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In 2006, researcher Marsha Melnick was running out of ideas for how to get her therapeutic exercise program into the living rooms of Parkinson's patients. For years, she had been trying to adapt the program, which employs clinically tested physical movements to improve gait and balance, into an accessible format for people to use at home. But the National Institutes of Health had already rejected a grant to make a video of it, so Melnick, a clinical professor of physical therapy at the University of California, San Francisco, with her collaborator Glenna Dowling, applied again, this time for a grant to make a DVD of the program. But she was rejected a second time.
Image courtesy of Red Hill Studios
So Melnick and Dowling, chair of UCSF's Department of Physiological Nursing, reached out to Red Hill Studios, an interactive media company thirty minutes north of San Francisco. They thought it might help to make a professionally-produced sample video to include in grant applications. "Sure, we can do video," responded Red Hill founder and creative director Bob Hone, "but by the way, there's this new thing called the Wii."
"Great!" responded Dowling, and an unlikely collaboration was born. The team would eventually create an interactive game to help people suffering from Parkinson's -- a chronic and progressive neurodegenerative disease causing tremors, rigidity, slow movement, and impaired balance -- improve their bodies' movement. Strengthening muscles and flexibility through the repetition of specific, targeted movements, the game's interactivity helps to motivate Parkinson's patients to work on their rehabilitation at home.
Since 2007, the UCSF School of Nursing and Red Hill Studios have won $1.1 million in small business technology transfer grants from the NIH to develop a proposed "Wii-hab" program for people with Parkinson's. Rather than try to manipulate an off-the-shelf game, Red Hill built one from scratch based on Melnick's exercise program.
The game, called "Rail Runner," features an old-fashioned rail cart moving along a track. Players move through a virtual desert landscape by standing up to lift the cart's lever and sitting to push it down. "A video game interface is very immersive, and they'll do the exact same motion over and over in the game," says Bill Dwyer, senior producer at Red Hill who was previously a director of art at commercial video game maker Stormfront Studios. As in any game, changing levels and difficulty keeps players engaged. And thanks to the inherent record-keeping design of a video game, physical therapists can print out and review their patients' progress over time.
Last year, Melnick and Dowling tested the game in peoples' homes, where they will be most likely to use it. "The feedback was really good," says Dowling. The majority of people said they would play the game three to five times a week, far more often than they'd be likely to attend exercise classes. "A few said, 'This will be fun. My grandkids will love coming over to exercise with me'," says Melnick.
The game is currently designed to supplement a physical therapy program, rather than replace it, says Dowling. "Physical therapy isn't always covered by insurance, so this is a cost effective way to continue a program at home."
The team has completed phase I of the grant, testing the feasibility and safety of the game and its exercise regimen. In phase II, Red Hill is building a suite of seven games, in addition to "Rail Runner," to address various motions from Melnick's exercise program. The games will hopefully include a web interface, says Dowling, so players can compete against each other and physical therapists can track patient progress remotely. The team is designing the games to improve patients' stride length and gait speed -- quantifiable outcomes that will be assessed in a clinical trial in the fall, says Dowling. "We want this to be as applicable and real world as possible," she says.
UCSF and Red Hill have also begun a phase I trial of a prototype game based on movements shown to improve motor control for children with cerebral palsy. In the game, children spread their arms and lean from side to side to glide an airplane through an obstacle course, a way to practice shifting balance and improve their ability to walk. "They just love being able to play a game," says Dowling. "They know they're working on therapy, but [playing games] is what everyone else in the neighborhood does, so it excites them to be doing it too," adds Melnick.
During a round of testing the airplane game with children, "the physical therapists were practically in tears," says Dwyer. The kids had been playing for an hour and were asked if they wanted to take a break. "No!" they exclaimed. "We want to keep flying!"