Playing to Heal
Imagine if tying your shoes exhausted you. Brushing your teeth, sitting up in bed—mundane actions you’ve done all your life are now inordinately difficult.
It can happen. Each year, 795,000 people in the United States suffer a stroke—a sudden attack caused by a clot or hemorrhage in the brain. If treated quickly, they survive. But the damage from a stroke can include the loss of motor functions or physical sensation.
If you were a stroke survivor, what would you be willing to do in order to retrain your body and brain? Would you be willing to lift your leg 20 times per day, even if it completely fatigued you? How about 100 times? 1,000?
Would it be easier if it were a game?
IU’s Hamid Ekbia thinks the answer to the last question is “yes.” That’s why the School of Informatics and Computing professor is leading a project to create a special kind of game that serves stroke survivors and their physical therapists. “The most accurate term for it would be an interactive therapy platform that connects patients and therapists via telecommunication,” explains Ekbia.
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The technology for such a platform is probably familiar to you—it’s actually available at Target right now. It’s called Xbox Kinect™, a video game accessory featuring a camera that can sense your movements. “That device was a breakthrough,” Ekbia says. “Prior to that—for the purposes of the system we’re developing—you would have had to attach sensors to people’s bodies or have them use a controller.”
What makes Ekbia’s system innovative is that it turns this hardware into a tool that helps patients recover. This is done by creating games to lead a patient through specific movements. These movements leverage neuroplasticity, which is the brain’s ability to rebuild neural pathways through physical activity—such as lifting an arm repeatedly.
IU Health Bloomington physical therapist Steve Wiley feels a system like Ekbia’s has great potential for his patients. Wiley, a therapist for nearly 20 years, specializes in working with geriatric and neurologically impacted patients such as stroke victims. He believes this tool will help them get back on the move.
Making Recovery Fun
What therapists like Wiley need is a game they can control. “With the system Professor Ekbia is developing, I can change the intensity and tailor the movement to the patient. I can also adjust the number of repetitions,” he says.
In addition, such a system can provide feedback to both patient and caregiver. It can instantly tell a patient that she needs to lift her arm higher or more to the left. It can encourage her to try again. The system can also record what the patient did, how well she did it, and share that data among multiple caregivers. “That data gives me immediate feedback to help customize the therapy for that patient,” notes Wiley.
Plus, games are fun. Remember the idea of lifting your arm multiple times? Therapists like Wiley may prescribe that a patient repeat a motion 100 times over many days. Is the patient likely to do it?
“No, unfortunately they are not—even if I asked them to do it only 20 times,” notes Wiley. Not only are such exercises rote and routine, they are also physically challenging. “Anything that can make physical therapy more fun is something I would be excited to see,” adds Wiley.
The social nature of games can also keep patients motivated. “If you can create an environment where patients play together, whether remotely or in person, it can provide additional motivation,” explains Wiley. "You can also incorporate family members, which studies have shown can be very instrumental in the recovery process.”
Despite its promise, there are challenges to developing such a system. “Every time I am interviewed, I always mention the policy issue,” says Ekbia. Currently, insurance and Medicare do not reimburse care-providers for virtual or computer-mediated interactions with patients.
Funding is also an issue. Ekbia’s team includes software developers, game designers, and therapists like Wiley, who are contributing to the project because they believe in its potential. “We have made use of local and IU student talent to create a prototype,” Ekbia says. “But we have been unable to bring anyone full-time onto the project.”
Financial support would mean that the system would become available sooner to patients who need it. Ekbia has discussed the possibility of incorporating his system into regional clinics operated by the U.S. Department of Veterans Affairs. These clinics serve the VA’s sizable rural patient population, relieving them of the need to travel far distances to VA hospitals for care.
For these patients—and many others—every step toward this system’s completion is one step closer to healing.
Innovations like Ekbia’s need private support to become a reality. To learn how you can support Professor Hamid Ekbia’s work, contact Matt vandenBerg, assistant dean of development and alumni relations at the School of Informatics and Computing, at 812-856-0743 or firstname.lastname@example.org.