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      Perception of Game-Based Rehabilitation in Upper Limb Prosthetic Training: Survey of Users and Researchers

      research-article
      , MSc 1 , , , PhD 1 , , PhD 2 , , PhD 2
      (Reviewer), (Reviewer)
      JMIR Serious Games
      JMIR Publications
      upper limb, rehabilitation, arm prosthesis, serious games, engagement, transfer

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          Abstract

          Background

          Serious games have been investigated for their use in multiple forms of rehabilitation for decades. The rising trend to use games for physical fitness in more recent years has also provided more options and garnered more interest for their use in physical rehabilitation and motor learning. In this study, we report the results of an opinion survey of serious games in upper limb prosthetic training.

          Objective

          This study investigates and contrasts the expectations and preferences for game-based prosthetic rehabilitation of people with limb difference and researchers.

          Methods

          Both participant groups answered open and closed questions as well as a questionnaire to assess their user types. The distribution of the user types was compared with a Pearson chi-square test against a sample population. The data were analyzed using the thematic framework method; answers fell within the themes of usability, training, and game design. Researchers shared their views on current challenges and what could be done to tackle these.

          Results

          A total of 14 people with limb difference and 12 researchers participated in this survey. The open questions resulted in an overview of the different views on prosthetic training games between the groups. The user types of people with limb difference and researchers were both significantly different from the sample population, with χ 2 5=12.3 and χ 2 5=26.5, respectively.

          Conclusions

          We found that the respondents not only showed a general willingness and tentative optimism toward the topic but also acknowledged hurdles limiting the adoption of these games by both clinics and users. The results indicate a noteworthy difference between researchers and people with limb difference in their game preferences, which could lead to design choices that do not represent the target audience. Furthermore, focus on long-term in-home experiments is expected to shed more light on the validity of games in upper limb prosthetic rehabilitation.

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          Most cited references41

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          Qualitative research in health care. Analysing qualitative data.

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            Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning.

            Effective motor performance is important for surviving and thriving, and skilled movement is critical in many activities. Much theorizing over the past few decades has focused on how certain practice conditions affect the processing of task-related information to affect learning. Yet, existing theoretical perspectives do not accommodate significant recent lines of evidence demonstrating motivational and attentional effects on performance and learning. These include research on (a) conditions that enhance expectancies for future performance, (b) variables that influence learners' autonomy, and (c) an external focus of attention on the intended movement effect. We propose the OPTIMAL (Optimizing Performance through Intrinsic Motivation and Attention for Learning) theory of motor learning. We suggest that motivational and attentional factors contribute to performance and learning by strengthening the coupling of goals to actions. We provide explanations for the performance and learning advantages of these variables on psychological and neuroscientific grounds. We describe a plausible mechanism for expectancy effects rooted in responses of dopamine to the anticipation of positive experience and temporally associated with skill practice. Learner autonomy acts perhaps largely through an enhanced expectancy pathway. Furthermore, we consider the influence of an external focus for the establishment of efficient functional connections across brain networks that subserve skilled movement. We speculate that enhanced expectancies and an external focus propel performers' cognitive and motor systems in productive "forward" directions and prevent "backsliding" into self- and non-task focused states. Expected success presumably breeds further success and helps consolidate memories. We discuss practical implications and future research directions.
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              Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle.

              Hemiparesis resulting in functional limitation of an upper extremity is common among stroke survivors. Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for stroke rehabilitation. In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or "Jenga") among those receiving standard rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at 4 weeks after intervention. Overall, 22 of 110 (20%) of screened patients were randomized. The mean age (range) was 61.3 (41 to 83) years. Two participants dropped out after a training session. The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm. The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group (P=0.75). There were no serious adverse events in any group. Relative to the recreational therapy group, participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds (Wolf Motor Function Test, 7.4 seconds; 95% CI, -14.5, -0.2) after adjustment for age, baseline functional status (Wolf Motor Function Test), and stroke severity. VRWii gaming technology represents a safe, feasible, and potentially effective alternative to facilitate rehabilitation therapy and promote motor recovery after stroke.
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                Author and article information

                Contributors
                Journal
                JMIR Serious Games
                JMIR Serious Games
                JSG
                JMIR Serious Games
                JMIR Publications (Toronto, Canada )
                2291-9279
                Jan-Mar 2021
                1 February 2021
                : 9
                : 1
                : e23710
                Affiliations
                [1 ] Intelligent Sensing Laboratory School of Engineering Newcastle University Newcastle upon Tyne United Kingdom
                [2 ] Edinburgh Neuroprosthetics Laboratory School of Informatics University of Edinburgh Edinburgh United Kingdom
                Author notes
                Corresponding Author: Christian Alexander Garske c.a.garske2@ 123456ncl.ac.uk
                Author information
                https://orcid.org/0000-0001-6311-2681
                https://orcid.org/0000-0002-8707-0137
                https://orcid.org/0000-0003-0332-3764
                https://orcid.org/0000-0003-4217-0254
                Article
                v9i1e23710
                10.2196/23710
                7884217
                33522975
                5ee881e2-76ac-4053-8348-4826b9cca2b6
                ©Christian Alexander Garske, Matthew Dyson, Sigrid Dupan, Kianoush Nazarpour. Originally published in JMIR Serious Games (http://games.jmir.org), 01.02.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included.

                History
                : 21 August 2020
                : 3 November 2020
                : 17 November 2020
                : 26 November 2020
                Categories
                Original Paper
                Original Paper

                upper limb,rehabilitation,arm prosthesis,serious games,engagement,transfer

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