Cerebral palsy is a group of permanent movement and posture disorders, caused by a non-progressive lesion in the brain during its development. In addition to motor difficulties, changes in sensation, perception, communication, behavior, epilepsy and musculoskeletal problems may occur. Each child is affected differently: some have only one side of the body affected, others manifest involuntary movements or difficulties with balance and coordination. The degree of functional autonomy is often assessed based on walking ability and the use of hands in daily activities. Although there is no cure, it is possible to optimize motor function through repetitive training that stimulates the reorganization of neuronal circuits.
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TELEREHABILITATING CHILDREN WITH CEREBRAL PALSY THROUGH INTERACTIVE VIRTUAL GAMES
Publication type: Article Summary
Original title: O uso de jogos virtuais interativos para telereabilitação na paralisia cerebral
Article publication date: November 2020
Source: Repositório Científico do Instituto Politécnico do Porto
Author: Liliana Rodrigues
Supervisors: Firmino Silva & Maria João Trigueiro
What is the goal, target audience, and areas of digital health it addresses?
The present research aims to evaluate the effectiveness of a telerehabilitation intervention that uses interactive virtual games to improve upper limb motor skills in children with cerebral palsy. The target audience includes the families of these children, as well as rehabilitation professionals, namely occupational therapists, physiotherapists and speech therapists. This study falls within the domain of digital health, with a special focus on telerehabilitation, serious games and pediatric motor rehabilitation through interactive technologies.
What is the context?
Cerebral palsy is a group of permanent movement and posture disorders, caused by a non-progressive lesion in the brain during its development. In addition to motor difficulties, changes in sensation, perception, communication, behavior, epilepsy and musculoskeletal problems may occur. Each child is affected differently: some have only one side of the body affected, others manifest involuntary movements or difficulties with balance and coordination. The degree of functional autonomy is often assessed based on walking ability and the use of hands in daily activities. Although there is no cure, it is possible to optimize motor function through repetitive training that stimulates the reorganization of neuronal circuits.
Motor rehabilitation in this population is based on motor learning, which involves three components: acquisition (initial learning of movement), retention (ability to reproduce movement after training) and transfer of skills (application in different contexts). This learning is focused on improving motor skills, postural control, balance, bilateral coordination and upper limb functionality. To be effective, the training must be intensive, functional, motivating and adapted to the child’s needs.
Serious games are distinguished by having goals that go beyond entertainment, covering areas such as education, rehabilitation and health promotion. Exergames are a subcategory of serious games that require body movement as a form of interaction, assuming relevance in motor rehabilitation. Interaction can be mediated through technologies based on vision, audio, or sensors, and it is classified, according to the degree of immersion, as: immersive — with full immersion in virtual reality; hybrid — with images/videos overlaid on the real world; non-immersive — with a virtual environment displayed on a two-dimensional screen.
What are the current approaches?
Currently, several studies analyze the use of technologies in rehabilitation, both commercial and platforms specifically developed for motor rehabilitation. Among the commercial solutions, the Xbox Kinect stands out, with games such as Kinect Sports and Kinect Adventures, the Nintendo Wii with Wii Sports and Wii Fit and the PlayStation 2 with EyeToy. Although these technologies demonstrate benefits in terms of motivation and motor execution, they have limitations such as the lack of therapeutic personalization and accessibility barriers.
In contrast, platforms designed specifically for rehabilitation — such as Kinerehab, HB-RES, Mitii, RE-ACTION or Timocco — allow greater adaptation to clinical needs, favoring motor repetition and usability in home settings. The Timocco platform, in particular, integrates a variety of interactive games to stimulate motor, cognitive and communication skills, being a non-immersive virtual reality solution with a vision-based interface, already applied in the rehabilitation of children with cerebral palsy. However, in Portugal, there is a lack of studies on the use of virtual games for telerehabilitation of this population.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study was the use of the Timocco platform for upper limb telerehabilitation in children with cerebral palsy, in Portugal. The platform, accessible on any computer with an internet connection, uses the webcam to detect the child’s movements and sensors in the balls used in the games to accurately identify the position of the hands. The therapist can configure various parameters such as the background, the color and size of the cursor, difficulty level, among other game settings allowing customization of the intervention. At the end of each game, the platform provides immediate feedback through a rewards system that includes scores, virtual coins and motivational messages. The results are automatically recorded, allowing for continuous monitoring of the child’s progress over time.
