Can Physiotherapy Computer Games be Beneficial to Therapists?

[MegaFutureGames]

Hello and good day to you all.

We are Mega Future Games, a computer games and physiotherapy start-up company from Ireland. I have a few questions on the use of technology and games in physiotherapy, from the physiotherapist's point of view. Any and all opinions and feedback will help us. Thank you all in advance.

About Us: We are a multiple award winning team of games developers. We have won global contests in this area and worked with Microsoft and Intel (amongst others, as Team Symbiote) and our physiotherapy games are in currently being played in care homes in Finland. Our goal is to help people who sufferer from conditions that require physiotherapy and to help make physiotherapy a more fun and engaging process for all.


Questions:

1) Most patients under-adhere to their exercises, making them less effective. Would it benefit the physiotherapist to see an increase in the adherence of patients?

2) What are the major problems faced by physiotherapist when working with patients?

3) Is there any technological tools or solutions commonly used in physiotherapy?

4) Would it be beneficial for a physiotherapist to have access to detailed analytical data for their patients (i.e. the amount of time they exercise, when, which exercises, how well the perform etc.)?

5) Would it be beneficial for patient's exercises if they included a social interaction element? (e.g. performing exercises as a group or with a family member / friend)

6) If patients could play games at home that encourage exercise, increase adherence to therapy and produced analytical data that a therapist could monitor from a website and use in treatment, would this be something you would consider using as part of your service?

7) Would you be willing to pay for this service (see question 6), assuming it was appropriately priced?



Thank you all for your time. We graciously await your response,

-Mega Future Games

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[Fyzzio]

My answers:

1) I disagree; but as to your question: yes (who would say 'no'???)
2) To have enough time for assessment, analysis and documentation in the first session.
3) Diaries, calendars, phone reminders, communication devices, treadmills/ exercycles etc., Wii, X-Box
4) yes
5) sometimes; but it could be a hindrance more than a benefit
6) yes
7) Me??? Absolutely not a single cent. Encouraging compliance and encouraging patients to become major leaders in their own rehab is part of a Physio programme. I would prefer to find out why their compliance is poor and change the programme, rather than accept under adherance and let them play a game, which in any case will be far less specific than an individualised exercise programme can ever be.

And a comment to your questions: you might want to ask the Physios that answer to questions in what kind of area within Physio and in what environment they work. As this will influence their responses.

Good luck,
Fyzzio

[MegaFutureGames]

Thank you Fyzzio for your helpful feedback.

To reply to some of the points you made:

1) You disagreed that most patients under adhere to their exercises. According to my research this is true, but I have been looking at long-term conditions such as Parkinson's Disease. According to groups such as Parkinson's UK about 70% of people living with this condition under adhere. Perhaps I wasn't specific enough or I generalized too much. I will look more into more common conditions as well.

5) Can you please elaborate? In which way might it be more of a hindrance?

7) Again, I may have not been specific enough in my description. Should you find that the poor compliance is due to lack of motivation or a dislike of the repetition. Speaking from personal experience I have not performed all my physiotherapy when I was younger as I found it to be very repetitive and I disliked to take time out to do it. If this was the case with a patient and they expressed an interest in playing a game as part of their exercises, would you then consider prescribing this service?


Thanks again for your help. It is much appreciated.

-Mega Future Games

[Fyzzio]

Hi,

1) That's a research that you will not be able to generally translate to other conditions. Parkinson's is progressive - I do not doubt at all that therapists working with this client group will have a very difficult task ahead to keep patients sticking to an exercise programme. But you will find that most of us, most of the time will work with patients that are expected to recover/ improve. So the motivation in regards to "if you do this you will improve better and faster" is very different to "if you do this your decline might be not quite as bad".

5) Two sides to this: If you have to do a programme with another person, you will have to rely on this person being present. That requires you to make a plan/ appointment/ co-ordinate activities etc.., rather than being able to do the exercises whenever it suits you. Also, the other person is likely to be always better than you/ the patient. Not necessarily encouraging.

7) I think your comment to 'dislike taking time out to do exercises' is one of the biggest factors. Alongside with wrong approaches of therapist to prescribe exercises, e.g. giving them a script vs. asking them whether they like to invest into their own rehab. Goal setting and the likes. And as I said above, when indicated, we use Wii and X-Box games as home based exercises. We also use audio-visual games on the computer. As far as I know, there is quite a bit of research out already about the places and benefits of such interventions.

Generally, I wanted to highlight that you ask very generalised questions to a very broad target audience. The Physios working on General Surgery or on any other acute hospital ward will not be likely at all to use games. Others, e.g. in Outpatients might recommend it as home based exercises but won't have time to actually practice this with their patients. Also the game might be fun but not specific enough to address a certain deficit. In rehab or rest homes etc. they might use it in a group setting where they have a therapist alongside (that's by the way probably the only place where I can see this working and being cost effective).
I find that I spend a lot of time having to search through games (e.g. play them myself) in order to find whether they are appropriate for a particular patient - and time is luxury. And often - once they are doable for the patient (e.g. ease of movement, correct speed) - they are so boring that patients loose interest after a short time.

I find your comment interesting about your Physio games that are done in care homes. How does it work? The residents that have physical deficits take the game and play it every day? And everyone does their specifically designed programme? Or is it more like everywhere else where a group session is planned every day and a facilitator devises the programme?

But don't get me wrong. I would love you to prove me wrong and develop something that is adaptable and not too pricey while it can be used in a variety of settings (preferably portable) for a broad spectrum of patients with a large scale of differences in age and cognitive functioning.
Let me know !!!!
Cheers,
Fyzzio

[MegaFutureGames]

Interesting, very interesting. Thank you again for the feedback, as you said, "Time is luxury" and I appreciate yours.

To your question, currently our games are being prepared for longitudinal trials in Finland. At the moment our game focuses on the hands, using the Finger Touch, Finger Walk and Wrist Rotations exercises. We are working on incorporating more body parts and exercises as we develop. The games recognize each user from the test group and adjusts the game difficulty and sensitivity based on their previous performances (and recalculates these values at the end of the days session). This test group contains a variety of conditions, including people who do these exact exercises among others. A healthcare professional will be there to observe during the trial but the goal is to have the system not require medical supervision. Each day the patients play through the games that are relevant to there programme and the game gives them feedback on how well they are preforming them. The feedback is also available to the therapist.

The games themselves include building small structures, exploring an environment and solving a maze. We also have a co-operative card game in the works, similar to solitaire that use the exercises to place the cards.

The following is a link to the initial publication of our work: Exploring interactive gameplay for well-being enhancement ? How an international cooperation involving a multi-disciplinary team are developing state-of-the-art 3D computer games for special-needs users | Finn | AMK-lehti // Journal of Finnish Univer

A lot of the games that are used in physiotherapy at the moment are not specifically designed for medical use. I can see why games that are simple enough for most people to use are too simple to be entertaining for very long (at least the Wii Games I've seen used). this is why we are working on games that are adaptive and adjustable, while the entertaining elements are kept intact. This is also why I asked about the social interaction as multilayer co-operative elements can be used too.

I hope this has been of some help or interest to you.

-Mega Future Games

[Fyzzio]

That sounds really cool.
If you have got any updates or new developments, I wouldn't mind if you send me a message.
Cheers, Fyzzio