Use of Interactive Gaming for Enhanced Function after Spinal Cord Injury

使用互动游戏增强脊髓损伤后的功能

• 批准号: 8181327
• 负责人: Beatrice Jenny Kiratli
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8181327
• 关键词: Acute; Address; Adherence; Age; Age-Years; Area; Articular Range of Motion; Attention; Biomechanics; Cardiovascular system; Characteristics; Chronic; Chronic Disease; Clinical; Clinical Research; Communities; Community Participation; Computers; Continuity of Patient Care; Cross-Sectional Studies; Data; Educational Background; Effectiveness; Elements; Environment; Equilibrium; Ethnic Origin; Evaluation; Exercise; Familiarity; Family; Frequencies; Functional disorder; Gender; Goals; Golf; Habilitation; Habits; Hand; Health; Healthcare; Heart Rate; Home environment; Hospitals; Housing; Individual; Injury; Inpatients; Instruction; Internet; Intervention Studies; Intervention Trial; Joints; Knowledge; Laboratories; Life; Literature; Maintenance; Manual wheelchair; Marketing; Matched Group; Measurable; Measurement; Measures; Methods; Mind; Modeling; Monitor; Motivation; Movement; Muscle; Musculoskeletal; Occupational Therapist; Outcome; Outcome Measure; Paraplegia; Participant; Patients; Performance; Persons; Physical therapy exercises; Physicians; Pilot Projects; Play; Population; Prevention; Preventive; Problem Solving; Procedures; Process; Prospective Studies; Protocols documentation; Quadriplegia; Randomized; Reaction Time; Recruitment Activity; Regimen; Rehabilitation therapy; Relative (related person); Research; Research Design; Research Proposals; Risk; Running; Safety; Self Care; Self Management; Severities; Shoulder; Site; Socialization; Speed; Spinal cord injury; Sports; Stratification; Supervision; System; Target Populations; Technology; Tennis; Testing; Therapeutic; Therapeutic Effect; Therapeutic exercise; Time; Translating; Upper Extremity; Veterans; Video Games; Vocabulary; Wheelchairs; Work; abstracting; auditory feedback; base; compliance behavior; conditioning; design; disability; effectiveness trial; experience; eye hand coordination; fitness; flexibility; functional gain; functional outcomes; healthy volunteer; impression; improved; injured; injury prevention; innovation; interest; kinematics; novel therapeutic intervention; patient population; preference; primary outcome; programs; protocol development; response; satisfaction; social; therapeutic effectiveness; traditional therapy; treatment effect; trend; virtual; visual feedback

DESCRIPTION (provided by applicant): Project Summary/Abstract The primary objective of this project is to implement a program of interactive video gaming as a form of rehabilitation exercise and to evaluate its potential for positive therapeutic outcomes in individuals with spinal cord injury (SCI). The specific goals are to 1) enhance early rehabilitation post acute SCI by providing an innovative, fun, activity-based regimen that will increase patients' adherence to their rehabilitation exercises and to 2) improve upper extremity conditioning and shoulder function in order to improve and maintain physical status, self-care activities, and community participation for persons with stable SCI. While interactive video gaming has gained attention in the lay-press and is being used as a rehabilitation approach in some clinical settings with a variety of patient populations, there is an absence of clinical research regarding effectiveness and mechanisms of action. The purpose of this research proposal is to conduct two pilot studies designed to fill this gap in knowledge. Study 1 will involve a quantification of physical attributes of interactive gaming across multiple domains. Study 2 will involve a preliminary evaluation of the outcomes of interactive gaming as an adjunct to standard therapy during initial rehabilitation following an acute SCI. The target population will be persons with SCI who use a wheelchair as primary mobility. Healthy volunteers with tetraplegia or paraplegia, between 18 and 75 years of age, of any ethnicity and both genders will be recruited for these studies. The proposal consists of two components: Study 1: Quantification of Play. This will be a cross-sectional study with approximately 30 participants with SCI of greater than one year, evenly distributed between tetraplegia and paraplegia. The purpose will be to evaluate muscles used, active range of motion, forces generated, heart rate, and other measurable attributes of the actions used during interactive video gaming play. Participants will perform two sessions of gaming, one to establish familiarity and make adjustments as needed and the second for measurement of multiple variables related to kinematic, biomechanical, and physical aspects of gaming. Data will be analyzed separately for injury level (ie, comparisons will be made separately for high tetraplegia, low tetraplegia, and paraplegia). Study 2: Therapeutic Effectiveness Trial. This will be a prospective study involving the addition of an interactive video gaming regimen as adjunctive therapy to standard therapeutic exercise during rehabilitation following an acute SCI. Participants will be recently injured, medically stable, and undergoing initial rehabilitation. The protocol will run for six weeks, conducted "in house" to facilitate supervision. Participants will be randomized (with stratification for level of injury) into standard therapy or therapy plus gaming groups; those in the gaming group will be expected to play at least 3x per week, at least 30 minutes per session. More play will be allowed and will be monitored. Each person will serve as his/her own control. We expect 8-10 persons in each group to complete the protocol. Participants will perform at self-selected intensity; duration of each session and frequency of sessions will be automatically recorded. All measures will be assessed three times: at baseline, at 3 weeks, and at completion of the program. Changes in the following variables will be evaluated: balance, strength, active range of movement per joint, coordination, hand and shoulder function, and compared across groups, matching for injury level as described above. Outcome measures will include physical responses and changes in self care activities related to preventive health. Impressions of and satisfaction with interactive gaming will be determined especially as they relate to adherence with the program. Long term objectives, beyond the purview of this study, include systematic testing, likely in a multi-site study, of various gaming protocols to evaluate effectiveness related to level/severity of injury as well as identification of characteristics associated with outcomes (age, computer experience, etc) and potential for enhanced upper limb function, ongoing health maintenance, secondary injury prevention, and improved community mobility.

