Biofeedback-enhanced active video games to improve hand function in youth with cerebral palsy

MacIntosh, Alexander 1

1. Bloorview Research Institute

Background: Cerebral palsy (CP), affects 1 in 400 children, preventing many of them from using their hands to perform daily activities like reaching and grasping. Biofeedback training can help improve these activities. In biofeedback training, information about the person’s movement is given back to them, usually by visual, audio or haptic cues. This has the potential to enhance therapeutic value, particularly for strategies like active video games, which provide a motivational and flexible environment in which to practice. However, we do not know which combination of signals (e.g. kinematic, electromyographic (EMG)) is best to use, nor how to interpret and convey them to most benefit youth with CP. In three phases this doctoral project will answer the question: can biofeedback in active video games improve reach and grasp movements in youth with CP?

Methods: Study I. We will conduct a systematic review evaluating biofeedback interventions for people with CP. We will identify which methods have been used to present biofeedback, their associated outcomes and opportunities for future research. The review protocol has been published in Systematic Reviews. Study II. We will develop and determine the feasibility of using biological parameters as input and feedback in active video games for youth with CP. This will be completed through an iterative and participatory design process with a group of four persons with CP. We will: a) identify the features of EMG data that best characterize reach and grasp movements, b) use these features to classify gestures through a real-time active video game, and c) develop the relationship between the gestures and the forms of feedback presented in the game. Study III. The effectiveness of the biofeedback-enhanced active video game will be evaluated in a case-control, multi-centered pilot study. Ten children with CP, eight to 16 years old, at Manual Abilities Classification System levels I-III will be recruited in France and Canada. The video game therapy intervention period will be three one-hour sessions per week for three weeks, one group with and one without enhanced biofeedback. Forearm muscle activity (amplitude, timing, flexor: extensor co-contraction index) and upper extremity kinematics (joint trajectory, movement speed, movement variability) will be measured at each session. At baseline and follow-up assessments, wrist endurance, range of motion (ROM), Quality of Upper Extremity Skills Test (QUEST), and Canadian Occupational Performance Measure (COPM) will be evaluated.

Results: Studies I and II are underway and preliminary results are expected.

Significance: By advancing the efficacy of active video games with biofeedback we can offer a motivational outlet for practice that offsets the burden of intensive on-site rehabilitation.