interactive nature of these devices. Additionally, as tablets and smartphones continue to converge People around the world can essentially perform activities of daily living with a rehabilitation assistant in their pocket.

Research has examined video games as an intervention for various impairments including: balance mobility cognition and upper body function. Video game therapy is an emerging field of neurorehabilitation, with recent research demonstrating the effectiveness of gaming for upper extremity neurological disorders Recovery is promising. A systematic review and meta-analysis has shown that motor-controlled commercial video game training has a positive effect on hand and arm function in people with cerebral palsy of all ages. However, high-intensity studies of effectiveness are needed Training for patients with cerebral palsy, especially adults, using a motor-controlled commercial video game [65].