flex2play

1. An ankle strengthening device with virtual reality interface for children with cerebral palsy flex2play September 26, 2011 • BME 401 Senior Design • Mentor: Jack Engsberg, PhD • Kelly Hill (Presenter), Amanda Meppelink, Liz Phillips

2. Introduction○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Cerebral Palsy • Nonprogressive lesion in CNS during development • Characterization • Types of CP • Spasticity and Weakness • Gait • Impact on quality of life

3. Introduction○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Current Treatment Approach • Currently no cure • Treatments goals • Typical treatments • Surgical • Pharmaceutical • Orthotics • Physical, occupational, and speech therapies • Historical perspective • Recent research findings Engsberg 2007

4. Introduction ○Current Technologies ○ The Need ○ Project Scope ○ Our Approach Physical Therapy Devices for CP • Key Limitations • Lab vs home use • Cost • Reliability • Patient motivation • MIT AnklebotLokomatKinCom • Rutgers Ankle NeuroGym • Ankle Trainer

5. Introduction ○ Current Technologies ○ The Need○ Project Scope ○ Our Approach The Need • A strength training device that • is safe for in-home use • requires minimal setup or user training • is affordable • is portable • motivates patient participation

6. Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Virtual Reality in Rehabilitation • Virtual Reality • Rehabilitation Applications • Virtual Environments • Kinect • Rutgers Ankle • Wii Mirelman 2010 Sun Yat-Sen Memorial Hospital Engsberg 2011 • Rutgers Ankle

7. Introduction ○ Current Technologies ○ The Need○ Project Scope ○ Our Approach Virtual Reality in Rehabilitation • Virtual Reality • Rehabilitation Applications • Virtual Environments • Kinect • Rutgers Ankle • Wii

8. Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach The Scope To design an at-home ankle strengthening device – Flex2Play – that motivates participation by interfacing the therapy with a WiiMote which controls online video games

9. Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach 20° Dorsiflexion 0° Neutral –50° Plantarflexion Dorsiflexion τ=F*d*sin(θ) F=115Nm*0.28m*sin(90) F=402N Plantarflexion τ=F*d*sin(θ) F=173Nm*0.28m*sin(90) F=605N Specifications • Full range of motion • 20° from neutral in dorsiflexion • -50° from neutral in plantarflexion • Progressive Resistance • 115 Nm dorsiflexion torque • 173 Nm plantarflexion torque • Available in at least 15% increments • Affordable – $200 target • Portable – 8 ft3 • Virtual Reality Interface • 2010 BME401 Group “Wii Controlled Gaming for Therapy”

10. Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach Additional Design Considerations • Training muscles during concentric vs eccentric contractions • Training muscles at peak power

11. Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach The Flex2Play Approach Division of Labor • Kelly – Analytical • Preliminary • Presentation • Weekly Reports • Software • Interface • Manager • Amanda – Driver • Progress • Presentation • Schedule Manager • Design Safe • Meet weekly • with mentor • Write and revise reports • Conduct background research • Provide feedback to group • Liz – Expressive • Final Presentation • CAD Drawings • Web Designer Mentorship Dr. Jack Engsberg Dr. Frank Yin Lin Bai

12. Introduction ○ Current Technologies ○ The Need ○ Project Scope ○ Our Approach The Flex2Play Approach Schedule of Events – Design Fabrication and Optimization • – Preliminary Report • and Presentation • – FinalReport • and Presentation • – Progress Report • and Presentation – Design Safe Analysis – Concept Selection • – Choose Project • – Define Scope – Launch Website Oct 1 Nov 1 Dec 1 Sept 1

13. Works Cited • An, Tonya, Eric Boccio and Andrew Bolano. "Wii Controlled Gaming System for Therapy". BME401 Senior Design Report. St. Louis: Washington University in St. Louis, 2010. • Bax, MCO, O Flodmark and C Tydeman. "Definition and classification of cerebral palsy. From syndrome toward disease." Dev Med Child NeurolSuppl 109 (2007): 39–41. • Borggraefe, Ingo. "Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy." European Journal of Paediatric Neurology (2010): 496-502. • Cioi, D, et al. "Ankle Control and Strength Training for Children with Cerebral Palsy using the Rutgers Ankle CP." IEEE International Conference on Rehabilitation Robotics. Zurich, 2011. 654-659. • Damiano, DL and MF Abel. "Functional Outcomes of Strength Training in Spastic Cerebral Palsy." Arch Phys Med REhabil (1998): 119-125. • Dodd, KJ, NF Taylor and HK Graham. "A randomized clinical trial of strength training in young people with cerebral palsy." Developmental Medicine and Child Neurology (2003): 652-657. • Engsberg, Jack, Daniel Cioi and Janes William. "Ankle Control and Strength Training for Children with Cerebral Palsy using the Rutgers Ankle CP." IEEE International Conference on Rehabilitation Robotics (2011): 654-659. • Engsberg, JR, et al. "Gait and clinical movement analysis research priorities: 2007 Update from the research committee of the gait and clinical movement analysis society." Gait and Posture (2009): 169-171. • Engsberg, JR, SA Ross and DR Collins. "Increasing Ankle Strength to Improve Gait and Function in Children with Cerebral Palsy: A Pilot Study." Pediatric Physical Therapy (2006): 266-275. • Hocoma. Lokomat - Enhanced Functional Locomotion Therapy. 2011. 24 September 2011 <http://www.hocoma.com/en/products/lokomat/lokomatpro/>. • Levac, DE and J Galvin. "Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Application of a classification framework." Developmental Neurorehabilitation (2011): 177-184. • NeuroGym. NeuroGym Rehabilitation. 2010. 24 September 2011 <http://neurogymrehab.com/neurogym_trainer.html>. • —. NeuroGym Technologies. 2010. 24 September 2011 <http://www.neurogymtech.com/products/ankle_trainer.php>. • Roy, A., H. I. Krebs and D. J. Williams. "Robot-Aided Neurorehabilitation: A Novel Robot for Ankle Rehabilitation." Robotics (2009): 569-582.