Motion-Specific Toy Controllers for Upper Extremity Rehabilitation in Children

描述（由申请人提供）：脑瘫 (CP) 是一种神经运动障碍，由一组非进行性儿童临床综合征组成，其特征是运动功能障碍，大约每 500 名儿童中就有一人受到影响。物理治疗、职业治疗、支具、矫形器、电刺激、药物和手术是目前用于改善偏瘫性脑瘫的力量和关节活动范围、预防挛缩和增强功能的主要治疗形式。最近使用约束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。约束诱导运动治疗的一个挑战是，这种强化治疗干预需要塑造孩子的“好”肢体。机器人治疗仅限于机构环境中使用。该研究描述于 该提案将开发和评估一种游戏控制器，鼓励使用受影响的肌肉，以促进超出目前可用疗法所能实现的功能恢复。我们的方法利用了儿童的主要学习途径——游戏。该提案的前提是玩具和电脑游戏将鼓励延长使用受损肢体。我们的第一个具体目标是通过与标准光学动作捕捉措施进行比较，优化和验证用于遥控 (RC) 玩具和电脑游戏的治疗游戏控制器的设计。我们的设计要求包括：对市售玩具和电脑游戏的远程控制、目标相对关节运动的感测、感测关节运动的可配置范围和增益设置以及游戏期间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（遥控玩具和电脑游戏）展示游戏控制器的功效和可用性。这一目标将在受控诊所环境和为期 1 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测量并进行分析，以证明有效性和可用性。我们的第三个具体目标是获得经过验证的 Play Controller 临床和生活质量测量，为我们的临床试验提供动力。除了我们手部功能、力量的临床结果测量之外， 痉挛和语气，我们将包括评估身体影响和心理社会功能的生活质量 (QOL) 指标。在现有疗法的基础上，同时解决其成本、可及性和动机的局限性，我们方法的意义在于需要对有缺陷的儿童进行扩展的神经肌肉治疗。该项目开发的技术的潜在好处可适用于任何年龄和各种四肢神经运动障碍的患者。 R21 提案在开发游戏驱动治疗设备的方法上具有高度创新性，该设备结合了有针对性的关节运动、集中练习疗法、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.