title: MaLT - Combined Motor and Language Therapy Tool for Brain Injury Patients Using Kinect.
abstract: BACKGROUND
  The functional connectivity and structural proximity of elements of the language and motor systems result in frequent co-morbidity post brain injury. Although rehabilitation services are becoming increasingly multidisciplinary and "integrated", treatment for language and motor functions often occurs in isolation. Thus, behavioural therapies which promote neural reorganisation do not reflect the high intersystem connectivity of the neurologically intact brain. As such, there is a pressing need for rehabilitation tools which better reflect and target the impaired cognitive networks.
  
  
  OBJECTIVE
  The objective of this research is to develop a combined high dosage therapy tool for language and motor rehabilitation. The rehabilitation therapy tool developed, MaLT (Motor and Language Therapy), comprises a suite of computer games targeting both language and motor therapy that use the Kinect sensor as an interaction device. The games developed are intended for use in the home environment over prolonged periods of time. In order to track patients' engagement with the games and their rehabilitation progress, the game records patient performance data for the therapist to interrogate.
  
  
  METHODS
  MaLT incorporates Kinect-based games, a database of objects and language parameters, and a reporting tool for therapists. Games have been developed that target four major language therapy tasks involving single word comprehension, initial phoneme identification, rhyme identification and a naming task. These tasks have 8 levels each increasing in difficulty. A database of 750 objects is used to programmatically generate appropriate questions for the game, providing both targeted therapy and unique gameplay every time. The design of the games has been informed by therapists and by discussions with a Public Patient Involvement (PPI) group.
  
  
  RESULTS
  Pilot MaLT trials have been conducted with three stroke survivors for the duration of 6 to 8 weeks. Patients' performance is monitored through MaLT's reporting facility presented as graphs plotted from patient game data. Performance indicators include reaction time, accuracy, number of incorrect responses and hand use. The resultant games have also been tested by the PPI with a positive response and further suggestions for future modifications made.
  
  
  CONCLUSIONS
  MaLT provides a tool that innovatively combines motor and language therapy for high dosage rehabilitation in the home. It has demonstrated that motion sensor technology can be successfully combined with a language therapy task to target both upper limb and linguistic impairment in patients following brain injury. The initial studies on stroke survivors have demonstrated that the combined therapy approach is viable and the outputs of this study will inform planned larger scale future trials.
authors.affiliation: Maitreyee Wairagkar, Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights, Reading RG6 6AY, UK, E-mail: m.n.wairagkar@pgr.reading.ac.uk.
authors.forename: Maitreyee
authors.initials: M
authors.lastname: Wairagkar
authors.forename: Rachel
authors.initials: R
authors.lastname: McCrindle
authors.forename: Holly
authors.initials: H
authors.lastname: Robson
authors.forename: Lotte
authors.initials: L
authors.lastname: Meteyard
authors.forename: Malcom
authors.initials: M
authors.lastname: Sperrin
authors.forename: Andy
authors.initials: A
authors.lastname: Smith
authors.forename: Moyra
authors.initials: M
authors.lastname: Pugh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000503:physiopathology* / Q000628:therapy*; D005246:Feedback; D006801:Humans; D007808:Language Therapy; D008875:Middle Aged; D009043:Motor Activity; D010865:Pilot Projects; D013223:Statistics as Topic; D013647:Task Performance and Analysis; D013997:Time Factors; D018910:Video Games
keywords: Kinect; Multidisciplinary; brain injury; games based therapy; language rehabilitation; motor rehabilitation; stroke