GAME - Game to Advance Medical Efficiencies for people with Movement disorders.

There is no cure for PD but there are effective treatments for relieving symptoms. It is widely acknowledged that people with PD should be treated with a multidisciplinary approach in which pharmacological and surgical treatments are combined with physiot herapy, occupational therapy, speech and language therapy, psychological counseling and support, and education (Gage & Storey, 2004; Post, van der Eijk, Munneke, & Bloem, 2011). However, referral rates to adjunctive treatments and non-medical care remain inadequate (Mutch, Strudwick, Roy, & Downie, 1986; Tomlinson et al., 2012). This may be due to a weak evidence base for these complementary therapies, out-of-pocket costs for these treatments, or the lack of availability of these services (Yarrow, 1999). With the increasing popularity of digital games as an engaging form of entertainment along with the development of new interactive technologies, there has been increasing interest in the use of games and gaming technology in rehabilitation. Since the 198 0?s, the literature has docum. the potential of digital interactive gaming technology to engage and improve the health process outcomes of patients with various physical impairments such as cerebral palsy, traumatic brain injury, stroke, and congenital sp ine malformations (spina bifida) (22-25). Interactive digital games combined with biofeedback have been shown to improve dynamic balance control in case studies with physical therapy patients (26,27). The Wii system has also been shown to improve movemen t outcomes among patients who recently experienced a stroke (28). The reliability and validity of these commercially available movement platforms for use in a clinical setting has been demonstrated (29,30). The project validate that digital games signific antly improve PD symptoms and motivate patients with PD to engage in behaviors that sustain cost-effective use of health care services and improve self-care and patient empowerment. (ref. see attachment).

A goal of the JPND project is to conduct research-based development of a digital interactive game (GAME) designed to (1) motivate people with Movement Disorders (MD) to engage in behaviors that sustain cost-effective use of health care services, (2) impro ve self-care and (3) support to manage their paid or voluntary occupation and social life. People with MD will use GAME at an early stage in their conditions process to reduce the cost of health care, promote their health and delay work disability compare d to treatment as usual. We hypothesize that these results will be achieved through the mediating effects of increased engaged and motivation to engage in patient health care over time through the use of the GAME. Research will be conducted to further kno wledge about factors that promote cost-effective interactions with the health services and through improved self-care practices, at-home rehabilitation, and to manage their paid or voluntary occupation and social life. User testing and focus group researc h will help determine what kinds of interactive technologies are appealing and engaging to the user groups. An iterative evaluation and prototyping process will be used that combines research with technology development. The GAME developed in this project will be evaluated in a pilot randomized trial to test hypotheses that the use of this tool is more effective than traditional in its effectiveness. A pilot study evaluating the cost-effectiveness of the GAME will also be conducted. Measures will be take n to monitor the safety of the use of this tool among patients by tracking study- and intervention-related adverse events. The results will have a broad impact by contributing much needed knowledge on effective game-based approaches to changing behaviors that ultimately influence clinical outcomes. The results will be among the first to evaluate the cost effectiveness of the game-based approaches in health care delaying disability.