July 28, 2011

Tablet Therapy















Griffin Wajda normally doesn't answer questions. Often, the 10-year-old boy will mumble repeated phrases before being coaxed to talk.But at a once-a-week afterschool program run by University of Iowa researchers at an elementary school here, he has started opening up. Recently sitting in front of a Dell touch-screen tablet computer, he traced a big circle with a stylus around a group of stick figures drawn moments before by his brother seated across from him. When his mother asked him to explain the picture, he replied, "Summer school."


Griffin was learning to interact with his brother with the help of a collaborative-storytelling app designed by the Iowa researchers that requires autistic children to imagine stories aloud with their peers as they add on to each other's drawings on the touch screen.

Multitouch technology—which turned smartphones, iPads and other tablet computers into consumer sensations—has a new function: therapy for cerebral palsy and autism spectrum disorders, as well as a range of developmental disabilities. Researchers from at least three North American universities, including Iowa, are developing therapeutic applications for multitouch devices. Games developed by the Scientists' Discovery Room Lab at Harvard University, and by University of Alberta researcher Michelle Annett, encourage children with cerebral palsy and stroke victims to stretch their range of upper arm and wrist motion.

"It's a very motivating tool for the patients. It's visual, the feedback is instant and it's fun," said Isabel Henderson, vice president of Glenrose Rehabilitation Hospital in Edmonton, Canada, where games on a touch-screen table are part of stroke victims' physical rehabilitation.

The new apps offer patients engaging ways to address their medical conditions over the long term, said Quentin Ranson, an occupational therapist at the Alberta hospital. They also could help reduce the time patients need to spend in expensive traditional therapy, Mr. Ranson said.

One out of 110 children in the U.S. is affected by autism spectrum disorders, the diagnostic term for describing the range of lower- and higher-functioning autistic children, while 1 out of about 300 children has cerebral palsy, according to the Centers for Disease Control and Prevention. One out of every 380 Americans each year suffers a stroke, the third leading cause of death after heart disease and cancer in the U.S.

Standard social and physical therapies can be rote and fail to engage patients, therapists admit. The gold-standard therapy for autism spectrum disorders is Applied Behavior Analysis, a "drill and practice" of social behaviors such as answering questions and making everyday conversation, said Deb Scott-Miller, a special-education consultant involved in the Iowa City afterschool program.

Children with cerebral palsy—a group of disorders caused by brain damage before or shortly after birth—work to improve their motor skills and coordination through repetitive exercises like wiping a cloth across a table, stringing beads on a pipe cleaner or throwing a ball back and forth. Patients recovering from stroke do much of the same, stacking cones and flipping cards to help them lift their arms against gravity.

"We've been doing these [traditional] therapies for 30 to 40 years with little or no change," said Mr. Ranson in Alberta. "But we're at a real turning point in our profession" with the use of multitouch technology.

During Harvard's test trials last fall, children with cerebral palsy played "Catch the Butterflies" on Microsoft Surface touch-screen tables by holding a rubber ball to the angled surface to control the position of a virtual butterfly jar. Using a stylus in the other hand, they "captured" butterflies flitting about on the screen and slid them into the jar. A device the children wore recorded the tilt of their torsos and disrupted the game when they tried to compensate for their limited range of arm motion by leaning in toward the screen.

To encourage children and adults to exercise impaired sides of their bodies, therapists can adjust the speed and location of moving targets in the games. The Alberta researchers' "Pop Those Balloons" records the precise reaction time of patients down to the split second—something occupational therapists can't easily do.

"We knew we wanted to innovate to do what physical games can't accomplish," said Chia Shen, a co-director of the Harvard team.

Therapists occasionally use off-the-shelf Nintendo Wii games to work on improving patients' range of motion, but they say the games start at levels too difficult for most patients. Some rehab centers use 3-D, virtual-reality machines to help patients simulate driving and other practical tasks, but they are very costly and often untested. Mr. Ranson and others also think overstimulation can be counter-productive. "There's absolutely no way our clients could handle the sensory overload," he said.

The apps still need to be used in conjunction with other therapies, said Michelle Coldwell, an occupational therapist at Boston's Spaulding Rehabilitation Hospital who helped conduct trials on multitouch games at Children's Hospital Boston last year. Children need to be taught the basics of independent daily life, such as how to brush their teeth and get dressed, she said, and those skills can't be taught with an app. The current apps only help develop the upper extremities, not the legs and feet.

Still, the games are proving helpful for some patients. Griffin barely spoke after 18 months of age, and he was diagnosed with autism at age 3. Although a traditional therapy called Applied Behavior Analysis "worked wonders" for him, according to his mother Dava Wajda, his learning and communication skills were still far behind his peers. In 2004, the family moved from Omaha to Iowa City, which has more facilities available for autistic kids. During the school year, he is involved in four hours of different therapies a week, but he looks forward most to multitouch therapy, Ms. Wajda said. Now, she says he answers questions and follows directions from time to time, and takes turns on collaborative games with his brother, Brodey, a higher-functioning autistic child who is also in the program. "The kids love it. They don't even see it as work, they see it as fun," she said.

In the Iowa afterschool program, an 8-year-old autistic boy smiled after manipulating the face of app designer Juan Pablo Hourcade on the Photogoo app, which allows children to learn facial emotions. Two children with Asperger's syndrome, a developmental disorder at the milder end of the autism spectrum, drew illustrations on the touch screen and zoomed into characters' heads to write in thoughts as they told the tale of a biker who pedaled toward the sun.

Dr. Hourcade has made his apps available free of charge as an online download because he believes universities must "do the research that businesses can't."

Researchers say efficacy studies on the apps are required before they can be commercially viable. With no federal agency regulating technology that claims to aid therapy, charitable agencies and therapists only start using new games after they see "solid research" or recommendations from fellow agencies, said Monica Ryan-Rausch, an Asperger's specialist in the Iowa City program.

Word of mouth led to "thousands" of downloads of a multitouch therapy-aiding app called Proloquo2Go, says its developer, Amsterdam-based David Niemeijer. Available for $189.99 at Apple's App store, Proloquo2Go is designed to help people who aren't verbal—which includes many with autism, cerebral palsy and stroke—to communicate by pressing symbol buttons or typing sentences into an iPhone or iPad, which will then speak for them.

Similar "Augmentative and Alternative Communication" tools can cost $4,000 to $7,000 dollars and run on computer-like devices rather than the iPad, says Mr. Niemeijer, chief executive and founder of AssistiveWare, a private company that specializes in technology that assists people with disabilities.

Mr. Niemeijer, a former university researcher, says he hasn't conducted formal studies on the app's efficacy. He says he is letting the users and therapists decide if it's effective.

Meanwhile, Mr. Ranson said he is following the lead of a 68-year-old patient who suffers from apraxia, the inability to perform purposeful motions, like picking up a pen, due to brain damage. After playing the popular "Angry Birds" game for two hours every night on an iPad—of her own volition—her fine motor skills have improved tremendously, said Mr. Ranson, who has started a checklist of available iPad apps that can help patients practice different motor functions.


(Source: WSJ)

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