Game-Based NeuroFitness - Blending Balance, Gait, Visuomotor, and Cognitive Training

Overview

Safe, independent mobility is a marker for successful development and healthy aging and is the sixth vital sign in geroscience.

Mobility limitations, combined with cognitive decline, are prevalent in many patient populations, children with neurodevelopmental disorders (e.g. cerebral palsy), Parkinson's disease, and older adults. In addition to the importance of muscle and cardiac fitness, daily life mobility requires a combination of balance, locomotor, visuomotor, cognitive, and dual-tasking skills (i.e. which we refer to as NeuroFitness).

Studies have used multimodal interventions, combining motor and cognitive training, to improve both mobility skills and executive cognitive functions. These programs are referred to as dual-task training regimes. In this regard, the application of technology and digital media provides several promising approaches.

For these purposes, we have developed and validated a computer game-based rehabilitation platform (GRP) for treadmills augmented with automated assessment, to provide an engaging, integrated approach to screen, assess and treat the decline in balance, gait, visuomotor, and executive cognitive functions.

About the Game-Based Rehabilitation Platform (GRP)

The GRP components and functions will be presented in this course along with the application for the rehab of adults with mobility limitations and for people with acquired brain injuries and neurodegenerative disorders.

The GRP was designed to be used with any standard treadmill. A standard computer display is placed at the front of the treadmill for participants to view and interact with a wide range of computer-generated cognitive activities while walking. Many inexpensive common and modern computer games are readily available, in which processing speed, cognitive inhibition, task switching, working memory and problem-solving are the main components of interactive play.

We use several different computer mice to interact with the cognitively challenging computer games while the client is performing targeted balance activities in standing and then while walking on the treadmill. For example, we use a miniature, wireless, inertial-based (IB) computer mouse secured to a headband and thus head rotation can be used to interact with most commercial computer games to control the motion of a game sprite or avatar.

Importantly, the IB mouse and other mice we use are plug-n-play and can be used to play almost any common or modern computer game as well as brain fitness/cognitive computer games (e.g., NeuroNation, Lumosity, Happy Neuron etc.).

At the core of the platform is an in-house-built rehabilitation software application for assessment and treatment, called ‘repetitive task practice’ (RTP), that computes several visuomotor and cognitive outcome measures and provides immediate feedback. It also uses data obtained from treadmill-mounted pressure mats for unobtrusive recording of Centre of Foot Pressure (COP) and computing several gait performance measures. 

Learning Objectives

By the end of the course, the participant: 

1. Will be able to assemble, in whole or in part, a game-based, multicomponent balance and treadmill training platform including a computer mouse, computer games, various balance disks, and treadmill.
   
   
2. Will have a good understanding of the telemonitoring hardware/software used for assessment of balance,  locomotor performance, visuomotor, and cognitive functions tested singly or in combination (i.e. dual-task interference effects).
   
   
3. Will be able to plan and conduct various dual-task balance and dual-task treadmill training programs for:

• • Older adults with mobility limitations and cognitive decline;
  • Parkinson's Disease;
  • Stroke; and
  • Young children with Cerebral palsy and acquired brain injuries.

Audience

This online course is for physiotherapists, clinicians, students, researchers, stakeholders, and other individuals involved in the screening, assessment and rehabilitation of people with mobility limitations (balance-gait disorders), cognitive decline, and high fall risk.

Presenter Bio: Tony Szturm, PT, PhD

My expertise is in Physical Therapy, Neuroscience, and Biomedical Engineering. My main research area is the design, development, and validation of affordable technologies for rehabilitation, such as digital media, innovative wireless, plug-n-play computer input devices, and wearable motion sensors.

My research contributions include: 

1. Screening and treatment of mobility limitations and high fall risk. Specifically, integration of balance, gait, visuomotor, and executive cognitive training (dual-task functions). Populations include aging (mobility limitation & dementia), Parkinson’s, traumatic brain injury and stroke) and young children with cerebral palsy and acquired brain injuries.
   
   
2. Computer game-based rehabilitation/telerehabilitation platform with a focus on manual dexterity. Patient populations include adults with acquired brain injury (stroke, spinal cord injury, and traumatic brain injury) and children with neurodevelopmental disabilities.
   
   
3. Vestibular Rehabilitation.