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Knols R1,2, Swanenburg J1,3, Wütrich F4, De Bon D2, Gennaro F2, Bettex D5, De Bruin E2,6
1University Hospital Zurich, Directory of Research and Education, Physiotherapy Occupational Research Centre, Zurich, Switzerland, 2ETH Zurich, Department of Health Sciences and Technology (D-HEST), Institute of Human Movement Sciences and Sport, Zurich, Switzerland, 3Balgrist University Hospital, Integrative Spinal Research ISR, Department of Chiropractic Medicine, Zurich, Switzerland, 4University Hospital Zurich, Physiotherapy & Occupational Therapy PEU, Zurich, Switzerland, 5University Hospital Zurich, Institute of Anesthesiology, Zurich, Switzerland, 6Karolinska Institute, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
Background: Physical and cognitive deterioration may occur after surgery in heart patients on the Intensive Care Unit (ICU). These patients may benefit from structured, challenging, and repetitive videogame-based training.
Purpose: To determine the usability of a purpose developed bedside exergaming console (COPHYCON) and the acute effects of exergaming.
Methods: Eight elective heart surgery patients were recruited. Usability, security, acceptance of the COPHYCON and acute training effects were evaluated. Eligible patients performed a cognitive game intervention (CogniPlus, SCHUHFRIED Austria), including exercises aimed at improving awareness (ALERT) and selective attention (SELECT) for maximum 5 days on the ICU of a University Hospital. Acceptance was assessed with the Technology Acceptance Model (TAM) together with measures of the achieved game level, gaming reaction times, correct responses during ALERT and SELECT videotraining. Regional cerebral hemoglobin saturation (rS02%), as measure of prefrontal cortical involvement of the brain, was assessed with functional near infrared spectroscopy (fNIRS). Results of ICU patients were compared to healthy elderly (n=5) assessed in a one time ambulatory session.
Results: Five patients were able to perform at least one complete ALERT and SELECT videotraining on the first day of the investigation. Of these five, three patients could perform in both the ALERT and SELECT games on two, three and five ongoing days on the ICU. For three patients, it remained too challenging, due to tiredness. There were no adverse events. Perceived usefulness and perceived ease of use (acceptance) of the COPHYCON were moderate to high in those patients able to perform videotraining in both the ALERT and SELECT games, as well as in the healthy elderly. The ALERT reaction speed varied between 647 ms and 907 ms in the patients (healthy 399-481 ms). The correct responses varied between 50% and 85% (healthy 70-90%). The reaction speed of SELECT gaming varied between 647 ms and 1013 ms (healthy 399-481 ms) and the correct responses between 28% and 87% (healthy 99-100%), respectively. There was a small, but significant decrease of rS02% in the right prefrontal cortex compared to the left prefrontal cortex in both the patients and the healthy individuals (p 0.001), after videotraining in the ALERT and SELECT games
Conclusion(s): This study demonstrates that the game-based intervention was perceived useful by ICU patients with sufficient vigilance. A small but positive acute effect on prefrontal cortical involvement in both the patients and healthy participants was retrieved. Further testing of exergaming devices with the intention to maintain and or improve brain function in a larger sample ICU patients in a clinical setting is warranted.
Implications: Usability studies provide valuable insights for information technology developers and rehabilitation specialists who wish to use innovative approaches to rehabilitate their patients. Findings of this work are relevant to inform the development of new emerging virtual reality-based rehabilitation methods that try to enhance prefrontal cortical involvement in ICU patients.
Keywords: Critical Care, Usibility, Exergames
Funding acknowledgements: The Swiss Heart Foundation and the Swiss Physiotherapy Association (Physioswiss)
Purpose: To determine the usability of a purpose developed bedside exergaming console (COPHYCON) and the acute effects of exergaming.
Methods: Eight elective heart surgery patients were recruited. Usability, security, acceptance of the COPHYCON and acute training effects were evaluated. Eligible patients performed a cognitive game intervention (CogniPlus, SCHUHFRIED Austria), including exercises aimed at improving awareness (ALERT) and selective attention (SELECT) for maximum 5 days on the ICU of a University Hospital. Acceptance was assessed with the Technology Acceptance Model (TAM) together with measures of the achieved game level, gaming reaction times, correct responses during ALERT and SELECT videotraining. Regional cerebral hemoglobin saturation (rS02%), as measure of prefrontal cortical involvement of the brain, was assessed with functional near infrared spectroscopy (fNIRS). Results of ICU patients were compared to healthy elderly (n=5) assessed in a one time ambulatory session.
Results: Five patients were able to perform at least one complete ALERT and SELECT videotraining on the first day of the investigation. Of these five, three patients could perform in both the ALERT and SELECT games on two, three and five ongoing days on the ICU. For three patients, it remained too challenging, due to tiredness. There were no adverse events. Perceived usefulness and perceived ease of use (acceptance) of the COPHYCON were moderate to high in those patients able to perform videotraining in both the ALERT and SELECT games, as well as in the healthy elderly. The ALERT reaction speed varied between 647 ms and 907 ms in the patients (healthy 399-481 ms). The correct responses varied between 50% and 85% (healthy 70-90%). The reaction speed of SELECT gaming varied between 647 ms and 1013 ms (healthy 399-481 ms) and the correct responses between 28% and 87% (healthy 99-100%), respectively. There was a small, but significant decrease of rS02% in the right prefrontal cortex compared to the left prefrontal cortex in both the patients and the healthy individuals (p 0.001), after videotraining in the ALERT and SELECT games
Conclusion(s): This study demonstrates that the game-based intervention was perceived useful by ICU patients with sufficient vigilance. A small but positive acute effect on prefrontal cortical involvement in both the patients and healthy participants was retrieved. Further testing of exergaming devices with the intention to maintain and or improve brain function in a larger sample ICU patients in a clinical setting is warranted.
Implications: Usability studies provide valuable insights for information technology developers and rehabilitation specialists who wish to use innovative approaches to rehabilitate their patients. Findings of this work are relevant to inform the development of new emerging virtual reality-based rehabilitation methods that try to enhance prefrontal cortical involvement in ICU patients.
Keywords: Critical Care, Usibility, Exergames
Funding acknowledgements: The Swiss Heart Foundation and the Swiss Physiotherapy Association (Physioswiss)
Topic: Robotics & technology; Critical care; Disability & rehabilitation
Ethics approval required: Yes
Institution: University Hospital Zurich
Ethics committee: Cantonal Ethics Committee of Zurich
Ethics number: 2013-0571
All authors, affiliations and abstracts have been published as submitted.
