Game-Based Rehabilitation for Myoelectric Prosthesis Control.
BACKGROUND
A high number of upper extremity myoelectric prosthesis users abandon their devices due to difficulties in prosthesis control and lack of motivation to train in absence of a physiotherapist. Virtual training systems, in the form of video games, provide patients with an entertaining and intuitive method for improved muscle coordination and improved overall control. Complementary to established rehabilitation protocols, it is highly beneficial for this virtual training process to start even before receiving the final prosthesis, and to be continued at home for as long as needed.


OBJECTIVE
The aim of this study is to evaluate (1) the short-term effects of a commercially available electromyographic (EMG) system on controllability after a simple video game-based rehabilitation protocol, and (2) different input methods, control mechanisms, and games.


METHODS
Eleven able-bodied participants with no prior experience in EMG control took part in this study. Participants were asked to perform a surface EMG test evaluating their provisional maximum muscle contraction, fine accuracy and isolation of electrode activation, and endurance control over at least 300 seconds. These assessments were carried out (1) in a Pregaming session before interacting with three EMG-controlled computer games, (2) in a Postgaming session after playing the games, and (3) in a Follow-Up session two days after the gaming protocol to evaluate short-term retention rate. After each game, participants were given a user evaluation survey for the assessment of the games and their input mechanisms. Participants also received a questionnaire regarding their intrinsic motivation (Intrinsic Motivation Inventory) at the end of the last game.


RESULTS
Results showed a significant improvement in fine accuracy electrode activation (P<.01), electrode separation (P=.02), and endurance control (P<.01) from Pregaming EMG assessments to the Follow-Up measurement. The deviation around the EMG goal value diminished and the opposing electrode was activated less frequently. Participants had the most fun playing the games when collecting items and facing challenging game play.


CONCLUSIONS
Most upper limb amputees use a 2-channel myoelectric prosthesis control. This study demonstrates that this control can be effectively trained by employing a video game-based rehabilitation protocol.
Christian Doppler Laboratory for Restoration of Extremity Function, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria.
Cosima
http://orcid.org/0000-0001-9379-5110
C
Prahm
Clinic for Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, Department of Neurorehabilitation Systems, University Medical Center Göttingen, Göttingen, Germany.|Department of Bioengineering, Imperial College London, London, United Kingdom.
Ivan
http://orcid.org/0000-0002-7394-9474
I
Vujaklija
Human Computer Interaction Group, Institute for Design and Assessment of Technology, Technical University of Vienna, Vienna, Austria.
Fares
http://orcid.org/0000-0002-0896-4715
F
Kayali
Human Computer Interaction Group, Institute for Design and Assessment of Technology, Technical University of Vienna, Vienna, Austria.
Peter
http://orcid.org/0000-0001-5453-5631
P
Purgathofer
Christian Doppler Laboratory for Restoration of Extremity Function, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria.
Oskar C
http://orcid.org/0000-0001-5530-726X
OC
Aszmann
EMG control; gaming; intrinsic motivation; neuromuscular rehabilitation; serious games; upper extremity amputees; upper limb prosthesis control