Project Falcon: Exploring a Virtual Reality-based Video Game for Young People With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      This study seeks to 1) adapt a low-cost controller, the Novint Falcon, and a set of video
      games that would provide rehabilitative feedback for young people with cerebral palsy, and 2)
      explore feasibility of the Falcon system and it's effect on upper limb and hand function.
    

Detailed description: 
      Motivation: Children with cerebral palsy (CP) experience various challenges in upper limb
      motor function (e.g. muscle weakness, impaired manual abilities, spasticity, ataxia,
      athetosis and/or dystonia) that can impede their activities and participation in daily life.
      Rehabilitation strategies to support children with CP in achieving improved upper limb
      control target these areas through strengthening, endurance building, and motor learning
      activities. Neuroplasticity and motor learning are promoted by repetitive practice in a
      motivating and rewarding environment, immediate feedback on performance, and use of tasks
      with appropriate complexity that is increased as progress is made. Many elements of video
      games (e.g. progressive difficulty levels, engaging game play) may support motor learning and
      early evidence suggests that interactive computer play is likely effective for improving
      lower limb function with some promising indications for upper limb rehabilitation. The
      majority of evidence comes from studies that have used commercial gaming systems where
      children interact with virtual objects on the screen via their movements. These systems,
      however, do not provide haptic feedback, which may aid in motor learning and the transference
      of skills practiced in virtual environments to real-life.

      The Novint Falcon is a low-cost, three degree-of-freedom video game controller that can
      provide force and tactile feedback during game play. The three motors that enable the
      provision of haptic feedback can also be used to assist movements. A software development kit
      is available and enables custom design of games and applications. One previous study
      investigated this device in adults for stroke rehabilitation. While promising, one drawback
      identified was that the available mini-games did not practice therapeutically relevant
      movements.

      Objective: Considering the upper limb motor challenges experienced by children with CP and
      the potential of the Novint Falcon to assist in their rehabilitation, research is needed to
      develop challenging video games adapted for this controller. The objectives of this proposal
      are 1) to adapt a low-cost haptic controller and compile a set of video games that provide
      tactile and force feedback for the rehabilitation of young people with CP, and 2) to explore
      the feasibility of the system and the effects on upper limb and hand function.

      Methods: In pursuit of these two objectives:

        1. Existing mini-games will be reviewed in partnership with therapists to identify
           promising games. Thereafter, new mini-games will be designed as needed to meet with
           therapeutic goals identified by the therapists. The design of the controller's grip will
           then be reviewed via a participatory design approach that engages both therapists and
           children with CP. New grips will be created as needed.

        2. The resulting system will be evaluated in a clinic setting by children with hemiplegic
           CP (ages 7 to 16 years; n=14; 7/site) at Holland Bloorview Kids Rehabilitation Hospital
           and Institut de réadaptation en déficience physique de Québec. Each child with CP will
           take part in one initial assessment session, 12 one-hour rehabilitation sessions over 12
           weeks during which they will play games developed for the Novint Falcon, and one final
           assessment session. Independent evaluators will assess the children with CP before (two
           baseline measurements will be established) and after the 12-week intervention. The
           outcomes of interest include: Canadian Occupational Therapy Performance Measure, Quality
           of Upper Extremity Skills Test, sensory profile, grip strength, and upper extremity
           range of motion. Further, child participants will complete the Physical Activity
           Enjoyment Scale, while therapists will complete the System Usability scale.

      Expected Outcomes. The results of this study if promising, will lay the foundation for a CIHR
      grant to explore the role of haptic feedback in interactive computer play therapies. Through
      this research, the investigators hope to offer an appealing tool to aid in the rehabilitation
      of children with CP that is both therapeutically valuable and enjoyable.
    

Intervention name(s): Falcon
Intervention type(s): Device
Intervention description(s): The Falcon contains a selection of 25+ games that require wrist extension and challenges children to grasp the controller with their affected hand. As children progress, they may advance to more difficult games that challenge the child to work against a resistance and/or apply greater grip forces. Therapists will be trained on the system, games, and given a guide summarizing the available games and the motor function areas targeted in the game. Using this guide, therapists can choose the games that are most suited to the child's abilities and goals. As multiple games will target many of the same motor function areas, children will have the option of choosing the games they like best to maximize motivational value. While this introduces some variability in the intervention, this flexibility is required to ensure that the therapy is targeting the specific interests, needs and goals of each individual child and is reflective of how ICP is used in a clinic setting.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: haptic feedback; Novint Falcon; upper limb motor function; rehabilitation; motor learning; neuroplasticity; video games