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Methods Inf Med 2017; 56(02): 127-137
DOI: 10.3414/ME16-02-0015
REHAB
Schattauer GmbH

MaLT – Combined Motor and Language Therapy Tool for Brain Injury Patients Using Kinect [*]

Maitreyee Wairagkar
1   Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, UK
,
Rachel McCrindle
1   Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, UK
,
Holly Robson
2   School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
,
Lotte Meteyard
2   School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
,
Malcom Sperrin
3   Medical Physics, Royal Berkshire Hospital Reading, Reading, UK
,
Andy Smith
4   Clinical Engineering, Royal Berkshire Hospital Reading, Reading, UK
,
Moyra Pugh
5   Physiotherapy & Occupational Therapy, Royal Berkshire Hospital Reading, Reading, UK
› Author Affiliations
Funding: This work has been funded by a grant from the NIHR (National Institute for Health Research) Brain Injury Innovation Small Funding Competition administered by the Brain Injury Healthcare Technology Co-operative.
Further Information

Publication History

received: 06 March 2016

accepted: 24 February 2016

Publication Date:
25 January 2018 (online)

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Summary

Background: The functional connectivity and structural proximity of elements of the language and motor systems result in frequent co-morbidity post brain injury. Although rehabilitation services are becoming increasingly multidisciplinary and “integrated”, treatment for language and motor functions often occurs in isolation. Thus, behavioural therapies which promote neural reorganisation do not reflect the high inter-system connectivity of the neurologically intact brain. As such, there is a pressing need for rehabilitation tools which better reflect and target the impaired cognitive networks.

Objectives: The objective of this research is to develop a combined high dosage therapy tool for language and motor rehabilitation. The rehabilitation therapy tool developed, MaLT (Motor and Language Therapy), comprises a suite of computer games targeting both language and motor therapy that use the Kinect sensor as an interaction device. The games developed are intended for use in the home environment over prolonged periods of time. In order to track patients’ engagement with the games and their rehabilitation progress, the game records patient performance data for the therapist to interrogate.

Methods: MaLT incorporates Kinect-based games, a database of objects and language parameters, and a reporting tool for therapists. Games have been developed that target four major language therapy tasks involving single word comprehension, initial phoneme identification, rhyme identification and a naming task. These tasks have 8 levels each increasing in difficulty. A database of 750 objects is used to programmatically generate appropriate questions for the game, providing both targeted therapy and unique game-play every time. The design of the games has been informed by therapists and by discussions with a Public Patient Involvement (PPI) group.

Results: Pilot MaLT trials have been conducted with three stroke survivors for the duration of 6 to 8 weeks. Patients’ performance is monitored through MaLT’s reporting facility presented as graphs plotted from patient game data. Performance indicators include reaction time, accuracy, number of incorrect responses and hand use. The resultant games have also been tested by the PPI with a positive response and further suggestions for future modifications made.

Conclusion: MaLT provides a tool that innovatively combines motor and language therapy for high dosage rehabilitation in the home. It has demonstrated that motion sensor technology can be successfully combined with a language therapy task to target both upper limb and linguistic impairment in patients following brain injury. The initial studies on stroke survivors have demonstrated that the combined therapy approach is viable and the outputs of this study will inform planned larger scale future trials.

Keywords

Multidisciplinary - motor rehabilitation - language rehabilitation - stroke - brain injury - games based therapy - Kinect

* Supplementary material published on our website https://doi.org/10.3414/ME16-02-0015


 

