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  • Mission and core strategy

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  • 1. www.out-front.com Demand more. Demand better. Get Out-Front ®
  • 2. What do Nintendo, Exercise, and Rehab Have in Common? The GameCycle ®
  • 3. What is the GameCycle?
    • Upper body exercise and rehabilitation merged with game play
      • Control Nintendo videogames by cranking and steering
      • Makes game play easy for adults, kids, and seniors
  • 4. GameCycle Highlights
    • The development of the GameCycle was funded by 2 grants from the National Institutes of Health
      • There was a clear need for an engaging upper-body exercise and rehabilitation device
    • The unique merging of game play, exercise, and rehab:
      • Motivates better effort and adherence to rehab routines
      • Facilitates a variety of rehabilitation outcomes:
        • Cognitive benefits: Visual motor and bilateral integration
        • Improved core and upper body strength
        • Fosters cardiovascular fitness
        • Improved ADL function and enhanced self-esteem
  • 5. GameCycle Settings and Uses: Video Clips of Your Peers
    • As you’ll see in the videos to follow, the GameCycle is ideal for a variety of populations:
      • Spinal Cord Injury
      • Neurological disorders
      • Orthopedic
      • Pediatric
      • Seniors
    • For these populations, the GameCycle inserts fun and excitement into their exercise and rehab routines
  • 6. Video 1: Cindy Kamphaus, PT SoloPro Physical Therapy
    • Note the variety of clients – Orthopedic, neuro, complex soft tissues, seniors, etc.
    • Note the ways in which her clients are positioned when playing the GameCycle (exercise balls, therabands, etc)
    • She emphasizes the importance of the immediate feedback that the GameCycle provides
    • Insert Video Click Here to Watch Video (http://www.3rivers.com/GameCycle-SoloPro.htm)
  • 7. GameCycle Cognitive Benefits
    • The Cognitive Benefits of the GameCycle
      • Visual motor integration occurs because the persons motion must match the visual feedback from the Game
      • Bilateral integration or Hemiplegic neglect is addressed because both arms must work in unison to control the game
  • 8. Video 2: Jodi Paniagua, PT St. Joseph's Hospital and Medical Center
    • Spinal Cord Injury Population
    • Over 125 patients per day come through clinic
    • Compares the GameCycle with standard arm-ergometers and emphasizes how the GameCycle encourages more effort
    • With her younger population (18-36), the GameCycle brings out their competitive instinct
    • Insert Video Click Here to Watch Video (http://www.3rivers.com/GameCycle-StJoes1.htm)
  • 9. GameCycle Research: Yes, it really does encourage greater effort!
    • Fitzgerald and her colleagues (2004) compared exercising with an arm ergometer (without a videogame) to exercising with the GameCycle
    • Results: Although metabolic data showed that more calories were being expended while using the GameCycle, research participants did not perceive greater exertion.
    • Conclusion: Participants were exercising harder with the GameCycle, but did not feel it or realize it.
  • 10. GameCycle Research: Yes, it also leads to improved outcomes
    • Widman and her colleagues (2006) examined outcomes of GameCycle use after a 4-month period
      • Adolescents with mobility impairments due to spina bifida used the GameCycle over a 4-month period
      • Before and after measures included maximum exercise capacity, heart rate, and oxygen uptake
    • Key Findings:
      • 87% increased their maximum exercise capacity
      • 87% rated the GameCycle as challenging, but also as enjoyable
      • Participants also reported that the GameCycle motivated them to exercise longer (75%) and more often (62%)
    • Conclusion: The GameCycle is an effective tool for encouraging exercise and adherence to rehab routines
  • 11. Video 3: Jim Davis, OT National Neuro
    • Neurological Population
    • Demonstrates the cognitive benefits discussed earlier:
      • The GameCycle addresses hemiplegic neglect because it requires the user to engage both sides of their body
      • Visual motor integration is also addressed because the user has to respond to what is happening on the screen
    • Emphasizes benefits for balance and trunk control as users strive for fluid movement during game play
    • Reminds us that perhaps the most important aspect of the GameCycle is that it brings “fun” into the rehab setting
    • Insert Video Click Here to View Video (http://www.3rivers.com/GameCycle-NationalNeuro.htm)
  • 12. Why is having fun important?
