How gaming and hi-tech can help in rehab and physical therapy.

How gaming and hi-tech can help in rehab and physical therapy.

Gaming often gets a bad rap in the media. Between stories about rampant sexism, on-line bullying, and violent video games, you could be forgiven if your take on electronic entertainment ranges from cautious disregard to downright negative.

But, it might surprise you to learn, doctors and physical therapists are using electronic gaming and other technology to help with rehab, stress reduction, and pain management.  I suppose this shouldn't be too much of a shock.  Many of us use apps on our phones or our wrists to measure our own fitness and even motivate us.  Today, for instance, I'm wearing Level eyeglass frames ($270 excludes lenses),  from a company called VSP, that has sensors built into the temple pieces that measure each step I take and record it to an app on my phone to track steps, calories, distance and more. Unlike my fitness band which I often forget, I almost always have my glasses on when I'm moving, so my numbers are super accurate.  Seeing the numbers motivates me to keep going. 

Inventors, doctors and physical therapists are working to incorporate this technology and more into the lives of people in rehab: gamification of rehab medicine has all sorts of benefits.

Keeping engaged and motivated to do the hard work of rehab and physical therapy can be difficult.  Let's say you've been assigned by your therapist to squeeze a ball a hundred times, or flex your wrist side to side or up and down.  Right away you have two tasks: Do this arguably tedious activity, and keep track of how many times you've done it.  Meanwhile, your progress isn't quantified, and your therapist has to take your word on how often and to what extent you're doing the "work" of getting better.

The Neofect Rapael Gloves

That is where a company named Neofect comes in.  It creates games and controllers specifically designed to gamify and quantify physical therapy.  For example, they have two "gloves", one for adults and another for children, that look a bit like an ectoskeleton.  The glove is fitted with sensors that relay information about how you're moving your hand and wrist wirelessly to a tablet that is running its custom software. 

Now, before rushing out to Amazon to buy these devices, my recommendation would be to talk to your doctor/therapist first.  At $2999, these are not cheap, and you want to be sure that the use case fits into your overall rehab plan. 

The software can analyze your range of movement, and then (depending on the diagnosis you've received, and often in conjunction with a physical therapist) serve up games that incorporate the repetitive exercises you've been assigned. 

For instance, if you need to work on your wrist movements you might play a fishing game, or one with a table tennis setting. These games are specifically designed to gamify certain movements. While you're playing, the glove is relaying information to the tablet, measuring how many repetitions you've done, and the extent of your range of movement.  This data, in turn, can be seen over time and reviewed by your physical therapist. 

By gamifying the exercise regime, the Rapael glove incentivizes the exercise program, while providing valuable feedback to the patient, therapist, and physician.

The Neofect Home Smart Board

If the gloves are designed primarily to measure and exercise hand and wrist movement, Neofect also has a Smart Board ($3999) that gamifies exercise of the upper arm and elbow, targeting those who have lost arm reaching ability or who might be suffering other limitation of movement of the upper arm.  Neofect says the SmartBoard can be helpful for people with central nervous system and muscular skeletal issues such as stroke, spinal injury or Multiple Sclerosis, and muscular skeletal disorder, and for people with other limitation of movement issues.

Though the SmartBoard resembles a joystick, there are significant differences.  First, there is a rest/support for the lower arm, and the hand can be strapped to the control stick.  These adaptations mean even a person who can't hold or control a joystick may be able to lean into this device and make it work.  Further, joysticks tend to exercise the wrist, whereas the SmartBoard exercises the whole arm.  The handle physically moves forward and back, left and right, not just tilting. 

Like Neofect's gloves, the Smart Board can be used to evaluate and measure the individual’s abilities over time.  You can see a video of the device in use at https://www.youtube.com/watch?v=baVTD7gS4IU.  Range of movement, visual motor mapping development (such as the ability to reach to a particular point), and coordination are designed to be tested over time, through periodic evaluation and historical game results.  Things like the ability to draw a particular shape, the speed of task completion, range of movement, and accuracy, are all tracked.

Last week I spoke with James Kaplan, M.Ed, CTRS, ATP, at the James A. Haley Veteran's Hospital in Tampa Florida, and he filled me in on the exciting work he's been doing in partnership with Microsoft to incorporate gaming into rehab.  He says gaming can help in several areas with physical, and cognitive rehabilitation, as well as having psycho-social benefits. 

Now, well you may ask, "how could a person who has limited mobility or, for that matter, may have lost all or part of a hand, be able to play a video game?"  Microsoft developed a controller for just this use case scenario.  The Microsoft Adaptive Controller ($99)  plugs directly into the standard Xbox One game console, and can even control a Windows 10 computer!  It can be used in conjunction with other switches, for instance foot pedals, and pads, and even special joysticks that are larger, and easier to manipulate. (Note, these other controllers can add significantly to the cost of adapting the adaptor to your individual needs.  Your medical team may be able to help you identify which you would need and what the full cost will be.)

