Development and pilot testing of novel game-based respiratory rehabilitation exercise devices for patients with tetraplegia

Abstract

BACKGROUND: Individuals with spinal cord injuries (SCI) show restricted breathing patterns with reduced lung volumes and capacities. OBJECTIVE: To improve breathing in such individuals, we aimed to develop breathing exercise devices using a user-centered design (UCD) and then assess the effects of these devices on breathing. METHODS: Patients with SCI were involved in the device development. Preliminary online survey participants were recruited from the community, and interview and pilot test participants were recruited from a patient self-help group. The four UCD phases were repeatedly performed. Users required fun, easy, multi-player, and safe exercise devices. RESULTS: Seven breathing exercise devices were developed, and 10 different game-based exercises were performed. Two individuals participated in a pilot test involving a respiratory rehabilitation exercise program conducted twice weekly for 60 min/session over 8 weeks. Lung function was assessed using a spirometer. Forced vital capacity, forced expiratory volume in 1 s, and vital capacity showed minimal changes, whereas maximum inspiratory and expiratory pressures improved. Participants reported that the exercises were entertaining and that the competitive nature of the game-like exercises encouraged further participation. CONCLUSION: Breathing exercise programs using our developed devices can improve breathing and positively affect the psychological states and sociability of users.

A preliminary study on the feasibility of community game-based respiratory muscle training for individuals with high cervical spinal cord injury levels: a novel approach

“…These findings highlighted the possibility that the game-based RMT helped strengthen the muscles involved in inspiration and expiration, thus, improving the MIP and MEP. The improvements in the MIP and MEP may be attributed to the hyperventilation that occurred due to the participants' efforts to win, a part of the RMT protocol, which might have helped activate and strengthen the respiratory muscles of the participants [22]. Thus, the RMT intervention program proposed in this study could be used to effectively improve the MIP and MEP.…”

“…Before the evaluation, the participants were taught regarding the test method. The respiratory function was measured using a digital respiratory function measuring device (Pony FX, COSMED, Rome, Italy) [22]. For accurate measurement, the examiner provided sufficient explanation to the participant to comprehend the test, presented the process, and measured the respiratory function [23].…”

“…The participants were trained in the use of a developed game-based RMT device [22] This training protocol was reported to be feasible and effective in patients with CSCI [22]. The participants were provided weekly training diaries noting the training repetition and set number, perceived rate of exertion, and adverse responses.…”

“…Breathing training is thus inconvenient. Gamebased RMT was developed to overcome these issues and provide engaging and more practical breathing training; this program incorporated the term "game" into RMT [22]. It was created to allow individuals with CSCI to be excited and engaged, thus enabling the easier performance of RMT within the community.…”