Goblin Post office
In Partnership with
- Liverpool John Moores University, Liverpool, UK
- The Movement Centre, Oswestry, UK
- Alder Hey Children's Hospital, Liverpool, UK
- The WellChild Trust
Introduction
Good posture and movement of the core of the body is a pre-condition of moving the legs and arms efficiently when performing activities of daily living. Cerebral palsy develops as a result of a brain damage around birth in about 1 in every 400 babies leading to primary problems including weakness, reduced selective motor control and spasticity. Many children with this condition receive physiotherapy treatment in order to improve control of their trunk and pelvis (core) but there is a lack of agreement on how core control can be measured and improved best.
Goal
The aim of this study was to test if custom made CAREN games can improve core control and consequentially the quality of walking, and if this technique is more beneficial than conventional physiotherapy.
The games were expected to make core control automatic following training.
In addition to improved control of force generation, the muscles moving the core develop strength while balance reactions improve.
Repeated practice and direct feedback of pelvic and trunk motion through motivating games lead to an enjoyable experience to children with measurable improvements of movement function.
Outcome measures of the study involved three dimensional movements of the pelvis and trunk, full clinical gait analyses, and scores of clinical functional assessments.
Population
Children with Cerebral Palsy diplegia
Game play
The CAREN application lets children ride a flying dragon through an endless cave while collecting floating bonus envelopes on their way. Navigation of the dragon is done by pelvic and trunk motions.
Unique opportunities
Baseline results derived from the first occasion when a group of children with cerebral palsy played the GPO game, showed reduced control of tilt in comparison to rotation and cephalo-caudal reduction of control.
A case study of one child demonstrated that control was translated from the trunk to the pelvis through tighter coupling when comparing the interaction between the pelvis and trunk before and after games training. The tighter coupling of the pelvis to the trunk may be regarded as a strategy to make use of the trunk’s better control at the pelvic level.
Using game speed as a measure of movement control, we found that the trunk is better controlled than the pelvis, rotation has a more unambiguous mapping than tilt, and single plane movements are easier to perform than cross-plane combinations of rotation and tilt.
Continued work is expected to lead to clinical implementation and commercial application making core control training available for children with movement disorders even at home.
Publications
- Dutch Game Awards – Oscars Game Industrie – Uitgereikt
- Remarkable researcher is rewarded with national WellChild Award
- Verslag uitreiking Dutch Game Awards 2009
- Barton GJ, Holmes G, Hawken M, Lees A, Vanrenterghem J (2006) A virtual reality tool for training and testing core stability: a pilot study. Abstract / Gait and Posture, 24/Suppl. 2: S101-S102. 1st Joint ESMAC – GCMAS Meeting, Amsterdam, The Netherlands, 28-30 Sept. Winner of the Best Poster Prize.
- Barton GJ (2008) Improving core control of children with cerebral palsy using virtual reality games. 1st Conference of the Institute for Health Research, Liverpool John Moores University. 9 May. Winner of Best combined Oral and Poster Prize.
- Hawkins PJR, Hawken MB, Barton GJ (2008) Effect of game speed and surface perturbations on postural control in a virtual environment. Proceedings of the 7th ICDVRAT with ArtAbilitation, Maia, Portugal.
- Hawkins P, Hawken MB, Barton GJ (2008) The effect of game speed on performance in a virtual environment. Abstract / Gait and Posture, 28S: S70-S71. 17th ESMAC Meeting and Conference, Antalya, Turkey, 11-13 Sept.
- Foster RJ, Hawken MB, Barton GJ (2008) Movement co-ordination of the pelvis in a virtual game environment. Abstract / Gait and Posture, 28S: S10-S11. 17th ESMAC Meeting and Conference, Antalya, Turkey, 11-13 Sept.
- Barton GJ (2009) Virtual rehabilitation in cerebral palsy. Abstract / Journal of Sports Sciences, 27S1: S3. The Ergonomics Society: 6th International Conference on Sport, Leisure and Ergonomics. 16th Nov. 2007.
- Foster R, Bass A, Holmes G, Hawken M, Barton GJ (2009). Integration of a portable controller into virtual reality based core training for implementation in clinical practice. 2nd Conference of the Institute for Health Research, Liverpool John Moores University. 15th May. Runner up for Best Poster Prize.
- Barton GJ, Hawken MB, Butler P, Holmes G, Foster RJ (2009) Movement control of the trunk and pelvis in cerebral palsy diplegia. Abstract / Gait and Posture, 30 (S1):147-8. 18th ESMAC Meeting and Conference, London, UK, 15-19 Sept.
- Foster RF, Hawken MB, Butler P, Holmes G, Barton GJ (2010) The effects of game training on trunk to pelvis coupling: A case study of a child with Cerebral Palsy. BASES Biomechanics Interest Group Meeting, Bath, 21 April.
- Barton GJ (2010). Virtual rehabilitation – a focus on movement function. Biomechanica Hungarica. 2/2: 7-14.
- Barton GJ, Hawken MB, Butler P, Holmes G, Foster RJ (2010) Movement control of the trunk and pelvis in cerebral palsy diplegia. 3rd Conference of the Institute for Health Research, Liverpool John Moores University. 21st May. Runner up for Best Poster Prize and winner of Special Prize for External Collaboration.
