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: 7996521
• 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/7996521
• 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; 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. PUBLIC HEALTH RELEVANCE: Project Narrative Shoulder dysfunction represents a prevalent and disabling condition for persons with tetraplegia that interferes with daily activities and health. Effective preventive and corrective measures will be of tremendous benefit. Although there is a growing popular literature espousing the advantages of video gaming for rehabilitation applications, there is little evidence of its effectiveness. In this pilot project, we expect to characterize physical aspects of gaming and measure preliminary outcomes of gaming as therapy. Based on the findings of this pilot, we expect to initiate a larger scale study to evaluate whether interactive gaming can be implemented as an effective therapeutic program for individuals with acute and chronic SCI. If successful, this novel therapeutic approach would have high relevance to health care needs of veterans and their families throughout their lifetime. Health maintenance and prevention of further disablement and chronic illness is a high priority for VHA.

描述（由申请人提供）： 项目摘要/摘要本项目的主要目标是实施一个程序的互动视频游戏作为一种形式的康复锻炼，并评估其潜在的积极的治疗结果在个人与脊髓损伤（SCI）。具体目标是：1）通过提供一种创新的、有趣的、以活动为基础的方案来加强急性SCI后的早期康复，这将增加患者对康复锻炼的坚持性; 2）改善上肢训练和肩部功能，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在新闻界获得了关注，并在一些临床环境中被用作各种患者人群的康复方法，但缺乏关于有效性和作用机制的临床研究。本研究提案的目的是开展两项试点研究，以填补这一知识空白。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将涉及在急性SCI后的初始康复期间，将互动游戏作为标准治疗的辅助手段的结果的初步评估。目标人群将是使用轮椅作为主要行动能力的SCI患者。这些研究将招募年龄在18 - 75岁之间的四肢瘫痪或截瘫健康志愿者，不限种族和性别。该提案包括两个部分：研究1：游戏的量化。这将是一项横断面研究，大约有30名SCI超过一年的参与者，平均分布在四肢瘫痪和截瘫之间。其目的是评估在玩互动视频游戏期间使用的肌肉、活动范围、产生的力、心率和其他可测量的动作属性。参与者将进行两次游戏，一次是建立熟悉度并根据需要进行调整，第二次是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。将分别分析损伤水平的数据（即，将分别比较高位四肢瘫、低位四肢瘫和截瘫）。研究2：疗效试验。这将是一项前瞻性研究，涉及在急性SCI后的康复期间，将互动视频游戏方案作为标准治疗性运动的补充疗法。参与者最近受伤，病情稳定，正在接受初步康复。该方案将运行六周，“在内部”进行，以便于监督。参与者将被随机分配（根据受伤程度分层）到标准治疗组或治疗加游戏组;游戏组的参与者预计每周至少玩3次游戏，每次至少30分钟。更多的游戏将被允许，并将受到监控。每个人都将作为他/她自己的控制。我们预计每组8-10人完成方案。参与者将以自选强度进行;每次会议的持续时间和会议的频率将被自动记录。所有指标将评估三次：基线时、3周时和项目完成时。将评价以下变量的变化：平衡、力量、每个关节的活动范围、协调、手和肩功能，并进行组间比较，匹配上述损伤水平。结果测量将包括身体反应和与预防性健康相关的自我护理活动的变化。互动游戏的不受欢迎程度和满意度将被确定，特别是因为它们与遵守该计划有关。长期目标（超出本研究范围）包括系统性测试（可能在多中心研究中），对各种游戏协议进行评估，以评估与损伤水平/严重程度相关的有效性，以及识别与结局相关的特征（年龄、计算机使用经验等）和增强上肢功能、持续健康维护、二次损伤预防和改善社区流动性的潜力。 公共卫生相关性： 肩关节功能障碍代表了四肢瘫痪患者的一种普遍和致残性疾病，干扰了日常活动和健康。有效的预防和纠正措施将带来巨大的好处。虽然有越来越多的流行文献支持视频游戏对康复应用的优势，但几乎没有证据表明其有效性。在这个试点项目中，我们希望描述游戏的物理方面，并测量游戏作为治疗的初步结果。基于这项试验的结果，我们希望启动一项更大规模的研究，以评估互动游戏是否可以作为一种有效的治疗方案，用于急性和慢性SCI患者。如果成功，这种新的治疗方法将与退伍军人及其家人一生的医疗保健需求高度相关。健康维护和预防进一步残疾和慢性病是VHA的高度优先事项。