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Games For Health - Spirometer Game Talk

Games For Health - Spirometer Game Talk

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  • 1. Playing With Breath P.M. Bingham,* T. Ashikaga, T. Lahiri University of Vermont *Disclosure: co-inventor, UVM’s Breath Biofeedback System and Method (US Patent # 7,618,378)
  • 2.  
  • 3.  
  • 4. Competitive Apnea
  • 5. Spirometer Game Applications
    • Training Breathing Muscles (exercise)
    • Reinforce breath technique(s)
    • Breath Awareness (“ symptom detection ” proprioception training)
  • 6. Somatization www.tonysteelemorgan.co.uk/gallery.php?sort =f ...
  • 7. Respiratory Interoception – can it be learned?
  • 8. Game Technology
    • Digital spirometer, Software plots air flow on vertical axis
    • Points added every second the player keeps the ball on target
  • 9. … learning an eye-breath control game …
  • 10. Training “eye-breath” coordination in CF patients:
    • Distance to target:
    Bingham et al Clin Peds 2010 49:337
  • 11. What I’m Playing... www.myspace.com/ lokum music
  • 12. Neural Processing- Primary Breathing Sensors
    • Mechanoreceptors
    • Nociceptors
    • chemoreceptors
  • 13.  
  • 14. Neural Processing of Breath– High Roads and Low Roads
    •   Cognitive —spatial, temporal and intensity components (medullary nuclei, pons, thalamus, somatosensory, motor cortex)
    • Emotional —dyspnea (amygdala, anterior cingulate, insular cortex)
    • Convergent:
    • Thalamus, insular cortex, anterior cingulate cortex, amygdala
  • 15. Anterior Insula mediates ‘sense of self’ Craig, Nat Neurosci Rev 10 2009
  • 16. Fink JB, RESPIRATORY CARE • 2007 VOL 52
  • 17. http://www.nhlbi.nih.gov/health/dci/Diseases/cf/cf_signs.html
  • 18. Why Forced Expirations? Fink JB, RESPIRATORY CARE • 2007 VOL 52
  • 19.
    • Hypothesis : game playing increases forced expirations & alters PFTs
    • Design: within-subjects randomized crossover trial [ A (game) -B (control) or B – A]
    • 13 subjects, 7-12 yo
    • repeated measures analysis (days used)
    Outcomes: average FEs per day used Change in pulmonary function measures (FEV1, VC) Reinforcing Breath Technique – CF
  • 20. Study Procedures
    • subjects received spirometer, computer (games vs control setup)
    • both games and control software incite the player to perform forced exhalation maneuvers
    • weekly phone contact; “no nagging” policy
  • 21.  
  • 22.  
  • 23.  
  • 24.  
  • 25.  
  • 26.  
  • 27.  
  • 28. Software Usage, FEs, and %PFT Changes 0.03 -2.6 ± 5.3 0.4 ± 1.7 % VC Change/Days Used 0.05 -2.1 + 12.6 4.3 + 10.6 % VC Change 0.01 -2.5 ± 5.2 0.3 ± 2.4 % FEV1 Change/Days Used 0.16 -0.8 + 17.3 4.1 + 16.1 % FEV1 Change 0.65 11.6 ± 8.2 10.2 ± 5.2 Total HFEs/Days Used 0.02 1.6 ± 1.8 4.8 ± 4.4 Total Minutes Used/Days Used 0.59 8.5 + 7.2 10.0 + 11.2 Days Used 0.02 26.4 + 11.3 38.6 + 20.2 Days Available P (t test) Control Game
  • 29. Summary
    • FE count did not differ (10-12/day) but apparently exceeded baseline
    • Players were more engaged with the game than the control software (minutes/day used ~5 vs. ~2)
    • Game days increased Vital Capacity (p=.03) and FEV1 (0.01)
  • 30. Conclusions
    • Visual breath biofeedback can engage CF patients with FEs in a research setting … but for how long?
    • Game based visual feedback may improve PFTs
    • … improved test technique?
    • … formal clinical trial planned
  • 31. Acknowledgements
    • Families and Subjects with Cystic Fibrosis
    • Jason Bates
    • Sarah Waterman, Amanda Woods, Gwen Fitz-Gerald, Jackie Swartz
    • Vermont Children’s Hospital – Nurses/Staff
    • R.W. Johnson Foundation
    • NIH SBIR 103370