Motion-Specific Toy Controllers for Upper Extremity Rehabilitation in Children

描述(申请人提供)：脑性瘫痪(CP)是一种神经运动障碍，由一组以运动功能障碍为特征的儿童非进行性临床综合征组成，大约每500名儿童中就有一名儿童受到影响。物理疗法、作业疗法、支具、矫形术、电刺激、药物和手术是目前用于改善力量和关节活动范围、防止痉挛和增加功能的偏瘫脑瘫的主要治疗形式。最近使用强制诱导运动疗法和机器人疗法的研究表明，增加对残疾肌肉的熟练使用可能会促进功能恢复。强制诱导运动疗法的一个挑战是，这种密集的治疗干预需要给孩子铸造“好”的肢体。机器人疗法在机构环境中的使用受到限制。中描述的研究 该提案将开发和评估一种游戏控制器，该控制器鼓励使用受影响的肌肉，以促进功能恢复，而不是目前可用的治疗方法所能达到的效果。我们的方法充分利用了儿童的主要学习途径--游戏。这项建议的前提是，玩具和电脑游戏将鼓励延长对受损肢体的使用。我们的第一个具体目标是优化和验证遥控器(RC)玩具和电脑游戏的治疗性游戏控制器的设计，通过与标准的光学运动捕捉措施进行比较。我们的设计要求包括：遥控市面上出售的玩具和电脑游戏，感知目标的相对关节运动，感知关节运动的可配置范围和增益设置，以及游戏过程中关节运动的数据记录。我们的第二个具体目标是使用两个平台(RC玩具和电脑游戏)来演示Play控制器的有效性和可用性。这一目标将在受控临床环境和为期一周的家庭试点研究中实现。将在会议期间收集联合运动和游戏措施，并进行分析，以证明有效性和可用性。我们的第三个具体目标是获得Play控制器的经过验证的临床和生活质量测量，为我们的临床试验提供动力。除了我们的手部功能、力量、 对于痉挛和语调，我们将包括评估身体影响和心理社会功能的生活质量(QOL)测量。建立在现有疗法的基础上，同时解决其成本、可获得性和动机的限制，我们方法的重要意义是需要对有障碍的儿童进行扩展的神经肌肉治疗。在该项目中开发的技术的潜在好处可以翻译给任何年龄和各种肢体神经运动障碍的患者。这项R21提案在开发一种以游戏为动机的治疗设备方面具有很高的创新性，该设备结合了有针对性的关节运动、集体练习治疗、活动记录、现有玩具和电脑游戏以及成本效益。

DESCRIPTION (provided by applicant): Cerebral palsy (CP) is a neuromotor impairment comprised of a group of non-progressive clinical syndromes of children that are characterized by motor dysfunction and affects approximately one out of every 500 children. Physical therapy, occupational therapy, braces, orthotics, electrical stimulation, medications and surgery are the current major forms of treatment used to improve strength and joint range of motion, prevent contractures and increase function for hemiplegic cerebral palsy. Recent studies using constraint induced movement therapy and robotic therapy suggest that increased skilled use of disabled muscles may promote functional restoration. A challenge with constraint induced movement therapy is that this intensive therapeutic intervention requires casting a child's "good" limb. Robotic therapy is restricted in its use to institutional settings. The research described in this proposal will develop and evaluate a play controller that encourages the use of affected muscles in order to facilitate functional recovery beyond what can be achieved by currently available therapies. Our approach capitalizes upon a primary learning avenue for children - play. The premise of this proposal is that toy and computer game play will encourage extended use of the impaired limb. Our first specific aim is to optimize and validate the design of a therapeutic play controller for remote controlled (RC) toys and for computer games by comparison with standard optical motion capture measures. Our design requirements include: remote control of commercially available toys and computer games, sensing of targeted relative joint motion, configurable range and gain setting for sensed joint motion, and data recording of joint motion during play. Our second specific aim is to demonstrate the efficacy and usability of the Play Controller using two platforms (RC toys and computer games). This aim will be accomplished in a controlled clinic setting and in a 1-week home pilot study. Joint motion and play measures will be collected during the sessions and analyzed to demonstrate efficacy and usability. Our third specific aim is to acquire validated clinical and quality of life measures of the Play Controller t power our clinical trials. In addition to our clinical outcome measures of hand function, strength, spasticity and tone, we will include quality of life (QOL) measures assessing physical impact and psychosocial functioning. Building upon established therapies while addressing the limitations of their cost, accessibility, and motivation, the significance of our approach is the need for extended neuromuscular therapy in children with impairments. The potential benefits of the technologies developed within this project are translatable to patients of any age and a wide range of extremity neuromotor impairments. This R21 proposal is highly innovative in its approach to develop a play-motivated therapeutic device that incorporates targeted joint motion, massed-practice therapy, activity logging, existing toys and computer games, and cost-effectiveness.