- Barton GJ, Hawken MB, Foster RJ, Holmes G, Butler PB (2011) Playing the Goblin Post Office game improves movement control of the core: A case study. International Conference on Virtual Rehabilitation, Zurich Switzerland, 27-29 June.
Magician's apprentice
In Partnership with:
- University of North Texas Health Science Center
Introduction
Patients walk on an instrumented treadmill and explore a virtual environment consisting of multiple rooms and corridors separated by different types of doors. They have to perform specific arm movements in order to open the doors and proceed through the doorway. The challenge is to train both balance and walking impairments simultaneously with arm function in a functional task.
Goal
To study motor learning and recovery in a dynamic condition, such as walking, opening a door, and proceeding through the doorway and to investigate how balance control constraints influence the re-learning of upper-extremity movements. Subjects explore a virtual environment by walking on a treadmill and opening multiple types of doors. This is a first feasibility study in a series of experiments in which we plan to investigate the use of complex virtual environments to simultaneously train walking and arm function.
Population
The initial study is intended for stroke patients with hemiparesis. However, the task of walking, opening a door and proceeding through a doorway is something of interest for any patient that has both balance and upper extremity impairments. We would like the application to be extendable to other patient populations and not targeted for one type of patient in particular.
Game play
The virtual environment represents the interior of a building with corridors and rooms separated with doors that open either with a “simple reach”, “reach and pull” or “reach and push” movement of the arm. Sliding doors, revolving doors and usual hinge doors with different types of handles in three different sizes, large, medium and small are included and separated by a 10 m distance one from another. The location of door handles can be adjusted (left/ right and up/down) in a manner that requires each individual patient to use the involved upper limb with specified joint kinematics in order to open the doors. The ground surface of the corridors can be set up to be either flat or with a positive or negative slope and this can be synchronized with treadmill motion. In this environment, subjects view an avatar or a computer representation of their own arm interacting with the environment in a first person view. Extrinsic feedback (knowledge of results) is delivered in the form of a sound when the reach is both as fast and as accurate as specified, and the door opens. Knowledge of performance feedback about the quality of the upper limb movement patterns is delivered as an annoying sound when compensatory movements occur during reach.
Unique opportunities
- Controlled environment training for walk and reach
- Objectively monitor reaching
- Encouraging
- Scalable gait training with reaching as double task
Virtual mirror box
In Partnership with
- Liverpool John Moores University, Liverpool, UK
Introduction
Improvement of movement function in amputees, stroke and cerebral palsy has been reported following treatment with a mirror box which shows a reflection of the intact limb in place of the affected limb. Physical mirrors however are only capable of showing parallel movement of limbs in real time.
Goal
Our aim was to overcome these limitations by developing a Virtual Mirror Box which delays the mirrored image of limbs during gait.
Population
Amputees, stroke, cerebral palsy
Unique opportunities
Delayed mirroring of the arm or leg of one side resulted in a close match between the mirrored and the true limb. Asymmetry between the right and left gait cycles of patients causes a temporal discrepancy between initial contacts of the virtual and true limb but temporal morphing of the gait cycle can correct for this effect, enabling unconstrained virtual mirror therapy.
Back to topPhD Project on Balance Stability
In Partnership with
- Free University Amsterdam
- Military Rehabilitation Center Doorn
Introduction
Motek Medical is working on a PhD project with the faculty of movement science at the Free University in Amsterdam and the Military Rehabilitation Center Doorn.
Goal
The goal of the project is to create a protocol to assess gait and balance stability. The research looks at how visual and mechanical disturbances affect stability.
Population
The target group of this research consists of healthy subjects, stroke patients, amputees and orthopaedic patients.
Back to topNeuroSIPE program
Introduction
Motek Medical is partner in the NeuroSIPE program: System Identification and Parameter Estimation of Neurophysiological Systems. The goal is to develop diagnostic instruments to assess neurological conditions. The project is largely funded by the Dutch government and the Technology Foundation (STW). Motek Medical is partner for three projects.
BALROOM
This is a project that is being carried out with the Technical University of Twente. The goal is to develop a Balance test Room (BALROOM) that quantifies balance deficits, unravels the underlying pathophysiological mechanisms and predicts the risk of falling.
QDISC
Together with the faculty of movement science at the Free University in Amsterdam we will develop methods to quantitatively assess neuromuscular control of trunk muscles in LBP patients. Furthermore, we will study proprioceptive loss, pain sensitization and painrelated fear as determinants of motor control changes in LBP.
TORTICOLLIS
This is a joint project with the Technical University Delft. The goal of the project is to develop new test methods and neuromuscular identification methods to capture 3D neck stabilization, in order to diagnose and improve treatment for torticollis patients. A 6DOF motion platform will be used to apply trunk loading with subjects restrained to a rigid seat and a head loading device allowing bi-directional dynamic loading will be developed.
Back to topMOVE-AGE
In Partnership with
- Free University Amsterdam
- KU Leuven
- Manchester Metropolitan University
Introduction
Motek Medical is the associate partner in the Joint doctorate program 'MOVE-AGE', funded by the European Commission as part of the Erasmus Mundus program. In the MOVE-AGE program approximately 50 PhD students will receive a fellowship to study how mobility can be maintained during ageing. Loss of mobility with ageing is a vast and rapidly growing social and economic problem worldwide.
Back to top