In this study, two game plans were selected. The first, “Attention please mini“, includes the “bubble bath” game, in which the child must burst green and yellow bubbles, ignoring the red ones. This plan involves bilateral upper limbs movements and records specific data such as hand used, the number of bubbles burst correctly or incorrectly, and the number of bubbles ignored. The second plane, “Midline crossing“, contains the game “fruit basket” game, in which the child catches fruits in the upper corner of the screen and places them in the opposite lower basket. This plan requires different movement patterns and records specific data as the hand used, the number of fruits placed in the correct or incorrect basket, the number of fruits ignored, and the number of midline crossings.
The study involved ten children diagnosed with cerebral palsy, aged between 6 and 14 years, accompanied by the Associação de Paralisia Cerebral de Braga. The intervention lasted 5 weeks, with sessions three times a week of 10 to 15 minutes: two asynchronous, held at home with the support of caregivers, and one synchronous, conducted by a therapist through a digital platform.
The impact of the intervention was assessed using three complementary methods. The children’s interest and experience were analyzed with the intrinsic motivation inventory, while the usability of the platform was evaluated by caregivers through the telehealth usability questionnaire. In addition, the Timocco platform provided objective motor performance data, including total score, average response time, number of levels played, and movement efficiency.
What are the main results? What is the future of this approach?
The results of plan 1 reveal clear improvements in motor performance, with reduced average response time, increased scores (from 16 to 42 points between the first and last game) and evolution in the number of levels played, indicating faster movements. The number of bubbles bursting with the most affected limb increased (from 5 to 15 points between the first and last game), reflecting a greater number of movement repetitions throughout the sessions. The movement efficiency was high, indicating that almost no mistakes were made, such as bursting incorrect bubbles or ignoring correct bubbles, possibly due to the simplicity of the tasks and the lower presence of distracting elements.
In plan 2, the response time and the levels played remained stable, with a slight reduction in response time and with a slight tendency to increase in level in the last game. The total score increased significantly (from 36 to 66 points between the first and last game). The movement efficiency remained stable between the games, being at an intermediate value, which can be justified by the game’s higher motor demand, requiring continuous and coordinated movements between left and right sides.
Additionally, high levels of motivation were recorded (average of 4.33 out of 5), with children giving particularly high scores to the statements “I really like Timocco’s games” and “Timocco’s games are fun”. High levels of satisfaction were also observed (average 4.08 out of 5), particularly regarding future use, ease of use and learning, quality of interaction, and interface quality.
Overall, the data demonstrated that using the Timocco platform in a home setting is feasible, effective, and well accepted, promoting motor improvements and active family engagement.
In the future, it is recommended to expand the sample size, extend the intervention to assess long-term maintenance of gains and compare effectiveness among children with different autonomy or functional profiles.
Would you like to know all the details?
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Home / Publications / Publication
TELEREHABILITATING CHILDREN WITH CEREBRAL PALSY THROUGH INTERACTIVE VIRTUAL GAMES
Publication type: Article Summary
Original title: O uso de jogos virtuais interativos para telereabilitação na paralisia cerebral
Article publication date: November 2020
Source: Repositório Científico do Instituto Politécnico do Porto
Author: Liliana Rodrigues
Supervisors: Firmino Silva & Maria João Trigueiro
What is the goal, target audience, and areas of digital health it addresses?
The present research aims to evaluate the effectiveness of a telerehabilitation intervention that uses interactive virtual games to improve upper limb motor skills in children with cerebral palsy. The target audience includes the families of these children, as well as rehabilitation professionals, namely occupational therapists, physiotherapists and speech therapists. This study falls within the domain of digital health, with a special focus on telerehabilitation, serious games and pediatric motor rehabilitation through interactive technologies.
