Serious Games in Physical Rehabilitation: From Theory to Practice

154 Pages·2018·3.017 MB·English

by  Bruno Bonnechère (auth.)

Serious Games
in Physical
Rehabilitation
From Theory to Practice
Bruno Bonnechère
123
Serious Games in Physical Rehabilitation
Bruno Bonnechère
Serious Games in Physical
Rehabilitation
From Theory to Practice
Bruno Bonnechère
Laboratory of Anatomy
Biomechanics and Organogenesis
Université Libre de Bruxelles
Brussels, Belgium
Department of Electronic and Informatics - ETRO
Vrije Universiteit Brussel, Brussels, Belgium imec
Leuven, Belgium
ISBN 978-3-319-66121-6 ISBN 978-3-319-66122-3 (eBook)
https://doi.org/10.1007/978-3-319-66122-3
Library of Congress Control Number: 2017956924
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Preface
At first sight, for an uninformed reader, the title of this book must seem a bit unusual.
Actually, there may be a double astonishment.
The first one is this term serious attached to game: how can games be serious
since they are associated, for most people, with pleasure and fun? This first point is
nevertheless not too difficult to clarify since lots of games are serious (e.g., chess,
Go) and/or used to develop skills (e.g., management, reflection).
Actually, the title of this book should have been the use of serious video games
in physical rehabilitation. Indeed, in the last sixty years, video games have been
developed and are becoming every day more and more popular within the popula-
tion. While traditional games are accepted by most people and recognized as benefi-
cial the use of video games is more problematic. The most frequent criticisms about
video games are that they would be responsible for an increase in violence, decrease
in social contacts, and would turn the players more sedentary.
This leads to the second contradiction of the title of this book: video games and
physical therapy. Should not rehabilitation medicine be something serious and not
something fun?
The aim of this book is therefore to demonstrate that video games can indeed be
serious and used, successfully, in rehabilitation.
The transition of gaming consoles from the living room to the hospital and the
clinic is not that obvious and is far away from the classical development of medical
devices.
The typical stages of development and integration of new medical devices are
request from the clinics (need), team of researchers (engineers, doctors, etc.) work-
ing on a prototype, and then several interactions between clinics and the research to
get the final product. This is the classic translation between research and clinics.
Whether or not this product needs to be validated before being used in clinics is
debatable for medical devices whereas the questions about efficacy, effectiveness,
and safety are, naturally, not an option for drugs.
The integration of serious games within the rehabilitation is totally different: the
products have been designed and developed for fun and entertainment and then
some clinicians seeing a possible clinical interest tried to use the games with their
patients. It is only later on that researchers and developers have had interest for this
field and tried to develop specific games for rehabilitation, first based on existing
gaming device and then by developing specific devices too.
v
vi Preface
Both development of new medical devices and rehabilitation medicine being
highly multidisciplinary, this book has thus to be as broad and comprehensive as
possible.
In order to understand how video games could be used in clinics, it is important
to have a clear view of the current available technologies and what are the next
expected improvements.
As serious as they can be, serious games are still games, we will see how the
traditional games have been developed since ages and can be used for rehabilitation,
and then of course the rise of video games for entertainment and then in the health-
care domain.
The most important part of this book is the discussion about the clinical efficacy
and safety of such kind of new intervention for various pathologies and how to inte-
grate serious games within the conventional rehabilitation.
More than ever, in the global context of reducing healthcare costs, medical
devices must be validated in clinics in order to have a chance to be reimbursed;
therefore well-designed and controlled randomized clinical trial should be con-
ducted in this field, and an example is provided in this book.
Some people often forget that the last step of the translational process between
research and patient is…business! Therefore in the last part of this book we will
present some business aspects focusing on innovation and novelty, the two key ele-
ments to develop a sustainable business.
Brussels, Belgium Bruno Bonnechère
Contents
1 The Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 The Computers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 The Graphical (R)evolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 The Three-Dimensional Environment . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.4 T he Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.5 T he Commercial Video Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5.1 From Games to Sciences? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5.2 Nintendo Wii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.5.3 Sony PlayStation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.5.4 Microsoft Xbox Kinect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.5.5 Other Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2 Physical Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.1 Definition and Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.1.1 A Multidisciplinary Teamwork . . . . . . . . . . . . . . . . . . . . . . . . 12
2.1.2 The Neuromusculoskeletal System . . . . . . . . . . . . . . . . . . . . . 14
2.1.3 Treatment and Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.2 Obstacles to Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.2.1 Severity of the Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.2.2 Motivational Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2.3 Financial Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2.4 Access to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2.5 Lack of Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.3 Telemedicine and E-Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3 T he (Serious) Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.1 T he Games in the Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.1.1 Traditional Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.1.2 Video Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.2 G ames in Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.3 T he Serious Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.3.1 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.3.2 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
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3.3.3 Principles of Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.3.4 Field of Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4 Serious Games in Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
4.1 General Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
4.1.1 A New Trend? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
4.1.2 Commercial or Specific Games? . . . . . . . . . . . . . . . . . . . . . . 42
4.1.3 For Which Patients? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
4.1.4 Number of Session? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.2 Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.2.1 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.2.2 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4.2.3 Use of Serious Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4.3 Obesity and Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.3.1 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.3.2 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.3.3 Use of Serious Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
4.4 Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.4.1 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.4.2 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.4.3 Use of Serious Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
4.5 Balance Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
4.5.1 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
4.5.2 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
4.5.3 Use of Serious Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
4.6 Cerebral Palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.6.1 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.6.2 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.6.3 Use of Serious Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
4.7 Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.7.1 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.7.2 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.7.3 Use of Serious Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.8 Orthopedic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.8.1 Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.8.2 Prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
4.9 Other Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.9.1 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.9.2 Fibromyalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
4.9.3 Systemic Lupus Erythematosus . . . . . . . . . . . . . . . . . . . . . . . 93
4.9.4 Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.9.5 Down Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Contents ix
4.9.6 Mild Cognitive Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.9.7 Alzheimer’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.9.8 Pulmonary Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.9.9 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.9.10 Urinary Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.9.11 Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
5 Clinical and Practical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5.1 Body and Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5.1.1 History and Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5.1.2 Current Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
5.1.3 Physical Rehabilitation Using the Brain . . . . . . . . . . . . . . . . 112
5.1.4 Effect on Physical Activity on the Brain . . . . . . . . . . . . . . . . 113
5.2 Integration of Serious Games in the Conventional
Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
5.2.1 Early Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
5.2.2 During the Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
5.2.3 After the Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
6 The Need of Clinical Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
6.2 Designs of RCTs to Validate the use of Serious Games . . . . . . . . . . 120
6.2.1 Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
6.2.2 Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
6.2.3 Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
6.2.4 Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
6.2.5 Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
6.2.6 Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
6.2.7 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
6.2.8 Continuous Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
6.2.9 Statistical Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
6.3 D iscussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
7 I n the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
7.1 Problems to Solve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
7.1.1 Technological Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
7.1.2 Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
7.1.3 People’s Mind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
7.1.4 Financial Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7.2 A Lucrative Market? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7.2.1 Targeted Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7.2.2 The Current Companies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
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7.3 New Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
7.3.1 Functional Evaluation During Rehabilitation . . . . . . . . . . . . 140
7.3.2 Telemonitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
7.3.3 Evaluation of Clinical Trial . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.3.4 Haptic and Robotic Devices . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.3.5 Orthosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
7.3.6 Virtual Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
7.3.7 Machine Learning and Artificial Intelligence . . . . . . . . . . . . 143
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145