How does the Kinect work?
Microsoft’s Kinect sensor is a new commercially-available motion-capture gaming console designed for use with Xbox 360 games that allow for hands-free full body movement. The Kinect combines an infrared emitter and a regular webcam. Infrared light waves bouncing off of people and objects in the room are captured and processed by software that recognizes movements and allows users movements to control games through an onscreen avatar (Kinect ref). The Kinect also allows for voice recognition. New issues in terms of the software recognizing users in seated positions (as it is programmed to recognize relationships between joints in standing) and also whether the use of gait aids or someone else providing standing support to the user interferes with sensor recognition do exist. However, the next generation of the Kinect sensor will include an expanded field of view and enhanced motion tracking, allow for six people to play simultaneously, and read users heart rates. Given its low price point and motion control interaction, the Kinect likely represents the future of accessible VR in rehabilitation.
What do we know about the Kinect in rehabilitation?
Currently there is scant evidence about the Kinect in the rehabilitation literature. Microsoft has made its software development kit (SDK) available, meaning that engineers are able to design their own games and applications for the Kinect sensor, and this is naturally where much of the literature is focused. Several publications have explored the feasibility of rehabilitation-specific games developed for the Kinect (Pastor 2012, Garcia 2012, Lange 2011 and Chang 2011). Others have looked at energy expenditure of playing Kinect Xbox 360 games as compared to other video gaming consoles (Holmes 2012, Bronner 2013, Smallwood 2012 and O’Donovan 2012). Another area of research is exploring the validity of its potential as a low-cost motion-tracking tool for biomechanical analysis or movement tracking,comparing it to gold standard motion analysis tools like the VICON camera system (Clark 2012, Guerrero 2013, Gabel 2012 and Meniplay 2013).
Evidence is emerging for use of the Kinect Xbox games in adult stroke and multiple sclerosis and pediatric CP and ataxia populations. Rajaratnam et al (2013) compared conventional rehab plus VR games (Kinect and Wii Fit) to conventional rehabilitation alone in patients after stroke, finding equal effectiveness between the 2 groups in retraining balance outcomes, while the VR game group had significantly more improvements on the Functional Reach Test. Sin & Lee (2013) also compared the effect of Kinect plus conventional OT to conventional OT alone in stroke rehabilitation on outcomes of upper extremity function, finding significant improvements after training. However, they were not able to conclude whether this was due to a Kinect effect, or the fact that this group received more therapy overall. Guiterrez (2013) compared 10 weeks of Kinect games at home in patients with MS to conventional rehabilitation, finding improved Berg and Tinetti scores in the experimental group. Luna-Oliva et al (2013) explored how 8 weeks of Kinect intervention could support conventional rehab of 11 children with cerebral palsy (CP) in a school environment, finding improvements in balance and ADLs at follow up. Ilg et al (2012) trained 10 children with degenerative spinocerebellar ataxia for eight weeks using 3 Kinect games, finding a reduction in ataxia symptoms and improved balance.
Why is it important to support its use now?
Clearly evidence is needed to support use of Kinect Xbox 360 game as an effective rehabilitation intervention. However, to sustain interest and support the design of this research, clinicians interested in using this tool now require support to understand the different game possibilities. This type of support needs to be clinically relevant and geared towards client-centered decision-making. Clinicians play an integral role in VR-based therapy (Levac and Galvin, 2012). Use of the VR as a tool requires skills such as a good understanding of the software and hardware, the different games, and the ability to problem-solve to match games to the therapeutic goal, adding therapeutic adaptations as required. Currently, most entry-level PT programs do not place a lot of emphasis on training related to integration of VR technology in practice. It is likely that most institutions and clinics do not havethe resources or time to support clinicians in needed training. As such, having this support in the form of a widely-available web-based knowledge translation (KT) resource that clinicians can access on their own time and that can also provide them with a forum for discussing with others and including their own experiences and suggestions is ideal.
- Microsoft. (2013) Kinect for Xbox 360: http://www.xbox.com/en-CA/Kinect Accessed October 30, 2013.
- O’Brien T. (2013) Microsoft’s new Kinect is Official. http://www.engadget.com/2013/05/21/microsofts-new-kinect-is-official Accessed October 30, 2013.
- Pastor I, Hayes HA, Bamberg SJ. A feasibility study of an upper limb rehabilitation system using Kinect and computer games: Conf Proc IEEE Eng Med Biol Soc. 2012;2012:1286-9. doi: 10.1109/EMBC.2012.6346173. PubMed PMID: 23366134.
