Archives of Physical Medicine and Rehabilitation
Volume 91, Issue 1 , Pages 1-8.e1, January 2010

In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy

Presented to the Virtual Rehabilitation International Conference, August 25–27, 2008, Vancouver, Canada, and the Virtual Rehabilitation International Conference, June 29–July 2, 2009, Tel Aviv, Israel.

  • Meredith R. Golomb, MD, MSc

      Affiliations

    • Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, IN
    • Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
    • Corresponding Author InformationReprint requests to Meredith R. Golomb, MD, MSc, Indiana University School of Medicine, Building XE, Room 040, 575 West Dr, Indianapolis, IN 46202
    • ,
  • Brenna C. McDonald, PsyD

      Affiliations

    • Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
    • Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
    • ,
  • Stuart J. Warden, PT, PhD

      Affiliations

    • Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN
    • ,
  • Janell Yonkman, MS, OTR

      Affiliations

    • Department of Occupational Therapy, Indiana University School of Medicine, Indianapolis, IN
    • ,
  • Andrew J. Saykin, PsyD

      Affiliations

    • Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
    • Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
    • ,
  • Bridget Shirley, OTR

      Affiliations

    • Department of Occupational Therapy, Indiana University School of Medicine, Indianapolis, IN
    • ,
  • Meghan Huber, BS

      Affiliations

    • Department of Electrical and Computer Engineering, Rutgers University, Piscataway, NJ
    • Department of Biomedical Engineering, Rutgers University, Piscataway, NJ
    • ,
  • Bryan Rabin, BS

      Affiliations

    • Department of Electrical and Computer Engineering, Rutgers University, Piscataway, NJ
    • Department of Biomedical Engineering, Rutgers University, Piscataway, NJ
    • ,
  • Moustafa AbdelBaky, BS

      Affiliations

    • Department of Electrical and Computer Engineering, Rutgers University, Piscataway, NJ
    • Department of Biomedical Engineering, Rutgers University, Piscataway, NJ
    • ,
  • Michelle E. Nwosu, MBBS

      Affiliations

    • Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, IN
    • Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
    • ,
  • Monica Barkat-Masih, MBBS, MD

      Affiliations

    • Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, IN
    • Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
    • ,
  • Grigore C. Burdea, PhD

      Affiliations

    • Department of Electrical and Computer Engineering, Rutgers University, Piscataway, NJ
    • Department of Biomedical Engineering, Rutgers University, Piscataway, NJ

Abstract 

Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy.

Objective

To investigate whether in-home remotely monitored virtual reality videogame-based telerehabilitation in adolescents with hemiplegic cerebral palsy can improve hand function and forearm bone health, and demonstrate alterations in motor circuitry activation.

Design

A 3-month proof-of-concept pilot study.

Setting

Virtual reality videogame-based rehabilitation systems were installed in the homes of 3 participants and networked via secure Internet connections to the collaborating engineering school and children's hospital.

Participants

Adolescents (N=3) with severe hemiplegic cerebral palsy.

Intervention

Participants were asked to exercise the plegic hand 30 minutes a day, 5 days a week using a sensor glove fitted to the plegic hand and attached to a remotely monitored videogame console installed in their home. Games were custom developed, focused on finger movement, and included a screen avatar of the hand.

Main Outcome Measures

Standardized occupational therapy assessments, remote assessment of finger range of motion (ROM) based on sensor glove readings, assessment of plegic forearm bone health with dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), and functional magnetic resonance imaging (fMRI) of hand grip task.

Results

All 3 adolescents showed improved function of the plegic hand on occupational therapy testing, including increased ability to lift objects, and improved finger ROM based on remote measurements. The 2 adolescents who were most compliant showed improvements in radial bone mineral content and area in the plegic arm. For all 3 adolescents, fMRI during grip task contrasting the plegic and nonplegic hand showed expanded spatial extent of activation at posttreatment relative to baseline in brain motor circuitry (eg, primary motor cortex and cerebellum).

Conclusions

Use of remotely monitored virtual reality videogame telerehabilitation appears to produce improved hand function and forearm bone health (as measured by DXA and pQCT) in adolescents with chronic disability who practice regularly. Improved hand function appears to be reflected in functional brain changes.

Key Words: Cerebral palsy, Child, Fiber optic technology, Hand, Hemiplegia, Internet, Perinatal care, Rehabilitation, Stroke, Video games

List of Abbreviations: BMC, bone mineral content, CIMT, constraint-induced movement therapy, DXA, dual-energy x-ray absorptiometry, FA, flip angle, fMRI, functional magnetic resonance imaging, FOV, field of view, LSC, least significant change, MP-RAGE, magnetization prepared rapid acquisition gradient echo, MRI, magnetic resonance imaging, fMRI, functional magnetic resonance imaging, NEX, number of excitations, pQCT, peripheral quantitative computed tomography, ROM, range of motion, TE, echo time, TMS, transcranial magnetic stimulation, TR, repetition time, VR, virtual reality

 

 Supported by the National Institutes of Health (National Institute of Neurological Disorders and Stroke grant no. K23 NS048024); the Clarian Values Fund (grant no. VFR-171); the Center of Excellence in Neuroimaging; and the Indiana Economic Development Corporation (grant no. 87884).

 A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on the author or one or more of the authors. Golomb and Burdea have filed a patent application on principles incorporated in this system.

PII: S0003-9993(09)00817-X

doi:10.1016/j.apmr.2009.08.153

Archives of Physical Medicine and Rehabilitation
Volume 91, Issue 1 , Pages 1-8.e1, January 2010

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