Opening up the world of video games has many benefits, not the least of which is psychological.  Gaming (now an industry equaling that of the movie business) is an important part of the social world for many people.  Before the Xbox Adaptive Controller many were excluded from that experience and the joy of competing against the machine and with players from around the world. 

Moreover, games can be used to help the brain rewire itself, exercise range of movement, and train coordination.

Not to be overlooked, gaming can also be incorporated into pain management.  I had personal experience with this several years ago following a dental surgery that didn't go well.  I will spare you the bloody details, but suffice it to say that for several months I went through a level of pain that I still can't comprehend.  No meds I took were as effective as playing video games.  I am still at a loss to explain how it worked, but as long as I was gaming the pain seemed to get pushed to the background.

I asked Mr. Kaplan what kind of games he found most useful in rehab.  For the most part he cited sports games, like Madden, NBA2K, and Forza.  Because of PTSD issues, he tends to stay away from first person shooters. 

Through the partnership with Microsoft, some vets in his program can acquire the adaptive controllers for home use as part of their treatment.

Interesting, Kaplan also uses virtual reality apps to help in certain rehab situations.  He says that he has seen significant chronic pain reduction in some patients who use a 10 minute VR guided meditation program.  The same app can also lower heart rate by 6 beats per minute.

I've been in physical therapy for some time now, dealing with sometimes crippling back pain.  I've used a virtual reality exercise bike from VIRZoom for many years to help me keep moving when I just didn't have the ability to exercise in the park. Like the other devices mentioned, the diverse games in the virtual world encourage me to bike longer, while at the same time, the program tracks my progress.

Two other hi-tech devices have recently also entered my physical therapy. 

Upright Go 2.0

First is the Upright Go 2.0.  After being run over by a biker, I often found myself leaning forward all the time, particularly when I walked.  Many of us that work on computers or seated for long periods of time also develop a slouch.  For me it reached the point where I really couldn't tell when my posture was incorrect. I was literally "learning" to stand and sit badly in order to avoid pain, creating more problems! 

Enter the Upright Go 2.0  It is a small gadget, thinner and smaller than a matchbox, that adheres between my shoulder blades.  When I slump  or lean it vibrates gently, reminding me to straighten out.  It works with an app that trains and tracks, and it has improved my posture and lessened my pain.

The best thing about it, besides its small size, is that it really does “train” me to sit and stand more upright.  Even when I’m not wearing it, I could swear I still sometimes “feel” it vibrate when I start to slouch.  It is re-teaching me what “correct posture” should feel like.  Like a quiet voice in my ear, the Upright Go 2.0, reminds me without being obtrusive or annoying, while at the same time urging me to improve.

Oska Pulse

The other device is called Oska Pulse ($399).  It uses pulsed electromagnetic fields (PEMF) to reduce inflammation and reduce pain.  Unlike TENS units, it doesn't use pads; rather its pulse penetrates the skin and even your clothes.  According to the manufacturer, "When cells become distressed from disease, trauma or toxins, they lose their ability to function efficiently.  PEMF restores the positive and negative chargees in the cell, enabling it to perform its natural function while speeding tissue recovery."

At about ten times the price of the TENS unit I bought, I was very skeptical about these claims - it sounded too new-age-y to be true and I didn’t want a $400 pet crystal.  Also, I was even more on my guard when I was informed it could take a couple of weeks to feel the improvement. 

But, I was told the technology has been used for 60 years in clinical use, had no known major negative side effects, has been the subject of lots of studies, and might help with my pain.  If you know from chronic pain, you know that sometimes we’re willing to grab at straws.  So I tried it.

I've been using it for about a week.  It works on a built in rechargeable battery.  You slip it into a compression band that holds it to the area to be affected on your body, and wear it for 90 minutes, twice a day. 

I didn't feel anything while the first treatment was happening, except perhaps a sense of warmth below the surface of my skin.  I'm not sure I could have even told you it was on or off without looking at the blue light on the unit.  This all turned up my "snake-oil" spider sense. 

Then I took it off. 

What happened next is hard for me to believe.  I will preface this by reiterating that aside from being provided with a review unit, I have received nothing from the manufacturer. 

My pain level (which regularly hovers between a 3 to a 5) was floating somewhere between 0 and 1.  I haven't been at this level of comfort, this pain free in nearly a decade.  It honestly surpassed any medication I've tried to reduce pain.  

I have been wearing it now all week, twice a day,  and my pain has been low enough that I can get through my physical therapy exercises without a problem.  Perhaps the most amazing thing is what my wife commented on:  I am no longer waking up in agony.

Now, I know about placebo effects.  I can tell you that my TENS unit did not give me this kind of relief.  I don't know if it will last, but I'm sure going to find out.  I've sniffed around on-line and see that for some people it just doesn't seem to help.  I've also tried it on two other people this week.  One person, didn't see much relief.  However, my best friend's father, now 94, did receive significant reduction in pain in his leg after a single session.

My advice, if you have significant pain, discuss it with your doctor/physical therapist.  If they have no objection, try it on Amazon or from some other on-line retailer with a good return policy and see if you get relief.  If not, return it.  However, mine isn't going to be retired any time soon.