BioGaming

BioGaming, is the emerging leader in game based 3D assisted rehabilitation solutions. BioGaming is Medica's Innovation Award winner startup that has invented a platform for the gamification of physiotherapy exercises.

[biogaming-pt]

Is adherence a clinically significant measure? An evidence based overview

Ido Rokach, PT

Exercise programs are one of the main evidence based physical rehabilitation interventions for numerous medical conditions. According to motor learning studies, we know today that in order to regain functional capabilities a patient has to perform hundreds of repetitions of a specific task oriented exercise1.  The patient must dedicate a lot of time during the day to his physical rehabilitation exercise program.

A problem that physiotherapists frequently encounter is that patients fail to recover from their injury as expected, with no apparent pathological basis predicting such a limited outcome. This problem may occur due to low adherence.

Adherence is defined as “the extent to which a person's behavior corresponds with agreed recommendations from a healthcare provider” (WHO, 2003). In the physiotherapy clinical world, adherence reflects the patient's commitment to the physical rehabilitation program.

Physiotherapists have to come up with creative ways to engage their patients so that they will complete their exercise regimen. As a result, adherence has become the focus of many researchers. Research has revealed that non-adherence is a widespread phenomenon – with “up to 65% of patients being either non-adherent or partially adherent to their home programs”2.

How is adherence measured?

Measuring adherence is quite complex since adherence comprises many elements, including:

1.       Keeping appointments.

2.       Following advice from the PT.

3.       Performing the exercise regimen.

4.       The frequency of exercise regimen performance.

5.       Performing exercises correctly.

6.       Performing more or less what was prescribed3.

Measurements rely mainly on observations in the clinic and on questionnaires filled out at home, with patient diaries and self-report questionnaires being the most commonly reported methods of measuring adherence.

Diaries allow tracking and recording each time treatment activities are performed, including the number of repetitions of each exercise, the duration of application of ice or heat and other self-administered therapeutic methods, etc. Patients are expected to complete their diaries every time they undertake their home program, and bring them to each clinic appointment for checking and updating. The percentage of adherence to the prescribed home program can be calculated from the patient recordings.

The advantages of such dairies are that they can be an aid to adherence by acting as a cue to doing the activities, they are cheap, and they are very simple to use. These advantages, however, can be also viewed as a limitation –“a true objective measurement of the various aspects of patient’s adherence is not being obtained”2.

How can a therapist increase patient adherence?

This million dollar question is key to increasing outcome measures in physical rehabilitation programs. Increasing adherence may be different for each patient and should be tailored to physiological, psychological and social parameters. In general, however, there are a few points to which the physiotherapist can pay attention and make minor adjustments in order to either maintain or increase adherence:

1. Using quantitative measurements in the results4. For example, if the exercise regimen contains aerobic exercises such as walking or running, a pedometer is a good way to increase adherence.

2. Splitting the training into a few shorter (but more intense) sessions is better than one long session of moderate intensity5.

3. Giving less than 6 exercises in a session6.

4. Frequent supervision of exercises provides a higher level of adherence6.

5. Giving explanations and information regarding the exercises increases adherence6.

6. Providing feedback through goal-setting and repeated functional testing7.

At the end of the day it is the patient who is responsible to undertake the exercise regimen for good physical rehabilitation outcomes. The role of the physiotherapist is to implement effective and proven methods to enhance the patient’s adherence to the course of physical rehabilitation.

1. Gordon AM, Magill RA. Motor Learning:Application of Principles to Pediatric Rehabilitation. In: Campbell SK, Palisano RJ, Orlin MN, eds. Physical therapy for children. 4th ed. St. Louis, Mo.: Elsevier/Saunders;  2012:151-174.

2. Sandra Frances Bassett (2003). The Assessment of Patient Adherence to Physiotherapy Rehabilitation. New Zealand Journal of Physiotherapy 31(2): 60-66

3. Kolt G.S., Brewer B.W., Pizzari T., Schoo A.M.M., Garrett N. The sport injury rehabilitation adherence scale: a reliable scale for use in clinical physiotherapy. Physiotherapy. 2007;93(1)

4. Kirk, A., & Feo, P. (n.d.). Strategies to enhance compliance to physical activity for patients with insulin resistance. Appl. Physiol. Nutr. Metab. Applied Physiology, Nutrition, and Metabolism, 549-556.

5. Thøgersen-Ntoumani, C., Shepherd, S., Ntoumanis, N., Wagenmakers, A., & Shaw, C. (n.d.). Intrinsic Motivation in Two Exercise Interventions: Associations With Fitness and Body Composition.Health Psychology.

