Development of 3D videogame to train
the whole body coordination in
patients with TBI
Ustinova KI, Ingersoll CD, Cassavaugh ND
BACKGROUND & PURPOSE
• TBI affects the central and executive mechanisms
underlying arm and postural coordination.
• Little attention is paid to its restoration by
conventional rehabilitation
• As alternative, a customized 3D game was
developed to improve coordination in TBI patients
• Effect of a short-term gaming practice on the
arm and postural coordination of patients with
TBI was analyzed
PARTICIPANTS
• Thirteen patients with mild-to-moderate
manifestations of TBI
• Age 32±6.7 (6 males and 7 females)
• Ataxia Score according to Klockgether 5-12pts (35
severe ataxia)
• Berg Balance test 39-55pts (45 – high fall risk)
• Functional Gait Assessment Test 12-29pts (22 –
high fall risk)
• No severe visual perception deficits
• No severe cognitive deficits
GAME DESIGN
The game Octopus
•
•
•
•
Task – to pop the bubbles, with the left of right hand avatar
Bubble speed 1.5 m/s, reward – appearance of a new character
Gaming trial - 90 s, ~20-25 reach-to-pop movements
Practice consisted of 10 trials, with a 30-min interval, followed by 2
retention trials
GAME DESIGN
The bubble trajectories
3
4
5
2
1
20-25 cm
15-18 cm
• Reaching-to-pop bubble #3 with the dominant hand was
analysed
DATA COLLECTION & ANALYSIS
• Kinematic analysis included:
• Arm movement time (s)
• Arm trajectory curvature (arm trajectory
length/shortest path to the target)
• Arm-postural coordination (Principal
Component Analysis, PCA)
• Angular displacements of 9 body segments (i.e., 2
hands, 2 forearms, 2 upper arms, trunk, and 2 legs)
were included
• PCA percent variance, (PC I mainly)
• PC loading of each segment (significant if >0.7)
RESULTS
Trajectories of the arm (hand), trunk (C7), and legs (hip)
Trial 1
Trial 10
RESULTS
• As a result of short-term practice:
– Gaming task performance improved
– Arm movement time decreased
– Trajectory curvature decreased
Performance Score (pts)
30
2.5
1.8
#
24
*
*
#
2
1.2
18
12
Trajectory Curvature
Movement Time (s)
*
#
1.5
1
0.6
0.5
6
0
0
Trial 1 Trial 6 Trial 10
Ret
0
Trial 1 Trial 8 Trial 10
Ret
* difference between the first trial and the trial where significant changes occurred;
# difference between the first and the last trial;
Trial 1 Trial 8 Trial 10
Ret
RESULTS
• As a result of short-term practice:
– Inter-segmental coordination improved (PC1)
PCA Percent Variance (%)
80
#
*
60
40
20
0
Trial 1
Trial 8
Principal components:
Trial 10
pc1
Ret
pc2
* difference between the first trial and the trial where significant changes occurred;
# difference between the first and the last trial;
pc3
RESULTS
• As a result of short-term practice:
– Contribution (PC loadings) of postural segments into task
performance increased
PCs Loadings Trial 1
PCs Loadings Trial 10
0.9
0.9
*
*
0.6
0.6
*
*
0.3
0.3
0
0
ForeArm UpperArm
Trunk
DLeg
NLeg
Principal components:
* difference between the first and the last trial
ForeArm UpperArm
pc1
pc2
pc3
Trunk
DLeg
NLeg
DISCUSSION & CONCLUSION
• Upon completion ¾ of gaming tasks participants:
– Improved game performance, arm movement time and
precision
– Improved movement coordination
– Increased contribution of postural segments into movement
performance
– Improved on clinical tests: forward reach (10/13
participants), and single-leg stance time (9/13 participants)
• Changes were retained over the 30-min retention interval
• These results support the feasibility of using the custom-made
3D game for retraining of arm-postural coordination disrupted
by TBI.
ACKNOWLEDGEMENTS
• Supported by a grant from the US Department of
Defense
• Thank you to Chris Hausbeck, Jessica Gardon-Rose,
Amanda Schafer