What is the context?
Cerebral palsy is a group of permanent movement and posture disorders, caused by a non-progressive lesion in the brain during its development. In addition to motor difficulties, changes in sensation, perception, communication, behavior, epilepsy and musculoskeletal problems may occur. Each child is affected differently: some have only one side of the body affected, others manifest involuntary movements or difficulties with balance and coordination. The degree of functional autonomy is often assessed based on walking ability and the use of hands in daily activities. Although there is no cure, it is possible to optimize motor function through repetitive training that stimulates the reorganization of neuronal circuits.
Motor rehabilitation in this population is based on motor learning, which involves three components: acquisition (initial learning of movement), retention (ability to reproduce movement after training) and transfer of skills (application in different contexts). This learning is focused on improving motor skills, postural control, balance, bilateral coordination and upper limb functionality. To be effective, the training must be intensive, functional, motivating and adapted to the child’s needs.
Serious games are distinguished by having goals that go beyond entertainment, covering areas such as education, rehabilitation and health promotion. Exergames are a subcategory of serious games that require body movement as a form of interaction, assuming relevance in motor rehabilitation. Interaction can be mediated through technologies based on vision, audio, or sensors, and it is classified, according to the degree of immersion, as: immersive — with full immersion in virtual reality; hybrid — with images/videos overlaid on the real world; non-immersive — with a virtual environment displayed on a two-dimensional screen.
What are the current approaches?
Currently, several studies analyze the use of technologies in rehabilitation, both commercial and platforms specifically developed for motor rehabilitation. Among the commercial solutions, the Xbox Kinect stands out, with games such as Kinect Sports and Kinect Adventures, the Nintendo Wii with Wii Sports and Wii Fit and the PlayStation 2 with EyeToy. Although these technologies demonstrate benefits in terms of motivation and motor execution, they have limitations such as the lack of therapeutic personalization and accessibility barriers.
In contrast, platforms designed specifically for rehabilitation — such as Kinerehab, HB-RES, Mitii, RE-ACTION or Timocco — allow greater adaptation to clinical needs, favoring motor repetition and usability in home settings. The Timocco platform, in particular, integrates a variety of interactive games to stimulate motor, cognitive and communication skills, being a non-immersive virtual reality solution with a vision-based interface, already applied in the rehabilitation of children with cerebral palsy. However, in Portugal, there is a lack of studies on the use of virtual games for telerehabilitation of this population.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study was the use of the Timocco platform for upper limb telerehabilitation in children with cerebral palsy, in Portugal. The platform, accessible on any computer with an internet connection, uses the webcam to detect the child’s movements and sensors in the balls used in the games to accurately identify the position of the hands. The therapist can configure various parameters such as the background, the color and size of the cursor, difficulty level, among other game settings allowing customization of the intervention. At the end of each game, the platform provides immediate feedback through a rewards system that includes scores, virtual coins and motivational messages. The results are automatically recorded, allowing for continuous monitoring of the child’s progress over time.
In this study, two game plans were selected. The first, “Attention please mini“, includes the “bubble bath” game, in which the child must burst green and yellow bubbles, ignoring the red ones. This plan involves bilateral upper limbs movements and records specific data such as hand used, the number of bubbles burst correctly or incorrectly, and the number of bubbles ignored. The second plane, “Midline crossing“, contains the game “fruit basket” game, in which the child catches fruits in the upper corner of the screen and places them in the opposite lower basket. This plan requires different movement patterns and records specific data as the hand used, the number of fruits placed in the correct or incorrect basket, the number of fruits ignored, and the number of midline crossings.
The study involved ten children diagnosed with cerebral palsy, aged between 6 and 14 years, accompanied by the Associação de Paralisia Cerebral de Braga. The intervention lasted 5 weeks, with sessions three times a week of 10 to 15 minutes: two asynchronous, held at home with the support of caregivers, and one synchronous, conducted by a therapist through a digital platform.
