The design and evaluation of electromyography and inertial biofeedback in hand motor therapy gaming

ABSTRACT

This article details the design of a co-created, evidence-based biofeedback therapy game addressing the research question: is the biofeedback implementation efficient, effective, and engaging for promoting quality movement during a therapy game focused on hand gestures? First, we engaged nine young people with Cerebral Palsy (CP) as design partners to co-create the biofeedback implementation. A commercially available, tap-controlled game was converted into a gesture-controlled game with added biofeedback. The game is controlled by forearm electromyography and inertial sensors. Changes required to integrate biofeedback are described in detail and highlight the importance of closely linking movement quality to short- and long-term game rewards. After development, 19 participants (8–17 years old) with CP played the game at home for 4 weeks. Participants played 17 ± 9 min/day, 4 ± 1 day/week. The biofeedback implementation proved efficient (i.e. participants reduced compensatory arm movements by 10.2 ± 4.0%), effective (i.e. participants made higher quality gestures over time), and engaging (i.e. participants consistently chose to review biofeedback). Participants found the game usable and enjoyable. Biofeedback design in therapy games should consider principles of motor learning, best practices in video game design, and user perspectives. Design recommendations for integrating biofeedback into therapy games are compiled in an infographic to support interdisciplinary knowledge sharing.

KEYWORDS:

• assessment
• biofeedback
• developmental disability
• knowledge translation
• neurorehabilitation and brain computer interfaces
• pediatrics
• recreation
• usability

Acknowledgments

We are greatly appreciative of the time and input of the clients and families who helped us build and test this system. The authors wish to acknowledge the occupational therapists and research administration staff who supported this project. Special thanks to the head of the DISI, Rémy boyer and to the head of the UFR ST, Said Mammar of the University of Evry for lending computers. And to the developer of the game, Kastriot Sulejmani. The authors also wish to acknowledge the data processing and administrative assistance of the Research Manager, Ajmal Khan.

Disclosure statement

The authors have no conflicts of interest.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research [funding reference number RN304779-379428], the Campus France Eiffel Excellence Scholarship, and the Mitacs GobaLink program. The funders have not had any role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.