Serious games (SG) — video games designed with a primary purpose other than pure entertainment — are a reliable assessment tool for motor function in patients with advanced Friedreich’s ataxia (FA).
This functional evaluation can also be used during rehabilitation therapy with the patient seated in a wheelchair.
The study, “Automated functional upper limb evaluation of patients with Friedreich ataxia using serious games rehabilitation exercises,” was published in the Journal of NeuroEngineering and Rehabilitation.
FA is a rare, genetic, progressive disease that affects the nerves and muscles. Initially, patients usually notice an unusual loss of balance that gradually progresses to a complete loss of control of body movements, a medical condition known as ataxia.
Most patients are eventually unable to walk, and become bound to a wheelchair within 10-15 years after the onset of disease. Their state eventually continues to deteriorate due to the worsening of upper limb ataxia, muscle weakness, and severe difficulties in speaking (dysarthria) and swallowing (dysphagia).
As a result, standard tools commonly used to assess disease progression become less effective at evaluating the clinical decay of patients with advanced Friedreich’s ataxia, especially when they are in a wheelchair.
In this study, researchers aimed to analyze the potential of serious games specifically developed for patients with neurological disorders as an assessment tool to evaluate upper limb function in patients with advanced FA during rehabilitation therapy.
The study involved 27 patients with advanced FA who were enrolled in the European Friedreich’s Ataxia Consortium for Translational Studies (EFACTS, NCT02069509), a large natural history study designed to define clinical rating scales and quality of life measures for future clinical trials in FA.
All patients were asked sit in wheelchairs and perform upper limb rehabilitation exercises integrated with a specific serious game coupled with a Kinect sensor that had been previously validated to analyze upper limb function in healthy individuals.
Patients’ movements recorded by the Kinect sensor and other clinically relevant parameters were compared to a control group of 43 age-matched healthy individuals.
FA patients needed more time to perform the rehabilitation exercises (44 seconds vs. 25 seconds, an increase of 76%) and were less accurate at performing the task (88% vs. 94%, a decrease of 6%) compared to healthy subjects.
In addition, significant correlations were found between age and time to perform the rehabilitation exercises, accuracy, and the total displacement (movement) of the upper limbs. Statistically significant correlations were also found between the age of diagnosis and speed-related parameters.
Altogether, these findings demonstrate that combining rehabilitation exercises with serious games and an automated upper limb movement tracking sensor is a viable strategy to evaluate the clinical status of patients with advanced FA in wheelchairs.
“The use of new technologies in rehabilitation, including SG [serious games], is becoming increasingly important,” researchers wrote. “Future works are needed to determine if such [a] solution can be successfully integrated in the rehabilitation program and whether the kind of data presented in this paper can be used to predict disease progression.”