- Garcia,J.A., Felix Navarro,K., Schoene,D.; Smith,S.T.; Pisan,Y. Exergames for the elderly: towards an embedded Kinect-based clinical test of falls risk: Studies in Health Technology & Informatics, 2012, 178, 51-57
- Lange B, Chang CY, Suma E, Newman B, Rizzo AS, Bolas M. Development and evaluation of low cost game-based balance rehabilitation tool using the Microsoft Kinect sensor. : Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine & Biology Society, 2011, 1831-1834
- Chang YJ, Han WY, Tsai YC. A Kinect-based upper limb rehabilitation system to assist people with cerebral palsy: Res Dev Disabil. 2013 Sep 3;34(11):3654-3659. doi: 10.1016/j.ridd.2013.08.021. [Epub ahead of print] PubMed PMID: 24012594.
- Holmes H, Wood J, Jenkins S, Winship P, Lunt D, Bostock S, Hill K. Xbox Kinect™ represents high intensity exercise for adults with cystic fibrosis: J Cyst Fibros. 2013 Jun 6. doi:pii: S1569-1993(13)00081-7. 10.1016/j.jcf.2013.05.005. [Epub ahead of print] PubMed PMID: 23746575.
- Bronner S, Pinsker R, Noah JA. Energy Cost and Game Flow of 5 Exer-games in Trained Players: Am.J.Health Behav., 2013, 37, 3, 369-380
- Smallwood SR, Morris MM, Fallows SJ, Buckley JP. Physiologic responses and energy expenditure of kinect active video game play in schoolchildren: .Arch.Pediatr.Adolesc.Med., 2012, 166, 11, 1005-1009
- O’Donovan C, Roche EF, Hussey J. The energy cost of playing active video games in children with obesity and children of a healthy weight: Pediatr Obes. 2013 Apr 29. doi: 10.1111/j.2047-6310.2013.00172.x. [Epub ahead of print] PubMed PMID: 23630041.
- Clark RA, Bower KJ, Meniplay BF, Paterson K, Pua YH. Concurrent validity of the Microsoft Kinect for assessment of spatiotemporal gait variables. : J Biomech. 2013 Oct 18;46(15):2722-5. doi: 10.1016/j.jbiomech.2013.08.011. Epub 2013 Aug 26. PubMed PMID: 24016679.
- Clark RA, Pua YH, Bryant AL, Hunt MA. Validity of the Microsoft Kinect for providing lateral trunk lean feedback during gait retraining: Gait Posture. 2013 Sep;38(4):1064-6. doi: 10.1016/j.gaitpost.2013.03.029. Epub 2013 May 3. PubMed PMID: 23643880.
- Guerrero C, Uribe-Quevedo A. Kinect-based posture tracking for correcting positions during exercise: Stud Health Technol Inform. 2013;184:158-60. PubMed PMID: 23400149.
- Gabel M, Gilad-Bachrach R, Renshaw E, Schuster A. Full body gait analysis with Kinect: Conf Proc IEEE Eng Med Biol Soc. 2012;2012:1964-7. doi: 10.1109/EMBC.2012.6346340. PubMed PMID: 23366301.
- Rajaratnam BS, Gui Kaien J, Lee Jialin K, Sweesin K, Sim Fenru S, Enting L, Ang Yihsia E, Keathwee N, Yunfeng S, Woo Yinghowe W, Teo Siaoting SDoes the Inclusion of Virtual Reality Games within Conventional Rehabilitation Enhance Balance Retraining after a Recent Episode of Stroke?: Rehabil Res Pract. 2013;2013:649561
- Sin H, Lee G. Additional virtual reality training using xbox kinect in stroke survivors with hemiplegia: Am J Phys Med Rehabil. 2013 Oct;92(10):871-80. doi: 10.1097/PHM.0b013e3182a38e40. PubMed PMID: 24051993.
- Gutiérrez RO, Galán Del Río F, Cano de la Cuerda R, Alguacil Diego IM, González RA, Page JC (2013) A telerehabilitation program by virtual reality video games improves balance and postural control in multiple sclerosis patients: Neurorehabilitation 2013 Sep 12; PMID: 24029009
- Luna-Oliva L, Ortiz-Gutiérrez RM, Cano-de la Cuerda R, Piédrola RM, Alguacil-Diego IM, Sánchez-Camarero C, Martínez Culebras MD. Kinect Xbox 360 as a therapeutic modality for children with cerebral palsy in a school environment: A preliminary study: NeuroRehabilitation. 2013 Sep 9. [Epub ahead of print] PubMed PMID: 24018364
- Ilg W, Schatton C, Schicks J, Giese MA, Schöls L, Synofzik M.Video game-based coordinative training improves ataxia in children with degenerative ataxia: Neurology. 2012 Nov 13;79(20):2056-60. doi: 10.1212/WNL.0b013e3182749e67. Epub 2012 Oct 31.
- Levac D, Galvin J. (2013) When is virtual reality ‘therapy’? Archives of Physical Medicine & Rehabilitation: 94(4):795-8
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