    • The power of positive association
      • If game play is considered fun, then associating game play with exercise and rehab will increase motivation
    • “Now I am doing it because its fun, not because I have to…” This encourages adherence to rehab regimens
      • The research discussed earlier supports this
      • And it makes sense
  • 13. The GameCycle Clinical Reporting Wizard
    • Enables clinicians to easily track the progress of their clients on the GameCycle
    • Patient Screen: Entry of identifying info and demographics along with diagnosis and any additional notes
    • Trial Data Screen: Entry of data from the Game Cycle Session Summary such as calories burned, average resistance, and duration of workout
    • After multiple sessions, “View Reports” displays summary graphs and tables
      • Summary reports may include “distance vs. time”, “calories vs. time”, and much more
  • 14. The GameCycle Use and Billing Codes
    • For your Patient
      • Endurance
      • Strength Training
      • Range of Motion
      • Flexibility
      • Balance
      • Core Stability
      • Coordination
      • Proprioception
      • a Amount based upon published reimbursement for Medicare in Arizona
    • For Your Clinic
    • CPT Code 97110
      • Billed in 15 minute units
      • Billing amount is $26.50 a
    • CPT Code 97112
      • Billed in 15 minute units
      • Billing amount is $27.61 a
  • 15. The GameCycle Revenue Model
    • Codes –
      • Therapeutic Procedures – 97110...................................... $26.50
      • Neuromuscular Re-Education – 97112............................ $27.61
    • Scenario over a 1 month period –
      • 1 Patient in Clinic exercising 3 x week for 2 units (23-30 minutes)
      • TheraX + NM Re-Ed – ( $ 26.50 + $ 27.61 ) x 12 = $ 649.32 ( $ 649 )
        • Total Amount to be billed: $ 649.32 ( $649 )
      • How many people each month??
      • 10 - $6490 20 – $12,980 30 - $19,470 40 – $25,960
  • 16. The Goods: GameCycle Features
      • Compatible w/ Nintendo GameCube games controlled w/ speed & steering
      • Exercise mechanism similar to riding a hand-cycle
      • QuickStart sets up the GameCube and takes you directly to the start of game play
        • No need to learn or navigate videogame set-up screens
        • QuickStart includes 4 different games for a variety of skill levels
      • Set-up screens allow for selection of resistance (levels 0-9) and duration of workout
      • Session Summary reports miles, calories, average resistance, and duration of workout
      • Variety of handgrip options are available for varying hand function
      • Games can be controlled by cranking backward or forward
      • Adjustable steering sensitivity for game play
      • Adjustable forward & reverse crank speeds for game play
      • Adjustable height
      • Moved from one place to another via roller wheels
  • 17. GameCycle Compatible Nintendo Games
    • Need for Speed Underground (also 2 and Hot pursuit)
    • Monster 4 x 4 - Masters of Metal
    • Racing Evolution
    • Cars
    • Crazy Taxi
    • Nascar Dirt to Daytona
    • Mario Kart Double Dash
    • SX Superstar
    • F-Zero GX
  • 18. GameCycle Usage
    • Remember be patient with yourself, the gaming environment of the GameCycle is meant to challenge you.
    • It takes time to learn and get use to the cranking and steering mechanism of the GameCycle
    • May just start with the screen off so you can get a feel for how the GameCycle cranks and steers.
    • One of the keys is being able to crank and steer at the same time.
    • Before turning the game on, set a resistance level that is comfortable for you
    • Then turn the game on and steadily crank while steering with a leaning type motion like you might do while riding a bicycle.
    • Remember as you play you will be learning how to crank and steer the GameCycle and learning how to play the Nintendo game itself.
  • 19. Give it a try!!! And have some fun!
  • 20. References
    • 1. Physical Activity and Health. A Report of the Surgeon General Executive Summary . U.S. Department of Health and Human Services, 1996.
    • 2. Janssen, T.W.J., Van Oers, C.A.J.M., van der Woude, L.H.V., & Hollander, A.P. Physical strain in daily life of wheelchair users with spinal cord injuries. Med. Sci Sports & Ex , 1994, 26(6):661-670.
    • 3. Sedlock, D.A., Knowlton, R.G., & Fitzgerald, P.I. Circulatory and metabolic responses of women to arm crank and wheelchair ergometry. Arch Phys Med & Rehab , 1990, 71:91-100.
