CREATION OF A POST STROKE REHABILITATION PROGRAMME FOR THE XBOX KINECT DESIGNED FOR IN HOSPITAL AND AT HOME SCENARIOS

S (BEAT BOX)
The Need
The neurological impairments that can result from a stroke include hemiparesis, coordination difficulties, apraxia and impairments in postural control. All of these, especially those affecting postural control, will have a dramatic impact on a persons balance and mobility in everyday activities. For community dwelling adults with stroke, the incidence of falls ranges from 23%-50%, immediately following discharge from rehabilitation services, this rate is much higher. As active rehabilitation programs encourage mobility, this may represent a higher risk environment when compared with a general medical ward. Moreover, restricted activity as a consequence of the patients fear of new falls will have a negative impact on the rehabilitation process. The number of hospital falls among stroke patients has been found to be a significant predictor of falls after hospital discharge, which in turn has been associated with lower activity levels, depressed mood, and pressure on caregivers. Post stroke rehabilitation helps stroke survivors to relearn skills that are lost when part of the brain is damaged e.g. these skills could include coordinating leg movements in order to walk or carrying out the steps involved in any complex activity. Rehabilitation also teaches survivors innovative ways in performing tasks to circumvent or compensate for any residual disabilities. Individuals may need to learn how to bathe and dress using only one hand, or how to communicate effectively when their ability to use language has been compromised. There is strong consensus among rehabilitation professionals that the element of carefully directed, well focused, repetitive practice is paramount in a rehabilitation programme the same kind of practice used by all people when learning new skills such a playing an instrument.

The Project
This proposal aims to develop a rehabilitation programme for the Microsoft Xbox Kinect platform which uses a combination of exercise therapy and gaming to promote physical activity also known as Exergaming. Therapeutic exergaming involves the use of exergaming technology, combined with human motion capture, as part of a prescribed rehabilitation programmed for movement impairment and disorders, sometimes also referred to as virtual rehabilitation systems. Exercise intervention is a critical component in musculoskeletal conditions with patients typically undergoing both clinical and home-based treatment. When treatment moves to the home a return to full physical function may be hampered by lack of adherence to the rehabilitation programme and/or poor performance of the exercise technique. If a patient is not executing their exercise accurately they may not gain the full benefit of the exercise. When certain complex exercises are involved, inaccuracy can potentially lead to further injury. However this programme will have the potential to provide feedback on quality of movement, allowing patients to adjust and correct their positioning and movements during the rehabilitation. Malta Industrial Innovation for SMEs UB 5B, Industrial Estate, San wann, SGN 3000, Malta, Europe. Tel: +356 21 482 144 Fax: +356 21 482 144 info@miis.com.mt www.miis.com.mt

Home based stroke rehabilitation games have the potential to help patients in recovering from a stroke. By decreasing monotony of hundreds of repeated motions and providing performance feedback, games may increase both the quality and quantity of patients home therapy. Our long term goal is to create a game authoring system in which therapists can create or customise games for use by individual patients.

The Impact - Health and social care costs

Overall, CVD is estimated to cost the EU economy 192 billion a year. Of the total cost of CVD in the EU, around 57% is due to health care costs, 21% due to productivity losses and 22% due to informal care of people with CVD. The cost of stroke to the social and healthcare system of the UK in 2006/2007 was just over 2.5 billion. Over 80% of these costs were for inpatient hospital care (1.1 billion) and residential care (nearly 900million). This reflects the debilitating impact of stroke on individuals and the long process of rehabilitation.

Health & Social Care Cost of Stroke, 2006/7, in UK

Inpatient care 44% Primary Other Care 1% 4% Residential care 36% Medications 8% Outpatient care 7%

Relatively few stroke patients who experience paralysis are able to live independently. Research shows that stroke patients tend to feel an acute sense of social isolation; some describe spending hours watching Television. The idea of creating a game/s that could incorporate roles for family members and using therapeutic games to help stroke patients connect with their families presents a strong potential motivation. Games may also help stroke patients and their caregivers feel a greater sense of connection as peers. Many stroke victims family members serve as their primary caregivers, which is by its nature a very unequal relationship: one person is dependent on the other. Perhaps rehabilitation games, in addition to motivating patients to exercise, can also provide a context in which stroke patients and caregivers collaborate as equals. It is believed that collaborative games hold more potential as stroke rehabilitation games. The combination of a readily affordable rehabilitation programme, improved rehabilitation by taking the patient out of hospitals into their familiar home settings, increasing motivation for patient, Malta Industrial Innovation for SMEs UB 5B, Industrial Estate, San wann, SGN 3000, Malta, Europe. Tel: +356 21 482 144 Fax: +356 21 482 144 info@miis.com.mt www.miis.com.mt

therapist and carer through the constant feedback of the programme, reduced need for therapist visits could potentially reduce health and social costs, reduce levels of frustration, anger and potentially lessen the chances of clinical depression and possibly improve rehabilitation rate (injury depending). The aim after all, is to use the interactive interface with audio and video feedback to enhance patients motivation, interest and most importantly perseverance to the rehabilitation programme. Therefore, we believe that games designed for rehabilitation at home have the potential to help stroke patients regain lost motion. Understanding the social context that stroke patients find themselves in, may help identify opportunities for rehabilitation games to tap into deep motivations and potentially give way to an improved quality of life and reduced rehabilitation costs. The partners of the project consortium will benefit from the: Sales of the Beat Box rehabilitation game Sales of services offered towards the developed technology (e.g. training, programming, etc.) The potential for development of further rehabilitation programmed for other neurological disorders and injuries such as Muscular Sclerosis, Aphasia, Muscular dystrophy & GuillainBarr syndrome

Contact Person

Ms. Karla M. Fabri/kfabri@miis.com.mt

Malta Industrial Innovation for SMEs UB 5B, Industrial Estate, San wann, SGN 3000, Malta, Europe. Tel: +356 21 482 144 Fax: +356 21 482 144 info@miis.com.mt www.miis.com.mt