Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study

Abstract

Background: Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting.

Methods: Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31-69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged.

Results: The usability of the system was considered average to satisfying (mean 60.1-93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems.

Conclusions: Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system.

Trial registration: ClinicalTrials.gov NCT02368223.

Keywords: Cerebral palsy; Children and adolescents; Clinical utility; Data glove; Game-based; Neurorehabilitation; Pediatrics; Tele-rehabilitation; Upper extremities; User satisfaction; YouGrabber.

Figures

Fig. 1

The portable YouGrabber system. a A patient playing the Airplane game on the portable YouGrabber system. b The complete data glove with sensor-“box”, bending sensors, and vibrating units attached to the size fit neoprene glove. c The complete equipment packed for “take away”

Fig. 2

Relationship between manual ability and total pure playtime. The boxplots of total pure playtime for the different Manual Ability Classification System (MACS) levels show that more severely affected children and adolescents tend to train less with the system

Fig. 3

Correlation of VAS score of patient questionnaire, question 3, with age. Age correlated with question 3 “was the training length appropriate?” of the patient questionnaire. VAS scores could vary between 0 – not at all, and 100 – absolutely. Clear dots: patients under 9 years, dark dots: patients over 9 years