The impact of the intervention was assessed using three complementary methods. The children’s interest and experience were analyzed with the intrinsic motivation inventory, while the usability of the platform was evaluated by caregivers through the telehealth usability questionnaire. In addition, the Timocco platform provided objective motor performance data, including total score, average response time, number of levels played, and movement efficiency.
What are the main results? What is the future of this approach?
The results of plan 1 reveal clear improvements in motor performance, with reduced average response time, increased scores (from 16 to 42 points between the first and last game) and evolution in the number of levels played, indicating faster movements. The number of bubbles bursting with the most affected limb increased (from 5 to 15 points between the first and last game), reflecting a greater number of movement repetitions throughout the sessions. The movement efficiency was high, indicating that almost no mistakes were made, such as bursting incorrect bubbles or ignoring correct bubbles, possibly due to the simplicity of the tasks and the lower presence of distracting elements.
In plan 2, the response time and the levels played remained stable, with a slight reduction in response time and with a slight tendency to increase in level in the last game. The total score increased significantly (from 36 to 66 points between the first and last game). The movement efficiency remained stable between the games, being at an intermediate value, which can be justified by the game’s higher motor demand, requiring continuous and coordinated movements between left and right sides.
Additionally, high levels of motivation were recorded (average of 4.33 out of 5), with children giving particularly high scores to the statements “I really like Timocco’s games” and “Timocco’s games are fun”. High levels of satisfaction were also observed (average 4.08 out of 5), particularly regarding future use, ease of use and learning, quality of interaction, and interface quality.
Overall, the data demonstrated that using the Timocco platform in a home setting is feasible, effective, and well accepted, promoting motor improvements and active family engagement.
In the future, it is recommended to expand the sample size, extend the intervention to assess long-term maintenance of gains and compare effectiveness among children with different autonomy or functional profiles.
Would you like to know all the details?
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In recent years, ULSAS has been gradually implementing robotic systems, reinforcing its commitment to innovation and improving healthcare. Recently, the institution acquired a state-of-the-art robotic system, developed under the concept of an ‘immersive intuitive interface’,…
Online Intervention Aims to Prevent Anxiety in the General Population
Anxiety disorders are a global problem, affecting 300 million people worldwide and placing significant pressure on individuals and healthcare systems. In Europe alone, the economic impact reached 74.380 million in 2010, with 62.2% attributed to…
Rehabilitation of Facial Paralysis Through Virtual Assistants
Facial paralysis, defined by the inability to move one or both sides of the face, has an incidence of 20 to 30 cases per 100,000 people annually. This condition often causes facial weakness, difficulties in…
Detection of Anxiety and Panic Attacks in Real Time
The growing number of people with anxiety disorders, along with increased awareness of mental health, drives the need for new technological tools that provide remote and continuous monitoring of anxiety and panic disorders. Thus, the…
A Novel Approach for Robotic-assisted Tele-echography
Currently, robotic systems for ultrasound diagnostic procedures fall into two main categories: portable robots that require manual positioning and fully autonomous robotic systems that independently control the ultrasound probe’s orientation and positioning. Portable robots rely…
From Big Data to Big Decisions: How AI Stratifies Cancer Cases by Risk Factors
The CLARIFY Decision Support Platform (DSP) is a responsive web application designed to support decision-making in cancer care through real-time data integration and predictive analytics. Built on Big Data Europe, the platform integrates a variety…
From “Free Text” to Structured Clinical Data: the Foundation for Clinical Decision Support Systems
Currently, the practice of recording clinical information in “free text” offers flexibility, but hinders automatic data extraction, limiting the application of analytical models. Most records are unstructured, and the use of non-standard abbreviations increases ambiguity,…
Artificial Intelligence used in Depression Detection in Cancer Survivors
The goal of the FAITH project (Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment) is to remotely identify and predict depressive symptoms in cancer survivors using a federated machine learning approach…
Integration of SONHO v2 and SClínico Systems at ULS of Coimbra to Improve Healthcare Services