6. Medina-Mirapeix, F., Escolar-Reina, P., Gascón-Cánovas, J., Montilla-Herrador, J., Jimeno-Serrano, F., & Collins, S. (n.d.). Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: An observational study. BMC Musculoskeletal Disorders, 155-155

7. Grindem, H., Risberg, M., & Eitzen, I. Two factors that may underpin outstanding outcomes after ACL rehabilitation. British Journal of Sports Medicine Br J Sports Med, 1425-1425.

[biogaming-pt]

The need for ADHERENCE in rehabilitation

By Roy Tzemah, PT Head of Clinical Affairs

Adherence, defined as “the extent to which a person’s behavior corresponds with agreed recommendations from a healthcare provider”, is considered to be a very important pre-requisite for the success of exercise programs for musculoskeletal disorders.  Adhering to an exercise program enhances its effectiveness, and patients who undertake regular physical activity may be less likely to progress to recurrent, persistent, or disabling problems (Melanie A Holden, 2014).

Adherence has implications on treatment cost and effectiveness. Despite its importance, adherence to clinic-based exercise protocols is often around 50% or less and is usually worse for unsupervised home exercise programs (Melanie A Holden, 2014). Some studies even suggest that non adherence with treatment and exercise performance could be as high as 70% of patients (Kirsten Jack, 2010 Jun). Non-adherence to exercise recommendations may negatively affect treatment effectiveness, treatment duration, efficiency of use of personnel and equipment, therapeutic relationship, waiting times, and cost of care (Melanie A Holden, 2014) (Kirsten Jack, 2010 Jun).

Computer-oriented exercise programs and training has been found to improve compliance in musculoskeletal patients exercising at home (Dhurjaty, 2001). Exergaming may also result in an increase of daily physical activity and over-all motivation to actually train more. (Leonie Klompstra, 2014)

BioGaming innovative line of rehabilitation games (www.yugonow.com) provide state of the art, Kinect based, games that aim to increase adherence to training programs both in the physiotherapist clinic and at home.

Works Cited

Dhurjaty, S. (2001). Challenges of Telerehabilitation in the Home Environment. Telerehabilitation and Applications of Virtual Reality, (pp. 89-93). Washington DC.

Foster, N. E. (2014). A multicentre, pragmatic, parallel group, randomised controlled trial to compare the clinical and cost-effectiveness of three physiotherapy-led exercise interventions for knee osteoarthritis in older adults: the BEEP trial protocol. Foster et al. BMC Musculoskeletal Disorders, 15:254.

Kirsten Jack, S. M. (2010 Jun). Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. MANUAL THERAPY, 15(32):220-228.

Leonie Klompstra, T. J. (2014). Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study. Klompstra et al. BMC Geriatrics, 14:119.

Melanie A. Holden, K. L. (2014). Recommendations for exercise adherence measures. Holden et al. Systematic Reviews, 3:10.

}b!8EJ

[biogaming-pt]

YuGo by BioGaming is changing the way physical therapy exercises are performed

OUT – boring exercises, IN – 3D virtual reality computer games!

Developed by PTs for PTs, BioGaming’s new solution – YuGo – is the first fun, user-friendly, cost-effective, and professional tool that motivates patients to actually perform their exercises, and to do so correctly. YuGo creates a motivational environment in which tedious, repetitive exercises are “disguised” within exciting personalized video games that direct the patient’s attention towards a fun activity and away from boring technical execution. BioGaming has created entertaining, interactive therapy sessions that look and feel like some of the best video games you’ve ever played.

"YuGo makes you forget about your injury! It makes you think about getting to the next level" says 35 year old Nadav Zelber who is recovering from a hip fracture.

BioGaming recognizes that doing an exercise the wrong way can sometimes prove worse than not exercising at all. Unprecedented research and development efforts have been invested in an innovative gesture recognition technology, which analyses the quality of exercise execution. Using data collected by a Kinect camera, our algorithms analyze the performance input in real time so that auditory and visual feedback is provided to patients as they exercise. Therapists use an intuitive dashboard to build patient-specific training programs, and to access detailed qualitative and quantitative reports on patient compliance and status. BioGaming's technology takes into account the subtle differences between patients in terms of ability, strength, body size, and progress in performance.

The BioGaming team comprises both experienced PTs who outline clinical needs and requirements, and gaming specialists whose sole purpose is to create the most engaging experience for the patient. Together we have created a new and innovative tool for the PT tool box.

[biogaming-pt]

BioGaming will attend APTA Combined Sections Meeting. Will you ?