    • 4. DeVivo MJ, Black KJ, Stover SL. Causes of death during the first 12 years after spinal cord injury. Archives of Physical medicine and Rehabilitation , 1993,74: 248-254.
    • 5. Whiteneck GG, Charlifue SW, Frankel HL, Fraser MH, Gardner BP, Gerhart KA, Krishnan KR, Menter RR, Nuseibeh I, Short DJ, et al. Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia . 1992, 30(9):617-30.
    • 6. Hoffman, M.D. Cardiorespiratory fitness and training in quadriplegics and paraplegics. Sports Medicine , 1986, 3:312-330.
    • 7. Cooper, R.A., Vosse, A., Robertson, R.N., & Boninger, M.L. An interactive computer system for training wheelchair users. Biomed Eng, App, Basis, Com, 1995, 7(1):52-60.
    • 8. Gehlot, N.L., Cooper, R.A., & Robertson, R.A. Playing video games for fitness and fun with any wheelchair. Proc 18th Ann RESNA Conference , Vancouver BC, 1995, 282-284.
    • 9. Hicks AL, Martin KA, Ditor DS, Latimer AE, Craven C, Bugaresti J, McCartney N. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord . 2003, 41(1):34-43.
    • 10. Cooper RA, Wheelchair Racing Sports Science: A Review, J. Rehabil. Res. & Dev ., vol. 27, no. 3, pp. 295-312, 1990.
    • 11. Curtis, KA., McClanahan, S., Hall, KM., Dillon, D., & Brown, KF. Health, vocational, and functional status in spinal cord injured athletes and nonathletes. Archives of Physical Medicine and Rehabilitation, 1986; 67:862-865.
    • 12. Kinne S, Patrick DL, Maher EJ. Correlates of exercise maintenance among people with mobility impairments. Disability and Rehabilitation , 21(1):15-22, 1999.
    • 13. Cooney MM, Walker JB. Hydraulic resistance exercise benefits cardiovascular fitness of spinal cord patients. Med Sci Sports Exerc 1986; 18:522-525.
    • 14. Gass GC, Watson J, Camp EM, Court EJ, McPherson LM, Redhead P. The effects of physical training on high level spinal lesion patients. Scand. J Rehab Med. 1980; 12: 61-65.
    • 15. Hooker SP, Wells CL. Effects of low and moderate intensity training in spinal cord-injured persons. Med Sci Sports Exerc 1989; 21:18-22.
    • 16. Pittman, TA. Motivation. In D.T. Gilbert, S.T. Fiske, & G. Lindzey (Eds.), The Handbook of Social Psychology, 1998 (4th ed., pp. 633-683). New York: Random House.
    • 17. Eagly, AH, Chaiken, S.). The Psychology of Attitudes . 1993, Fort Worth, Texas: Harcourt Brace Javanovich.
    • 18. Smith, RA, Biddle, SJH. Attitudes and exercise adherence: Test of the theories of reasoned action and planned behavior. Journal of Sports Sciences , 1999, 17 (4): 269-281.
    • 19. Ntoumanis. N, Biddle, SJH.. A review of motivational climate in physical activity. Journal of Sports Sciences , 1999, 17 (8): 643-665.
    • 20. Blanchard, CM, Courneya, KS, Rodgers, WM, Daub, B, Knapik, G. Determinants of exercise intention and behavior during and after Phase 2 cardiac rehabilitation: An application of the Theory of Planned Behavior. Rehabilitation Psychology , 2002, 47 (3): 308-323.
    • 21. Deci, EL., Ryan, RM.. Intrinsic Motivation and Self-determination in Human Behavior . New York: Plenum, 1985.
    • 22. Fitzgerald SG, Cooper RA, Thorman T, Cooper R, Guo S, Boninger ML. The GAME(Cycle) exercise system: comparison with standard ergometry. Journal of Spinal Cord Med . 2004;27: 453–459.
    • 23. Widman LM, McDonald CM, Abresch RT. Effectiveness of an Upper Extremity Exercise Device Integrated With Computer Gaming for Aerobic Training in Adolescents With Spinal Cord Dysfunction. Journal of Spinal Cord Med .2006, 29:1–8.