  • References

  • 1 State of the Nation Stroke statistics – January 2016. Stroke Association; 2016
  • 2 Lawrence E, Coshall C, Dundas R, Stewart J, Rudd A, Howard R. et al. Estimates of the Prevalence of Acute Stroke Impairments and Disability in a Multiethnic Population. Stroke. 2001; 32 (06) 1279-1284.
    CrossrefPubMedSearch in Google Scholar
  • 3 Hiller SL, Sharpe MH. Outcomes 5 years post traumatic brain injury (with further reference to neurophysical impairment and disability). Brain Injury. 1997; 11 (09) 661-675.
    CrossrefPubMedSearch in Google Scholar
  • 4 Engelter S, Gostynski M, Papa S, Frei M, Born C, Ajdacic-Gross V. et al. Epidemiology of Aphasia Attributable to First Ischemic Stroke: Incidence, Severity, Fluency, Etiology, and Thrombolysis. Stroke. 2006; 37 (06) 1379-1384.
    CrossrefPubMedSearch in Google Scholar
  • 5 Gil M., Cohen M., Korn C., Grosw Z.. Vocational outcome of aphasic patients following severe traumatic brain injury. Brain Injury. 1996; 10 (01) 39-46.
    CrossrefPubMedSearch in Google Scholar
  • 6 Nichols-Larsen D, Clark P, Zeringue A, Greenspan A, Blanton S. Factors Influencing Stroke Survivors’ Quality of Life During Subacute Recovery. Stroke. 2005; 36 (07) 1480-1484.
    CrossrefPubMedSearch in Google Scholar
  • 7 Kauhanen M-L, Korpelainen J, Hiltunen P, Määttä R, Mononen H, Brusin E. et al. Aphasia, Depression, and Non-Verbal Cognitive Impairment in Ischaemic Stroke. Cerebrovasc Dis. 2000; 10 (06) 455-461.
    CrossrefPubMedSearch in Google Scholar
  • 8 Hilari K, Northcott S, Roy P, Marshall J, Wiggins RD, Chataway J. et al. Psychological distress after stroke and aphasia: the first six months. Clinical Rehabilitation. 2010; 24 (02) 181-190.
    CrossrefPubMedSearch in Google Scholar
  • 9 Picelli A, Tamburin S, Gajofatto F, Zanette G, Praitano M, Saltuari L. et al. Association between Severe Upper Limb Spasticity and Brain Lesion Location in Stroke Patients. BioMed Research International. 2014; 2014: 1-6.
    CrossrefPubMedSearch in Google Scholar
  • 10 Geva S, Baron J-C, Jones PS, Price CJ, Warburton EA. A comparison of VLSM and VBM in a cohort of patients with post-stroke aphasia. Neurolmage: Clinical. 2012; 1 (01) 37-47.
    PubMedSearch in Google Scholar
  • 11 Heinsius T, Bogousslavsky J, Van Melle G. Large infarcts in the middle cerebral artery territory: Etiology and outcome patterns. Neurology. 1998; 50 (06) 1940-1943.
    CrossrefPubMedSearch in Google Scholar
  • 12 Meister IG, Boroojerdi B, Foltys H, Sparing R, Huber W, Töpper R. Motor cortex hand area and speech: implications for the development of language. Neuropsychologia. 2003; 41 (04) 401-406.
    CrossrefPubMedSearch in Google Scholar
  • 13 Meister IG, Sparing R, Foltys H, Gebert D, Huber W, Töpper R. et al. Functional connectivity between cortical hand motor and language areas during recovery from aphasia. Journal of the Neurological Sciences. 2006; 247 (02) 165-168.
    CrossrefPubMedSearch in Google Scholar
  • 14 Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S. et al. Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 1998 Through 2002. Archives of Physical Medicine and Rehabilitation. 2005; 86 (08) 1681-1692.
    CrossrefPubMedSearch in Google Scholar
  • 15 Hinckley JJ, Craig HK. Influence of rate of treatment on the naming abilities of adults with chronic aphasia. Aphasiology. 1998; 12 (11) 989-1006.
    CrossrefPubMedSearch in Google Scholar
  • 16 Platz T, Winter T, Müller N, Pinkowski C, Eickhof C, Mauritz K-H. Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: A single-blind, randomized, controlled trial. Archives of Physical Medicine and Rehabilitation. 2001; 82 (07) 961-968.
    CrossrefPubMedSearch in Google Scholar
  • 17 Meinzer M, Breitenstein C, Westerhoff U, Sommer J, Rosser N, Rodriguez AD. et al. Motor Cortex Preactivation by Standing Facilitates Word Retrieval in Aphasia. Neurorehabilitation and Neural Repair. 2010; 25 (02) 178-187.