Come meet us at booth 1242

[biogaming-pt]

The Importance of home training as part of the rehabilitation process

Noa Russo Ayash, B.Sc.PT – Physical Therapy Field Expert

BioGaming Ltd.

 A well-fitting exercise program is developed by the PT for each patient who enters a physiotherapy clinic.

As we already know, the exercises are used as a tool for recovery as they increase the patient's body strength, elasticity, balanced and endurance resulting with recovery in a shorter time span and with higher success.

Giving a tailor-made exercise program, taking into account a patient's problems and his physical situation, is one of the underpinning stones of the physical therapy field.

When giving an exercise program, the physical therapist has to provide two types of programs, one to be performed at the clinic and one for home practice.

For home practice, the PT has to choose exercises that will fit the practice space, will not include practice instruments and will be safe for the patient. Another thing to be consider is objects that every house contains, and can interfere or become a risk for the patient while practicing. A good example is a carpet.

A home exercise program is very important to the rehabilitation program! Because Average patients come to physical therapy treatments twice a week or less.  It is already known that for the improvement of body physical functionality, it is necessary to practice at list 4-5 times a week.  Home practice is the only available solution. There are many researches that documented the effectiveness of home exercise.

McKenzie, one of the manual therapy founders, based most of his treatment methods on home training. His rational was that every one of us, repeats the same movements thousands of times a day and in order to fix a problem, we need to do the opposite movement in a significant way. This is where home training is the solution.

But, there are some difficulties when using home based exercise programs. For start, the patient has to remember the exercises and how to do them correctly and accurately. Otherwise he may harm himself. Second, he has to actually perform it, even if he is busy or in pain (this is the main reason why home exercises are not very effective today). Third, the PT does not get accurate feedback on how the patient actually exercised and what was his real progress.

Here, in BioGaming, we thought about how to make home exercises safe, actually performed and with real and accurate feedback to the PT.

Yugo, BioGamings’ game based exercise platform enables patients to execute PT defined exercise programs in a Kinect based game which is safe, fun and provides accurate feedback to the PT. In addition, the patient receives real time feedback on his accomplishments and enjoys his exercises.

For more information visit – www.biogaming.com

[biogaming-pt]

The road to getting better – One step at a time

Noa Russo Ayash, B.Sc.PT – Physical Therapy Field Expert

BioGaming Ltd.

The world of physical therapy is unique and interesting; in most cases, a PT works closely with his patience and has significant professional pride as his patents get better.

Rehabilitation is similar to a journey that a patient passes through, in order to get well. Some patients have to take a very long journey towards complete recovery while others are lucky enough to endure a short one. It all depends on the injury.

In most cases, the medical individual who escorts the patient in this journey is the physical therapist. The therapist considers the patient’s problems with all the medical training and knowledge in his possession. He plans treatments and builds a gradual program fitting the patient’s physical situation and capabilities supporting him throughout the entire rehabilitation process.

A key part of the rehabilitation process is the physical exercises program. It consists of exercises the patient performs daily - encouraging improvement to his/her initially limited performance. Part of the program is implemented at the clinic (using training aids) and some of it is self-administered at home. It is well known in the literature that in order to improve a certain physical skill, one must train and repeat the related physical exercise many times. If the minimal amount of training was not achieved, the purpose of the training will never be achieved (remember that phrase? No pain – no gain). Performing the program at home, is therefore, critical to a successful rehabilitation.

A good example is a patient that broke his ankle so bad that he required a fixation surgery.  In the first two month after the surgery, the doctor’s orders were to avoid any weight bearing on the injured foot. Of course, even though the patient is not walking normally yet, after those two months it becomes something essential. In order to do so, the muscles on the specific leg needs to be strong enough to carry the body weight.

Therefore, initially, the rehabilitation program will not include exercises that require stepping on the injured leg but will advance gradually to exercises encouraging and promoting muscle strength in the muscles participating in walking to allow the usage of the injured leg resulting in safe walking as soon as possible. The program, will later on, address more advance functions, such as exercises to promote running and jumping.

The process of rehabilitation is very demanding, patients are asked to make a huge effort with daily training, repeatedly, while enduring pain and getting bored. It all results in long hours of training and usually significant less compliance resulting in longer rehabilitation time.

