Researchers at Nationwide Children’s Hospital in Columbus, Ohio, have developed a way to measure upper extremity movement in patients with muscular dystrophy using interactive video game technology. Now they hope to expand inclusion criteria for clinical trials to incorporate patients who use wheelchairs.

OT_News-01In a study, which was published Dec. 30 on the website of the journal Muscle and Nerve, researchers found scores in the game were highly correlated with parent reports of daily activities, mobility and social and cognitive skills.

Patients with diseases such as muscular dystrophy who have lost mobility and use wheelchairs are excluded from clinical trials because there is not an easy, affordable or comprehensive way to measure their muscular function. The standard measurement used in trials to demonstrate mobility is having the patient walk for a six-minute test.

The researchers hope the video game, designed with input from their patients, will demonstrate to the Food and Drug Administration that repeating the game with a patient accurately yields the same results and the results will change according to the progress of the patient.

“We were thrilled with the results,” Linda Lowes, PhD, PT, director of clinical therapies at Nationwide Children’s, said in a news release. “It’s very reliable day-to-day because it’s just fun. The scores are related to function, and really reflect what the boys could do in their life.”

Ability Captured Through Interactive Video Evaluation, also called ACTIVE-seated technology, uses a Kinect gaming camera, found in Xbox consoles. With a patient-requested zombie theme, the game requires the patients to reach with their arms in various directions to push forward a force field. The Kinect camera and ACTIVE-seated software measures how far and how long the patients reach. Measuring change over time is a primary goal. The development of the game relied almost entirely on the patients.

“The game allows them to disintegrate aliens, which they love,” Lindsay Alfano, DPT, PT, a physical therapist at Nationwide Children’s, said in the release. “In clinical trials we need to see that they’re getting better with all of their activities. They have to spend hours with us doing nothing that’s easy, only hard things. Looking at their faces after they play this game where they get to just play and be kids is a lot of fun to see.”

Alfano and Lowes both said motivation is important for the success of the game’s results. If a patient is not motivated to do something day after day, their performance will be different, making the assessment tool useless because it would not be measuring true function. Finding what is motivating yields the best outcome measure.

The study included 61 patients recruited from the Nationwide Children’s Hospital Muscular Dystrophy Association Clinic. The reachable area, which was visually represented as a series of boxes that appeared on a screen, was converted into a scaled score based on patients’ arm lengths. This allowed for the standardization of comparisons between patients of different sizes and the accommodation of growth in patients. The placement of the boxes is based on the size of the patient.

The study focused on patients with Duchenne muscular dystrophy, a type of muscular dystrophy that is most common in children, specifically young boys. The condition does not show itself at birth. Boys are born appearing healthy, but over time, parents notice their children are no longer keeping up with their peers. Children with Duchenne become weaker over time, slowly becoming unable to feed themselves, move normally and do various other tasks. Children often receive wheelchairs around age 12, and later in life they begin to lose respiratory and cardiovascular function.

“We developed this game because there was not an accepted outcome measure for boys with muscular dystrophy who couldn’t walk,” Lowes said in the release. “So we needed an outcome measure that would be reliable, valid and also give discrete quantitative measurements so they could measure small change or big change over time.”

Researchers hope the video game technology also can be proven to be effective for patients with other conditions that result in lack of mobility, such as cerebral palsy.

“As a clinical trial outcome measure, we really wanted this to be as universal as possible,” Alfano said in the release. “We want to be able to use this across sites, both in the U.S. and internationally, because most of the clinical trials are international at this point. Having something that’s commercially available, low cost and easy to implement was really a huge goal for us.”

Study abstract: http://onlinelibrary.wiley.com/doi/10.1002/mus.24557/abstract