With more than half a million hospital medical consultations carried out in the first half of 2024, the ULS of Coimbra stands out as an institution dedicated to integrated, high-quality and patient-centered healthcare, with 8…
Elderly Care Ecosystem: an Innovative Platform for Personalized and Efficient Services
The Elderly Care Ecosystem (ECE) is an integration of various digital health technologies, exploring the areas of telehealth and predictive analytics. The goal of this ecosystem is to improve the quality of life for elderly…
Innovative technology that subconsciously relieves anxiety through a scarf
The SCAARF technology aims to offer an alternative method to alleviate anxiety symptoms in a non-intrusive and subconscious way. This technology is an innovative idea in the field of digital health and wearable technology, designed…
Digital Health Interventions: Equity in Hypertension Care for Everyone
Nearly half of all adults in the United States have hypertension, one of the leading risk factors for cardiovascular disease, and only about a quarter (24%) of those people have their hypertension under control. Studies…
Personalization and Technology in Diabetes Management
IPDM has significant potential to improve diabetes management and drive health system reforms to become high-performing, effective, equitable, accessible, and sustainable. Evidence and good practices inspire health system transformation. Adopting person-centred approaches like co-creation and…
Negotiations on the European Health Data Space Advance With the Participation of the SPMS
The European Health Data Space will be a common health data sharing system across the European Union. It foresees the use of data for purposes that benefit people and society. It will ensure citizens have…
Secretary of State Margarida Tavares Emphasizes Digital Innovation in Health Promotion
Margarida Tavares spoke at the opening of the conference ” O Digital na promoção contínua da saúde e do bem-estar”, organized by the Associação para a Promoção e Desenvolvimento da Sociedade da Informação (APDSI) and…
ARS Algarve Modernizes Radiology With AI and New Data Center
The radiology service of ARS Algarve has already performed nearly 29,000 exams using Artificial Intelligence (AI) technology. In recent years, there has been a significant investment in image digitization and data storage, as well as…
European Health Data Space: Unified Access To Health Data In The EU
The COVID-19 pandemic highlighted the importance of digital services in health, but complex rules and increasing cyberattacks make it difficult to share data across Member States; the EHDS, based on several regulations, provides tailor-made rules…
European Commission Amends Digital Europe Programme With an Investment of €762.7 Million
The European Commission has amended the Digital Europe Programme work programmes 2023-2024, investing an additional €762.7 million in Europe’s digital transition and cybersecurity. The digital transition is the main work programme with a budget of…
SPMS Integrates the TEF-Health Initiative
SPMS participates in the TEF-Health initiative as a partner in a consortium composed of 51 entities from 9 European Union countries. This action is co-financed by the European Commission and has a duration of five…
FMUP Creates Inhealth Junior Academy for High School Students
The InHealth Junior Academy — Academia Júnior de Inovação em Saúde is an initiative of the Departamento de Medicina da Comunidade, Informação e Decisão em Saúde da Faculdade de Medicina da Universidade do Porto (FMUP)….
SPMS Represents Portugal as Vice-president of GDHP
The GDHP is an intergovernmental organization in the digital health sector that facilitates cooperation and collaboration between government representatives and the World Health Organization (WHO). Its purpose is to foster policymaking that promote the digitalization…
Digital Transformation of Health at INCoDe.2030 in Tomar
The “National Digital Skills Initiative e.2030, Portugal” (INCoDe.2030) is an initiative that aims to improve the Portuguese population’s level of digital skills, placing Portugal at the level of the most advanced European countries in this…
Braga Hospital Evaluates Memory With Interactive Game in Patients With Multiple Sclerosis
Multiple Sclerosis is known as a chronic disease of the central nervous system, with a wide variety of motor and sensory symptoms that can lead to work disability, socioeconomic burden, and reduced quality of life…
Neurosurgery Teleconsultation Wins Innovation Award
The aim of the BI Award for Innovation in Healthcare is to recognize innovative projects in the healthcare sector that improve the quality of life for the Portuguese people. In 2021, the specific theme was…
HealthData@PT: New SPMS Initiative for Health Data
Action HealthData@PT is launched in the context of the implementation of the European Health Data Space, and is an initiative approved by the European Commission under the EU4Health 2021-2027 programme. This initiative contributes to the…
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