Making rehabilitation affordable and fun

We have all been there, at the gym trying to accomplish something. We go there to achieve a better life quality, to lose weight, to get stronger, but the recipe is always the same: we have to do many reps of the same exercise over and over. It can become quite boring, right?

Imagine now you have to go through a long-term rehabilitation program, having to commit to do long and repetitive sets of exercises to simply recover the ability to perform daily tasks again. Holding a book, opening a door, closing a shirt button, opening a food can, all these tasks can be incorporated into a new rehabilitation therapeutic program that has been developed by U of M student Cynthia Swarnalatha Srikesavan, under supervision of Dr. Tony Szturm and Dr. Barbara Shay, from the dept. of physical therapy at the school of medical rehabilitation.

Their research involves developing a computer game based tele-rehabilitation therapeutic platform for long-term monitoring and management of people affected with rheumatoid arthritis and osteoarthritis of the hands. Srikesavan’s thesis project is focused on developing a home-based task oriented training program coupled with computer gaming for people with arthritis.

“It is a very simple computer game, that can be used to assist the hand function. For example, you can analyze the performance when you manipulate an object. Manipulation of objects are usually very difficult for people with arthritis,” says Srikesavan.

According to her, exercises are usually given to patients, but there are no studies that can prove that these exercises are indeed improving the hand’s movement. Also, another limitation is that there are no exercises to be done at home.

“People have to be able to do things like open a door, button up a shirt and all of this is very difficult for people with arthritis. So we started thinking: why not improve these things? Why not use these activities as exercises for rehabilitation?”

Srikesavan and her colleagues have adopted a function-based approach. It means that people can be repetitively trained to perform a specific task. The concept, then, is that patients can perform the same task intensively, until improving it. To achieve results that could easily be translated to the patient’s daily life, Srikesavan defined several categories of objects. They were assembled based on daily life activities, using objects that are difficult to handle, objects that require a full grip, fine coordination, or perhaps a bent wrist in order to manipulate them.

The team put together an assessment of people with arthritis, asking them “What is the most difficult task for you to do on your daily life? ” And most of the participants responded: holding something or fine tasks.

“By selecting objects that are suitable for those tasks, we started training people intensively by making them play games instead of asking them to perform certain exercises many times during the day,” said Srikesavan. “If you do the same thing every day, it becomes [quite] boring! By manipulating the objects, they are able to play games that require them to perform certain motions – for example, up and down, circular movements, opening and closing, etc.”

The key to this study was the integration of computer games with objects available in anyone’s routine. By using an attachable motion sensor mouse, Srikesavan and the other researchers are able to use many common objects (cans, mugs, books, balls, water bottles, etc.); it acts like a sensor, as it does not need a surface to work, when people move it, the computer will capture the signal.

Excited about the prospects of her work, Srikesavan states: “Patients can play the games from home. We have a platform set, where patients can use the ‘prescribed’ games at any time, without limitations. They only need a computer, without any special specification, and the mouse – which has been provided by us to all patients participating in the study.”

Dr. Szturm also spoke with the Gradzette to provide a summary of their work and explain how such research could potentially help those with more financial concerns.

“In today’s society [ . . . ] there is no question that rehabilitation one-to-one works really, really well,” said Szturm. “However, a lot a people don’t have access to that, and most insurance companies will pay for 10 visits and that’s it. What we are trying to do is to increase the access and improve the quality of rehabilitation.”

Besides the game-based therapy, the group has been developing tools to quantitatively assess the level of the hand function. Currently, this assessment is done by timing how long it takes for someone to do a simple task. Even the definition of the degree of the limitation is based on a questionnaire containing patients’ answers about what they feel and how hard specific tasks are.

“In order to make the rehabilitation more accessible, we are trying to make it possible to be done at home,” said Szturm. “However, the clinician has to be able to monitor you, [they have] to able to evaluate you, to support you, to write you a feedback. The way to do that? Computerizing it. Today we have computers, we have the Internet. That’s the way to do that.”

The Canadian Institutes of Health Research (CIHR) has already seen the potential of their study and their hand exercise-related research has been selected and published as one of the Research Success stories in the CIHR Institute of Musculoskeletal Health and Arthritis (IMHA) document titled, “Celebrating the Impact of Health Research: Success stories in arthritis, bone, muscle, musculoskeletal rehabilitation, oral health, and skin.”

This article was originally published in the Gradzette.