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ARRoW-CP: Virtual walking rehabilitation for children with cerebral palsy. Game design framework and Preliminary results.

Abstract : Introduction. Serious games (SG) combined with virtual or augmented reality technologies are used to improve gait parameters for children with cerebral palsy (CP)1,2 We have developed a SG using the Microsoft Hololens augmented reality headset called ARRoW-CP, which integrates motor learning theories3 and audio-visual feedback4 to perform a 4-week intensive overground gait training (OGT) for children with CP. Methods. This work followed the development framework PROGame5 within a multidisciplinary team. Regular user tests with therapists and patients were conducted to be as close as possible to their needs. Key steps of the project included: 1. A validity study of the algorithm measuring spatiotemporal gait parameters with the AR headset6 2. An experimental study to determine the best combination of feedback modalities to achieve maximum walking speed (WS)7 3. A randomized control trial (in progress) including children with CP. They participate in a four-week OGT with ARRoW-CP vs. treadmill training.8,9 Outcomes are the 6-minutes-walk test and the Muscle-Power-Sprint-Test, which assess functional capacity and anaerobic performance. Results. First qualitative results (N=5) show a significant improvement for 6MWT and MPST. Enjoyment and motivation are higher in the ARRoW-CP group. Children present a linear progression in WS between each session and weeks. Discussion and Conclusion. ARRoW-CP combines multiple ingredients of motor learning theories3: context focused therapy, goal-directed training,10 task-specific, variable practice, high intensity, feedback during therapy sessions and motivation of the patient.11 Preliminary results are very positive, we plan to include 40 patients to test our rehabilitation programme and the benefits of our SG. 1. Lopes S, Magalhães P, Pereira A, et al. Games Used With Serious Purposes: A Systematic Review of Interventions in Patients With Cerebral Palsy. Frontiers in Psychology. 2018;9(1712). doi:10.3389/fpsyg.2018.01712 2. Cho C, Hwang W, Hwang S, Chung Y. Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy. The Tohoku Journal of Experimental Medicine. 2016;238(3):213-218. doi:10.1620/tjem.238.213 3. Demers M, Fung K, Subramanian S, Lemay M, Robert M. Do virtual interventions in individuals with cerebral palsy make use of motor learning principles?: A systematic review (Preprint). JMIR Serious Games. Published online August 25, 2020. doi:10.2196/23822 4. Sigrist R, Rauter G, Riener R, Wolf P. Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review. Psychon Bull Rev. 2013;20(1):21-53. doi:10.3758/s13423-012-0333-8 5. Amengual Alcover E, Jaume-i-Capó A, Moyà-Alcover B. PROGame: A process framework for serious game development for motor rehabilitation therapy. Martinuzzi A, ed. PLOS ONE. 2018;13(5):e0197383. doi:10.1371/journal.pone.0197383 6. Guinet A-L, Bouyer G, Otmane S, Desailly E. Validity of Hololens Augmented Reality Head Mounted Display for Measuring Gait Parameters in Healthy Adults and Children With Cerebral Palsy. Sensors (Basel, Switzerland). 2021;21:2697. doi:10.3390/s21082697 7. Guinet AL, Biddiss E, Khan A, et al. Towards an AR game for walking rehabilitation: Preliminary study of the impact of augmented feedback modalities on walking speed. IEEE International Symposium on Mixed and Augmented Reality (ISMAR-Adjunct). Published online 2020. 8. Zwinkels M, Verschuren O, de Groot JF, et al. Effects of High-Intensity Interval Training on Fitness and Health in Youth With Physical Disabilities: Pediatric Physical Therapy. 2019;31(1):84-93. doi:10.1097/PEP.0000000000000560 9. Grecco LAC, de Freitas TB, Satie J, Bagne E, Oliveira CS, de Souza DR. Treadmill training following orthopedic surgery in lower limbs of children with cerebral palsy. Pediatr Phys Ther. 2013;25(2):187-192; discussion 193. doi:10.1097/PEP.0b013e3182888495 10. Novak I, Morgan C, Fahey M, et al. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020;20(2):3. doi:10.1007/s11910-020-1022-z 11. Cano-de-la-Cuerda R, Molero-Sánchez A, Carratalá-Tejada M, et al. Theories and control models and motor learning: Clinical applications in neurorehabilitation. Neurología (English Edition). 2015;30(1):32-41. doi:10.1016/j.nrleng.2011.12.012
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Submitted on : Thursday, September 2, 2021 - 11:16:10 AM
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Anne-Laure Guinet, Guillaume Bouyer, Samir Otmane, Eric Desailly. ARRoW-CP: Virtual walking rehabilitation for children with cerebral palsy. Game design framework and Preliminary results.. RehabWeek Virtual 2021, Sep 2021, Virtual Conference, France. ⟨hal-03331864⟩

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