Having a fun tool to make that rigorous training less boring and more challenging is a dream to many therapist and patients. It may change the entire exercise routine, make it better, both emotionally and physically and increase compliance significantly. Enjoying a rehabilitation journey, not just going through it. This is exactly were rehabilitation games take place. Gamification of physical therapy exercise routines is coming of age. Perform the same exercises while enjoy the excitement and joy of playing a game is what Yugo is all about.

www.biogaming.com

[biogaming-pt]

A YuGo patient's point of view

This time, we will let someone else do the talking for us...  https://www.youtube.com/watch?v=9jJcc7_223M

[biogaming-pt]

Case Study – Yugo for Kids – 16th of December 2014

By Ido Rokach, B.Sc.PT – Physical Therapy Expert

Patient TN is a 9 y/o’ kid suffering from Right hemi paresis due to Cerebral Palsy. She gets a bulk of sessions on a yearly basis from her NH provider. Her parents understand that she has to get the treatments on a weekly basis to keep her in a good shape because, luckily she can study in a regular school, without any help as long as she does her exercises.  When she walks or does a moderate effort her spastic pattern affect her movement .She participates in sport classes though she complains about her stamina (doesn’t like to run). Her father told me that she usually gets tired after a 300 meter walk. The purpose of our sessions is to improve her aerobic condition.

In her physical examination we found out that her range of motion in hip, knee and ankle in a resting position is complete. She has spastic patterns in her right leg which means that she walks with hip internal rotation, ankle plantar flexion and knee flexion.

After a set of standard stretches on the bed focusing on ankle and knee ROM and spasticity reduction, we initiated a YUGO session.

TN was very excited to play the Racy game. She sought ways to get first on the race all the time.  The system was very tolerant to her movements, thanks to the gesture level component which was set to minimum in the system. This capability allows a patient to learn the exercises while doing them and not get a lot of negative feedback for movements which are done incorrectly. After the patient does a certain amount of repetitions correctly, the component makes the gesture recognition tighter. TN was able to understand the game with little guidance though the game has a tutorial which explains the game and exercises in English.

In the second session, TN has succeeded to get to first place in the race and moved into the two tracks mode. She was very keen to shoot the Emps (the YUGO minions). I added more jumps into her program in order to make her HR (heart rate) to go higher. Two times she had to stop from playing because her HR was very high so she couldn’t go on. However (!!) after a break of less than a minute she wanted to play again.

In conclusion, the game allowed TN to play for almost a whole hour with tiny breaks and archive her rehabilitation goals. Though she will never get to pro mode in gesture level because of her spastic pattern, she was able to play the games and get positive feedback thanks to the gesture level management component. YUGO was a tremendous success providing enchanting and positive results.

I hope that in the next sessions we will add more exercises with the aim to make her stronger and better from an aerobic point of view.

I will continue to describe her story continuously on the BioGaming Blog.

[biogaming-pt]

The Challenge Factor – Impact on Rehabilitation Results

Do you go to the gym? How does that work for you? Early morning or on your way back from work; taking your gym bag with you and completing the same training routine 3-4 times a week. Occasionally, you switch it with a gym class (you know what they say – you have to change the training routine to keep it effective). This is boring. This is more like another chore on schedule than something exciting.

I don’t know how many gym members attend the gym on a regular basis, but I’m certain that most of the members do not develop addiction to the training program their gym instructor prescribed. Going from one training device to the next; performing the same thing over and over for weeks-months-years, tends to be not fun, not challenging and mainly – not interesting. The health benefits alone are not big enough to lure most of us to the gym or other alternatives - secretion of pleasure inducing hormones during aerobic exercises is a good start, but it’s not enough for most of us. Why? What is missing? How can we make it more appealing?

Well, how would a Challenge effect the quality of your exercise and your satisfaction?

Here comes the Challenge Factor. Ever played one of those “challenge-your-friend” apps? Ever played social games were your actions were compared to other’s performance? How about having an app that compares your activities to those of your friends? How about climbing a fictional ladder, gathering titles or even actual benefits? Now we’re talking about something challenging. You can already find some apps supporting such ideas, but still – this is not enough. You don’t see many people use such systems, as the main action is still boring – doing that repetitive training. What else can we do? What more is missing?

Here comes the Fun Factor. If it’s fun, if it’s challenging, it will be easy to keep your interest. If it brings a smile to your face and you look forward doing it (as any good game does), it becomes the ultimate solution. Not only do you do it, but you want to do it (and not for that health benefit, simply because it’s fun!).

Professionals call it compliance to training. We can simply call it the reason why I should put the efforts and keep on training – not because it’s good for me – because I enjoy it.

Don’t train - Play. It’s fun, its challenging, it’s great.

[biogaming-pt]

Happy Holidays from BioGaming !

[biogaming-pt]

BioGaming at the Health Care Technological Innovation program.

