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/摘要该项目的主要目的是实施一个互动视频游戏的程序，作为一种康复运动的一种形式，并评估其在脊髓损伤（SCI）患者（SCI）中阳性治疗结果的潜力。具体目标是1）通过提供一种创新，娱乐性，基于活动的方案来增强急性SCI的早期康复，该方案将增加患者对康复运动的依从性； 2）改善上肢调节和肩部功能，以改善和维持稳定SCI的人的身体状况，自我保健和社区参与。虽然交互式视频游戏在外行中引起了人们的关注，并且在某些临床环境中被用作康复方法，但缺乏关于有效性和作用机制的临床研究。这项研究建议的目的是进行两项旨在填补知识差距的试点研究。研究1将涉及跨多个领域的交互式游戏的物理属性的量化。研究2将涉及对互动游戏作为标准疗法的辅助性在急性SCI后初次康复期间作为标准治疗的辅助的初步评估。目标人群将是具有SCI的人，他们使用轮椅作为主要移动性。任何种族的健康志愿者，年龄在18至75岁之间的四肢瘫痪者或截瘫患者，将招募这些研究。该提案由两个组成部分组成：研究1：游戏量化。这将是一项横断面研究，大约30名SCI大于一年的参与者，分布在四肢链球运动和截瘫之间。目的是评估所用的肌肉，主动运动范围，产生的力，心率和其他可测量的属性，这些属性是交互式视频游戏过程中使用的动作。参与者将进行两次游戏会议，其中一场是建立熟悉度并根据需要进行调整，第二个用于测量与运动学，生物力学和物理方面有关的多个变量。数据将分别分析损伤水平（即，将针对高四脑，低四脑属和截瘫的比较进行比较）。研究2：治疗有效性试验。这将是一项前瞻性研究，涉及在急性SCI后康复期间添加互动视频游戏方案作为辅助治疗。参与者将最近受伤，医学稳定，并接受初步康复。该协议将运行六个星期，在“内部”进行促进监督。参与者将被随机分为标准治疗或游戏组的标准治疗或游戏组；游戏组中的那些人每周至少玩3倍，每节课至少30分钟。将允许更多游戏并将监视。每个人都将作为自己的控制。我们希望每个组中有8-10人完成协议。参与者将以自选的强度表现；每个会话的持续时间和会话频率将自动记录。所有措施将进行三次评估：基线，3周以及计划完成时。将评估以下变量的变化：平衡，强度，每个关节运动的活动范围，协调，手和肩部功能，并在各组中进行比较，如上所述匹配损伤水平。结果指标将包括身体反应和与预防健康有关的自我护理活动的变化。尤其是在与该计划遵守有关的情况下，将确定对交互式游戏的印象和满意度。除了本研究的权限之外，长期目标包括在多站点研究中进行的系统测试，以评估与损伤水平/严重程度相关的各种游戏协议，以及与结果（年龄，计算机经验等）相关的特征以及增强的上LIMB功能，增强的上肢健康维持，持续的健康维持，继发性伤害预测和改善的特征。 公共卫生相关性： 项目叙述性肩部功能障碍代表了四肢的人的普遍性和残疾状况，该病人会干扰日常活动和健康。有效的预防和纠正措施将带来巨大的好处。尽管越来越多的流行文献拥护视频游戏在康复应用中的优势，但几乎没有证据表明其有效性。在这个试点项目中，我们希望表征游戏的物理方面，并衡量游戏作为治疗的初步结果。根据该飞行员的发现，我们希望启动大规模研究，以评估是否可以针对患有急性和慢性SCI的人实施互动游戏作为有效的治疗计划。如果成功的话，这种新颖的治疗方法将与退伍军人及其家人一生的医疗保健需求具有很高的相关性。 VHA的健康维持和预防进一步的残疾和慢性病是当务之急。