    PubMedSearch in Google Scholar
  • 18 Bhogal SK, Teasell R, Speechley M, Albert ML. Intensity of Aphasia Therapy, Impact on Recovery – Aphasia Therapy Works!. Stroke. 2003; 34 (04) 987-993.
    CrossrefPubMedSearch in Google Scholar
  • 19 Bowen A, Hesketh A, Patchick E, Young A, Davies L, Vail A. et al. Effectiveness of enhanced communication therapy in the first four months after stroke for aphasia and dysarthria: a randomised controlled trial. BMJ. 2012; 345: e4407.
    CrossrefPubMedSearch in Google Scholar
  • 20 Chang Y-J, Chen S-F, Huang J-D. A Kinect-based system for physical rehabilitation: A pilot study for young adults with motor disabilities. Research in Developmental Disabilities. 2011; 32 (06) 2566-2570.
    CrossrefPubMedSearch in Google Scholar
  • 21 Lange B, Chang C-Y, Suma E, Newman B, Rizzo AS, Bolas M. Development and evaluation of low cost game-based balance rehabilitation tool using the microsoft kinect sensor. In: 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2011: 1831-1834.
    PubMedSearch in Google Scholar
  • 22 Lloréns R, Albiol S, Gil-Gómez J-A, Alcañiz M, Colomer C, Noé E. Balance rehabilitation using custom-made Wii Balance Board exercises: clinical effectiveness and maintenance of gains in an acquired brain injury population. International Journal on Disability and Human Development. 2014; 13 (03) 327-332.
    PubMedSearch in Google Scholar
  • 23 Simmons S, Mccrindle R, Sperrin M, Smith A. Prescription Software for Recovery and Rehabilitation Using Microsoft Kinect. In: Proceedings of the 7th International Conference on Pervasive Computing Technologies for Healthcare. 2013: 323-326.
    PubMedSearch in Google Scholar
  • 24 Microsoft Windows Text-to-Speech for Unity. Assistant to the Lounge-About [Internet]. Chadweisshaar.com.c2015 [cited 2016 July 18]. Available from: http://www.chadweisshaar.com/blog/2015/07/02/microsoft-speech-for-unity/.
    PubMed
  • 25 Greenwood A, Grassly J, Hickin J, Best W. Phonological and orthographic cueing therapy: A case of generalised improvement. Aphasiology. 2010; 24 (09) 991-1016.
    CrossrefPubMedSearch in Google Scholar
  • 26 Lohse K, Shirzad N, Verster A, Hodges N, Van Der Loos HF. Video Games and Rehabilitation. Journal of Neurologic Physical Therapy. 2013; 37 (04) 166-175.
    CrossrefPubMedSearch in Google Scholar
  • 27 Curtis L. Unit Costs of Health and Social Care 2011.. Kent: Personal Social Services Research Unit; 2011
  • 28 Broeren J, Bellner AL, Fogelberg M, Goransson O, Goude D, Johansson B. et al. Exploration of computer games in rehabilitation for brain damage. The 7th International Conference on Disability. Virtual Reality and Associated Technologies with ArtAbilitation; 2008: 75-80.
    Search in Google Scholar
  • 29 Chang YJ, Chen SF, Huang JD. A Kinect-based system for physical rehabilitation: A pilot study for young adults with motor disabilities. Res Dev Disabil. 2011; 32 (06) 2566-2570.
    CrossrefPubMedSearch in Google Scholar
  • 30 Ferreira C, Guimarães V, Santos A, Sousa I. Gamification of Stroke Rehabilitation Exercises Using a Smartphone. In: Proceedings of the 8th International Conference on Pervasive Computing Technologies for Healthcare. 2014: 282-285.
    PubMedSearch in Google Scholar
  • 31 Charles D, McDonough S. A participatory design framework for the gamification of rehabilitation systems. Proceedings of the 10th International Conference on Disability. Virtual Reality & Associated Technologies; 2014: 293-296.
    Search in Google Scholar
  • 32 González-González C, Toledo-Delgado P, Collazos-Ordoñez C, González-Sánchez JL. Design and analysis of collaborative interactions in social educational videogames. Computers in Human Behaviour. 2014; 31: 602-611.
    CrossrefPubMedSearch in Google Scholar