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

  • Image Result

    Coronal MP-RAGE images demonstrating degree of structural abnormality. (A) Subject 1. (B) Subject 2. (C) Subject 3. Subjects 1 and 3 both had perinatal strokes in the left middle cerebral artery terri

    Coronal MP-RAGE images demonstrating degree of structural abnormality. (A) Subject 1. (B) Subject 2. (C) Subject 3. Subjects 1 and 3 both had perinatal strokes in the left middle cerebral artery territory. Subject 2 had a left intraventricular hemorrhage due to prematurity and has atrophy of the left hemisphere.

  • Image Result
    Subject 2 practices in her bedroom. Note the 5DT sensor glove on her plegic right hand (small arrow) and the avatar on the video screen (large arrow).

    Subject 2 practices in her bedroom. Note the 5DT sensor glove on her plegic right hand (small arrow) and the avatar on the video screen (large arrow).

  • Image Result
    Increased ROM in the thumb and forefinger during the study. A session was defined as logging on, playing some games, and logging off. Subjects sometimes did more than one session a day if they signed

    Increased ROM in the thumb and forefinger during the study. A session was defined as logging on, playing some games, and logging off. Subjects sometimes did more than one session a day if they signed off for snacks or phone breaks, or if they experienced technical problems. All 3 patients showed improved ROM in the thumb and forefinger except subject 2 in the forefinger; we suspect this was due to glove malfunction rather than lack of true improvement because she and her mother reported improvement in function, and the occupational therapists noticed improved quality of hand movement (which could not be quantitated on the measures we used). The x axis varies among subjects because they varied in how many sessions they did; improvement is graphed by session. (A) Subject 1: thumb bending over 3 months (B) Subject 1: forefinger bending over 3 months (C) Subject 2: thumb bending over 3 months (D) Subject 2: forefinger bending over 3 months (E) Subject 3: thumb bending over 3 months (F) Subject 3: forefinger bending over 3 months.

  • Image Result
    fMRI preintervention and postintervention, hand grip task. Note the increase in activation in all 3 subjects. Superior (first 2 columns) and posterior (second 2 columns) views are shown for all 3 subj

    fMRI preintervention and postintervention, hand grip task. Note the increase in activation in all 3 subjects. Superior (first 2 columns) and posterior (second 2 columns) views are shown for all 3 subjects so that both cortical motor areas and cerebellum can be visualized.

 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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