描述（由申请人提供）： 项目摘要/摘要 该项目的主要目标是实施交互式视频游戏计划作为康复锻炼的一种形式，并评估其对脊髓损伤 (SCI) 患者产生积极治疗结果的潜力。具体目标是 1) 通过提供创新、有趣、以活动为基础的治疗方案来加强急性 SCI 后的早期康复，提高患者对康复锻炼的依从性；2) 改善上肢调理和肩部功能，以改善和维持稳定 SCI 患者的身体状况、自我护理活动和社区参与。虽然交互式视频游戏已经引起了大众的关注，并且在一些临床环境中被用作针对各种患者群体的康复方法，但缺乏关于有效性和作用机制的临床研究。本研究计划的目的是进行两项试点研究，旨在填补这一知识空白。研究 1 将涉及跨多个领域的互动游戏的物理属性的量化。研究 2 将初步评估互动游戏作为急性 SCI 后初始康复期间标准治疗的辅助手段的结果。目标人群是使用轮椅作为主要活动方式的 SCI 患者。这些研究将招募年龄在 18 岁至 75 岁之间、不限种族、不限性别、患有四肢瘫痪或截瘫的健康志愿者。该提案由两个部分组成： 研究 1：游戏的量化。这将是一项横断面研究，约有 30 名 SCI 时间超过一年的参与者，均匀分布在四肢瘫痪和截瘫之间。目的是评估互动视频游戏过程中使用的肌肉、主动运​​动范围、产生的力、心率以及其他可测量的动作属性。参与者将进行两场游戏，一场是为了建立熟悉度并根据需要进行调整，第二场是为了测量与游戏的运动学、生物力学和物理方面相关的多个变量。将分别分析损伤程度的数据（即，将分别对高位四肢瘫痪、低位四肢瘫痪和截瘫进行比较）。研究 2：治疗效果试验。这将是一项前瞻性研究，涉及在急性 SCI 后康复期间添加交互式视频游戏疗法作为标准治疗运动的辅助疗法。参与者最近受伤，病情稳定，正在接受初步康复治疗。该协议将运行六周，在“内部”进行，以促进监督。参与者将被随机分为标准治疗组或治疗加游戏组（按受伤程度分层）；游戏组的参与者每周至少玩 3 次，每次至少 30 分钟。更多的比赛将被允许并受到监控。每个人都将作为他/她自己的控制者。我们预计每组有 8-10 人完成该协议。参与者将以自行选择的强度进行表演；每次会话的持续时间和会话频率将自动记录。所有措施将评估三次：基线时、三周时和计划完成时。将评估以下变量的变化：平衡、力量、每个关节的主动运动范围、协调性、手和肩部功能，并进行组间比较、如上所述的损伤水平匹配。结果测量将包括与预防性健康相关的身体反应和自我护理活动的变化。对互动游戏的印象和满意度将被确定，特别是因为它们与对计划的遵守有关。超出本研究范围的长期目标包括系统测试（可能在多地点研究中）对各种游戏协议进行系统测试，以评估与伤害水平/严重程度相关的有效性，以及识别与结果（年龄、计算机经验等）相关的特征以及增强上肢功能、持续健康维护、二次伤害预防和改善社区流动性的潜力。