Evaluating the Microsoft Kinect for use in Upper Extremity Rehabilitation Following Stroke as a Commercial off the Shelf Gaming System. The Therapist’s Perspective by Luke Shires, David Brown, Nasser Sherkat, James Lewis and Penny Standen

1. Off the Shelf Kinect Games for
Stroke Rehabilitation
Perspective of the Therapist
Luke Shires, James Lewis, David Brown,
Nasser Sherkat
Computing and Technology team
Nottingham Trent University
Nottingham, UK
Penny Standen
Division of Rehabilitation and Aging
University of Nottingham
Nottingham, UK
luke.shires2007@my.ntu.ac.uk
p.standen@nottingham.ac.uk

2. Stroke
Stroke is the third most common disease in the UK with over
100,000 cases annually (Bupa 2011).
Stroke is also the leading cause for long term disability.
The cost of treatment and dealing with the long term disabilities
afterwards is estimated to cost the UK economy £8.9 billion a
year (Saka, McGuire and Wolfe 2009)
BUPA, 2011. Stroke [online]. . Available at: http://www.bupa.co.uk/individuals/healthinformation/directory/s/stroke [Accessed 12/9 2012].
SAKA, Ö., MCGUIRE, A. and WOLFE, C., 2009. Cost of stroke in the United Kingdom. Age and Ageing, 38
(1), 27-32.

3. Upper Limb Rehabilitation
Rehabilitation for an impaired upper limb following stroke
requires early and repetitive exercise to maximize recovery
(Feys, et al. 2004).
Outpatient facilities can be difficult to travel to for survivors with
mobility problems or long travel distances.
New thinking suggests long term rehabilitation may have a
positive effect but clinical resources are directed towards new
patients.
FEYS, H., et al., 2004. Early and repetitive stimulation of the arm can substantially improve the long-term
outcome after stroke: a 5-year follow-up study of a randomized trial. Stroke, 35 (4), 924-929.

4. Home Based Rehab
Gives patients the means to rehabilitate as much as they like,
when they like. Without increasing clinical resources.
Allows patients to perform effective rehabilitation exercises
independently.
Increases the amount of rehabilitation time available to the
patient, and allow cost effective rehabilitation in the long
term.

5. COTS Games
Commercial off the shelf games.
Pros
• Relatively low cost.
• Easily available.
Cons
• Games are designed for able bodied
users.
• Designed for use in a home setting.
• Might not encourage the ‘right’ kind
of exercise.
• Recent increase in the popularity of
motion controls.
• Visual and GUI design are often not
accessible
• Games with high production values.

6. Xbox 360 Kinect

7. Study Rational
COTS systems have previously been shown to have a positive
impact when used in conjunction with a normal course of
rehabilitation.
Kinect games provide full body tracking, and new possibilities of
exercises based interaction with games.
Want to learn about what works well with COTS games for
stroke, and use this to inform decisions about future rehab
systems.
MOUAWAD, M.R., et al., 2011. Wii-based movement therapy to promote improved upper extremity
function post-stroke: a pilot study. Journal of Rehabilitation Medicine, 43 (6), 527-533.

8. Study Rational
COTS studies have focused on proving improvement in limb
functionality, but ignored issues surrounding usability of the
device for a wide range of stroke patients.
We want to explore the individual joint movements encouraged.
And the minimum joint functionality the patients requires to
participate.

9. Study Configuration
Recruit occupational and physiotherapists with experience of
working with stroke patients
Participants received a demonstration of each Kinect game. Then
offered unlimited time to play.
Answer questionnaire on joint functionality required by the
Kinect game.
Allowed to return to the game at any point during the
questionnaire.

10. Study Configuration
Two games were chosen. Kinect Sports Bowling and Kinect
Sports Table Tennis.
Easy to learn as rules match real life equivalent.
Short play times allow study to be conducted in reasonable
timeframe.
Relatively low excretion for Kinect games titles explored.

11. Kinect Sports Bowling

12. Kinect Sports Table Tennis

13. Interim Results
Recruited six therapists.
All therapists completed study.
Aiming to recruit twelve overall.

14. Bowling Joint Function Required
Minimum joint functionality required to play
4
3
2
1
0
Joint movement
0. No motion required. 1. Reduced range of motion. 2. Partial range of motion. 3. Partial range of motion
against gravity. 4. Full range of motion against gravity.

15. Table Tennis Joint Function
Minimum Joint Functionality Required to play
4
3
2
1
0
Joint movement
0. No motion required. 1. Reduced range of motion. 2. Partial range of motion. 3. Partial range of motion
against gravity. 4. Full range of motion against gravity.

16. Bowling Movement Encouraged
Joint Exercise Encouraged
3
2
1
0
Joint movement
0. Not encouraged. 1. Encouraged but not required. 2. Implicit to fulfilling required task. 3. Explicit to
fulfilling required task.

17. Bowling Joint Exertion
Maximum Level of Exertion Encouraged
4
3
2
1
0
Joint movement
0. No exertion. 1. Low. 2. Medium. 3. High. 4. Dangerous.

18. Informal Findings
Requirement to stand presents a serious risk of falling. Especially
during table tennis.
Interface is not accessible, confusing to follow. Too many moving
elements.