When we think about children with
disabilities we easily imagine doctors, nurses and physiotherapists as part of their
team of caregivers, but how about engineers and videogame designers? At Holland
Bloorview Kids Rehabilitation Hospital in Toronto it seems engineers are a bit like magical
fairies creating possibilities for kids to overcome barriers to do things we
take for granted. They design devices that help disabled kids communicate or do cartwheels and they
design videogames that make physiotherapy fun.
One research group calls
themselves the Possibility Engineering and Research Lab, PEARL for short. Dr.
Elaine Biddiss, an engineer who leads the team says, “what we’re trying to do
is create the technology to allow kids to do what kids want to do in the most
enjoyable and engaging fashion.” Many of the PEARL team’s projects are in virtual
reality therapy, developing and adapting videogames for children with cerebral
palsy (CP) and other disabilities, so kids can enjoy their exercises and
accomplish more.
Kids don’t see the long term
benefits of things like homework and practising their reading, especially if it’s
difficult and there are other fun things they’d rather be doing. The same can
be said for kids and their physiotherapy and the prescribed exercises often don’t
get practised enough at home. At Holland Bloorview, kids can be prescribed
videogames to play.
“It takes a lot of practise to
improve, so the videogames provide the structure and the opportunity to do a
lot of repetitive movement, which could be boring just on their own, but with
the variety provided by the virtual world that the kids are navigating, and
rewards that they’re getting, and the stories that they’re following”, explains
Dr. Biddiss.
One of the challenges in kids
with CP is getting them to extend their wrist. Dr. Biddiss describes how they’ve
seen videogames working, “if you ask a child to extend their wrist as far as
possible, they’ll do that, and then when they’re playing the game and they want
to get that extra point or make it to the next level they can actually extend
their wrist even more than that maximum level which is really interesting.” While
in the game the child might be in a bike race, extending their wrist to jump
over obstacles or driving a helicopter and picking up people and squirting
water on fires.
CP is caused by damage to the developing
brain sometime either before, during or shortly after birth that disrupts the
communication between the brain and the muscles in the body. The good news is
that with practise the brain can reorganize its connections to improve control
of movement. A common problem that kids with CP have is that their muscles are
too tight. It’s really important for kids with CP to exercise their affected
limbs, not only because it will help with movement, balance and using their hands
for everyday things; but if they don’t exercise the affected limbs, they can
become so fixed in the flexed position that surgery might be needed.
Dr. Biddiss’s team adapts
videogames to kids with CP so that they have therapeutic value. “So the games
that we develop are always working towards extension of the body, so extension
of the shoulder, the elbow, the wrist, the fingers where possible and so it’s
really in the design of the activity where the therapeutic benefit comes”, explains
Biddiss. The PEARL team takes controllers and mainstream videogames and creates
middleware that allows the controller to communicate with the videogame in a
way that serves the therapy’s purpose. They also modify controllers so the
child can manipulate it and add supports where needed.
The team uses the body tracking
sensor Microsoft Kinect used by Xbox to monitor the child’s movement. In this
way a game can reward the child for using the limb that needs therapy, which is
particularly important in hemiplegic cases where CP affects only one side of
the body.
Since Kinect is not as good at
picking up fine motor movements, kids interact with real life objects for some
therapies. Dr. Biddis explains, “for the finer motor movements that are
associated with the hand and being able to manipulate and handle objects we
want the kids interacting with the real life objects because that’s what they
will be doing in real life. We call that mixed reality when we are using real
life objects to interact with the virtual world.” The PEARL team has a videogame
where the kids handle musical instruments like maracas or tambourines and there
are computer algorithms that can tell which instrument is being used and who is
playing those instruments.
It’s not easy developing virtual
reality therapies that engage the kids for the length of time needed to see
results. Biddiss explained that on the one hand commercial games that are
attractive to kids are not necessarily targeting the right movements. On the
other hand games designed for therapy purposes, on much lower budgets, may not
engage the kids as well and keep them playing. “So that is one thing we are
really trying to work on with the games we’re developing. That is including
many of the elements of mainstream videogaming; stories, myths and long term
progression, things that will keep the kids playing for a longer period at home
such that we will see changes in their function.”
The other element that Dr. Biddiss
thinks makes games more enjoyable is when they are multiplayer. As Biddiss
says, “we don’t want the kids at home playing by themselves. We want them
playing with brothers and sisters, parents, friends. For that reason we put a
lot of effort into creating gaming experiences that can be customized to
different skill levels while still being a meaningful experience for everyone
who is participating.” To level the playing field between the child in therapy
and a typically developing brother or sister the two players may have to
perform different actions to achieve the same points in the game. Whereas the
kids with CP may have to extend their wrist, the sibling may have to drop an
object, squat down and pick it up.
Dr. Biddiss found her calling
here at Holland Bloorview. She originally studied mechanical engineering and
says, “I loved the study of engineering but I had no idea what I was going to
do with it because I wasn’t really interested in cars and air conditioning and
things like that.” A guest lecturer opened her eyes to how engineering can be
applied to medicine. She recalls being inspired near the end of her engineering
degree when she had a tour of Holland Bloorview, back before it had this name,
and “it was just this sort of aha moment, this is exactly what I want to do
with my life, designing technologies for kids with disabilities.”
It’s hard not to be inspired by
Holland Bloorview Kids Rehabilitation Hospital. Meet some of the
kids and check out the #CrushBarriers campaign going on until March 4. See
the amazing possibilities being created by the research staff at Bloorview
Research Institute.
References:
Interview
with Dr. Elaine Biddiss, Assistant Professor of Biomaterials and Biomedical
Engineering at University of Toronto and a
scientist in Applied Innovation with the Bloorview Research Institute at
Holland Bloorview Kids Rehabilitation Hospital
Brain Reorganization following Intervention in Children with Congenital Hemiplegia: A Systematic Review. (2013) Neural Plasticity Article ID 356275
No comments:
Post a Comment