With Dr. Benny Zeevi at Tel Aviv University, Recanati Business School. 

[biogaming-pt]

BioGaming at the Israeli Association of Physical & Rehabillitation Medicine Annual convention

Roy Tzemah, BioGaming's Chief Physicl Therapist, at the Israeli Association of Physical & Rehabillitation Medicine Annual convention.

[biogaming-pt]

BioGaming is sharing a kept secret ...

https://www.youtube.com/watch?v=xZmRLCoWSzI&feature=youtu.be

[biogaming-pt]

The Israel Export Institute chose BioGaming as the Exporter of the month!!

  https://www.facebook.com/Israel.Export.Institute/photos/a.201567900934.170076.135555150934/10152774060905935/?type=1&theater

[biogaming-pt]

The BioGaming's experience - Medica 2014

The BioGaming team was excited to win the eHealth Venture Summit Innovation competition that took place at Medica, in Düsseldorf, Germany. It was a sweet ending to a great show for BioGaming. BioGaming's stand was a great attraction with its CEO and Management team all playing virtual reality computer games on large TV screens, jumping, lunging, squatting – all a part of the BioGaming's FUN aspect of its physical therapy software system. Dozens of meetings took place, hundreds of business cards were exchanged and many partnership and cooperation talks were initiated with follow up meetings and demos already set up for January 2015. "Medica was a great event for our company; it allowed us to showcase our technology to distributors, manufacturers and even health providers from all over the world. It also gave us a very good overview of the digital health market and the great need it has for tele rehabilitation solutions", said Ronit Harpaz, VP Marketing & Sales for BioGaming.  “We are looking forward with anticipation to Medica 2015.

[biogaming-pt]

Yugo your Training Game - Tailor made VR Training Solution

A part of every Physiotherapist routine includes examinations, evaluations, data processing and hopefully, evidence based activities, focusing on patients’ complaints, physical compensations and other activity limiting symptoms. As a PT, you are required to notice every fine detail, figure its relevance and contribution to the patient’s current state and prepare a suitable treatment program to address all that is wrong, so that your patient will get back to his best possible performance.

This is difficult to explain, but a professional physiotherapist will understand the process quickly – clinical reasoning - it is a part of every health-related profession. Once a PT has an understanding as to what needs to be done, a treatment scheme is prepared. Use of treatment modalities (devices and all kinds of equipment found in many Physiotherapy clinics) and a simple (or comprehensive) exercise list is formed to teach the patient what to do in order to ensure progress.                

For many physiotherapists, that simple exercise list is something easy to prepare. You can find all kinds of software and smartphone applications that enable you to print out a fine list of exercises and even modify them to suit your exact needs. That sheet of paper is given to the patient, along with clear instructions on what he/she should do to make the best of it and… that’s it… you don’t know if or how your patient is doing the exercises at home, you have no feedback but the report given to you by the patient next time you meet.

The alternative to that is something completely different. You can use all kinds of advanced technologies, such as Nintendo Wii, Kinect games and other similar products. The game industry offers a lot of alternatives. However, none is easily modified; none can be tailored to your patients’ needs and non provides a comprehensive feedback reports.

What if you had a website where you can design a specific training program; adjust each exercise to best suit your patient; set an appropriate difficulty level to challenge your patient and avoid frustrating him/her and above all – receive a report describing exactly how well the program was performed?

That is simple – Yugo - your training program: www.yugonow.com

[biogaming-pt]

Virtual reality training improves balance function

eural Regen Res. Sep 1, 2014; 9(17): 1628–1634.

doi:  10.4103/1673-5374.141795

PMCID: PMC4211206

Virtual reality training improves balance function

Abstract

Virtual reality is a new technology that simulates a three-dimensional virtual world on a computer and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These findings suggest that virtual reality training can activate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.

Keywords: nerve regeneration, brain injury, spinal cord injury, stroke, virtual reality, balance dysfunction, mechanism, sensorimotor function, neural plasticity,vision, vestibule, proprioception, somatosensory, balance, reviews, rehabilitation, NSFC grant, neural regeneration

  Yurong Mao, Peiming Chen, Le Li, and Dongfeng Huang, M.D.

Department of Rehabilitation Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China

Corresponding author: Dongfeng Huang, Department of Rehabilitation Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China, nc.ude.usys.liam@fdgnauh.

Author contributions: Mao YR, Chen PM and Li L helped in reviewing the studies and experimental data. Huang DF critically revised the manuscript. All authors approved the final version of the paper.

Accepted July 9, 2014.

Copyright : © Neural Regeneration Research

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.