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Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance

View Article: PubMed Central - PubMed

ABSTRACT

Background: It is important to monitor how patients with juvenile and adolescent idiopathic scoliosis comply with their physiotherapeutic scoliosis-specific exercises (PSSE). Physiogame, a newly developed video game using the Game-Trak 3D interactive game controller, combines correct PSSE performance with gaming. It tracks the position of the working limb in 3D space during the exercises as participants aim to hit certain targets and avoid others, and gives direct feedback by stopping the game if the working limb leaves the target 3D space, which is chosen to secure the corrective position according to the Schroth method. Physiogame records the quality and frequency of the exercises performed. We aimed to investigate the influence of this tool on motivation to perform regularly and, correctly, and with self-assessment of performance quality.

Methods: This case series included 8 consecutive patients with idiopathic scoliosis (thoracolumbar 7, lumbar 1), ages 7-13 years, all female and treated according to SOSORT guidelines; the COBB angle of primary curve at the start of brace therapy was 22-34°. In addition to Full Time Rigid Bracing (FTRB, Cheneau) and PSSE (Schroth), the participants were to perform two standardized Schroth exercises (muscle cylinder in standing position, mainly addressing the thoracic curve, and in side-lying position, mainly addressing the lumbar curve) with video game assistance every day for 6 months. The development (first to last month) of the following parameters was analyzed with descriptive methods: the actual training time to assess motivation, the ratio of the actual playing time versus total playing time to assess exercise improvement, and self-assessment of quality of performance.

Results: The average number of sessions with Physiogame was 217 per study participant (range 24 to 572, the study protocol targeted at least 180); actual training time decreased from 79 to 52 min (first to last month). Actual playing time increased from 73% of the total playing time to 83% (first to last month), and positive hits per second from 0.33 to 0.56. Self-assessment increased from “good” to “very good”. The curve angles (°Cobb) were maintained over the study period (upper thoracic mean -1.3°, median -1°; lower thoracic mean 3°, median 2°; lumbar mean 0.5, median 0).

Conclusions: The improvement we saw in exercise performance, is thought to result primarily from the direct given feedback during the game, as the exercises themselves were already familiar to the patients. The synchronous recording of actual training time allows evaluation of Schroth therapy for idiopathic scoliosis, since both prescribed training time and actual training time are captured. No comparable tool was found in literature.

Electronic supplementary material: The online version of this article (doi:10.1186/s13013-016-0104-9) contains supplementary material, which is available to authorized users.

No MeSH data available.


Physiogame, three different game environments
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Fig3: Physiogame, three different game environments

Mentions: The Physiogame software was specifically designed for use with these two standardized exercises. It uses the hardware of the Game-Trak 3D interactive game controller (In2Games Ltd, Rickmansworth, UK), a 3-dimensional game control system based on position tracking. This hardware was selected on the basis of its use in several commercial applications of video games. The Game-Trak comprises a base unit connected to a personal computer and two cuffs to track the exact position of two points at one time. One is placed on the extremity in training (wrist for the “muscle cylinder in standing position” or ankle for the “muscle cylinder in side-lying position”); the other sensor is placed on the trunk (attached to the bra or a girdle) to monitor the stabilization of the spinal column in the muscle cylinder in standing position (for the muscle cylinder in side-lying position the second sensor is on stand-by, as the patient’s trunk is stable, positioned side-lying on the floor). Three different game environments are offered: “catching flowers”, “prick balloons with a needle” and “landing the helicopter” (Fig. 3). In each game there are positive targets to hit and negative targets to avoid. At the same time the working limb should not leave a predefined 3-dimensional space in order to retain the corrective posture during the exercise. The 3D space is adjusted individually for each patient to assure correct positioning during the game. The selection of the working limb depends on the Schroth curve type. The duration of one game can be adjusted to different levels of difficulty (i.e. by adjusting the duration to patient’s level of muscle endurance to maintain the corrective posture). The game stops the time count if the extremity leaves the predefined space. This results in a gross or total playing time and a net or actual playing time during which the working limb is inside the 3D target space (actual training time). As soon as one level has been completed, a game report appears with the duration of the game, score, positive and negative target hits, positive targets hit per second as well as a query concerning self-assessment: “today I did well” (range 1 = excellent to 5 = poor), “today I managed to stabilize my vertebral column” (range 1-5), and “I want to play again/quit playing” as the last question (Additional file 1).Fig. 3


Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance
Physiogame, three different game environments
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5121954&req=5

Fig3: Physiogame, three different game environments
Mentions: The Physiogame software was specifically designed for use with these two standardized exercises. It uses the hardware of the Game-Trak 3D interactive game controller (In2Games Ltd, Rickmansworth, UK), a 3-dimensional game control system based on position tracking. This hardware was selected on the basis of its use in several commercial applications of video games. The Game-Trak comprises a base unit connected to a personal computer and two cuffs to track the exact position of two points at one time. One is placed on the extremity in training (wrist for the “muscle cylinder in standing position” or ankle for the “muscle cylinder in side-lying position”); the other sensor is placed on the trunk (attached to the bra or a girdle) to monitor the stabilization of the spinal column in the muscle cylinder in standing position (for the muscle cylinder in side-lying position the second sensor is on stand-by, as the patient’s trunk is stable, positioned side-lying on the floor). Three different game environments are offered: “catching flowers”, “prick balloons with a needle” and “landing the helicopter” (Fig. 3). In each game there are positive targets to hit and negative targets to avoid. At the same time the working limb should not leave a predefined 3-dimensional space in order to retain the corrective posture during the exercise. The 3D space is adjusted individually for each patient to assure correct positioning during the game. The selection of the working limb depends on the Schroth curve type. The duration of one game can be adjusted to different levels of difficulty (i.e. by adjusting the duration to patient’s level of muscle endurance to maintain the corrective posture). The game stops the time count if the extremity leaves the predefined space. This results in a gross or total playing time and a net or actual playing time during which the working limb is inside the 3D target space (actual training time). As soon as one level has been completed, a game report appears with the duration of the game, score, positive and negative target hits, positive targets hit per second as well as a query concerning self-assessment: “today I did well” (range 1 = excellent to 5 = poor), “today I managed to stabilize my vertebral column” (range 1-5), and “I want to play again/quit playing” as the last question (Additional file 1).Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: It is important to monitor how patients with juvenile and adolescent idiopathic scoliosis comply with their physiotherapeutic scoliosis-specific exercises (PSSE). Physiogame, a newly developed video game using the Game-Trak 3D interactive game controller, combines correct PSSE performance with gaming. It tracks the position of the working limb in 3D space during the exercises as participants aim to hit certain targets and avoid others, and gives direct feedback by stopping the game if the working limb leaves the target 3D space, which is chosen to secure the corrective position according to the Schroth method. Physiogame records the quality and frequency of the exercises performed. We aimed to investigate the influence of this tool on motivation to perform regularly and, correctly, and with self-assessment of performance quality.

Methods: This case series included 8 consecutive patients with idiopathic scoliosis (thoracolumbar 7, lumbar 1), ages 7-13 years, all female and treated according to SOSORT guidelines; the COBB angle of primary curve at the start of brace therapy was 22-34°. In addition to Full Time Rigid Bracing (FTRB, Cheneau) and PSSE (Schroth), the participants were to perform two standardized Schroth exercises (muscle cylinder in standing position, mainly addressing the thoracic curve, and in side-lying position, mainly addressing the lumbar curve) with video game assistance every day for 6 months. The development (first to last month) of the following parameters was analyzed with descriptive methods: the actual training time to assess motivation, the ratio of the actual playing time versus total playing time to assess exercise improvement, and self-assessment of quality of performance.

Results: The average number of sessions with Physiogame was 217 per study participant (range 24 to 572, the study protocol targeted at least 180); actual training time decreased from 79 to 52 min (first to last month). Actual playing time increased from 73% of the total playing time to 83% (first to last month), and positive hits per second from 0.33 to 0.56. Self-assessment increased from “good” to “very good”. The curve angles (°Cobb) were maintained over the study period (upper thoracic mean -1.3°, median -1°; lower thoracic mean 3°, median 2°; lumbar mean 0.5, median 0).

Conclusions: The improvement we saw in exercise performance, is thought to result primarily from the direct given feedback during the game, as the exercises themselves were already familiar to the patients. The synchronous recording of actual training time allows evaluation of Schroth therapy for idiopathic scoliosis, since both prescribed training time and actual training time are captured. No comparable tool was found in literature.

Electronic supplementary material: The online version of this article (doi:10.1186/s13013-016-0104-9) contains supplementary material, which is available to authorized users.

No MeSH data available.