Playing With Breath P.M. Bingham,* T. Ashikaga, T. Lahiri University of Vermont *Disclosure: co-inventor, UVM’s Breath Bio...
 
 
Competitive Apnea
Spirometer Game Applications <ul><li>Training Breathing Muscles (exercise) </li></ul><ul><li>Reinforce breath technique(s)...
Somatization www.tonysteelemorgan.co.uk/gallery.php?sort =f ...
Respiratory Interoception – can it be learned?
Game Technology <ul><li>Digital spirometer, Software plots air flow on vertical axis </li></ul><ul><li>Points added every ...
…  learning an eye-breath control game …
Training “eye-breath” coordination in CF patients: <ul><li>Distance to target: </li></ul>Bingham et al Clin Peds 2010 49:337
What I’m Playing... www.myspace.com/ lokum music
Neural Processing- Primary Breathing Sensors <ul><li>Mechanoreceptors </li></ul><ul><li>Nociceptors </li></ul><ul><li>chem...
 
Neural Processing of Breath– High Roads and Low Roads  <ul><li>  Cognitive —spatial, temporal and intensity components (me...
Anterior Insula mediates ‘sense of self’ Craig, Nat Neurosci Rev 10 2009
Fink JB, RESPIRATORY CARE • 2007 VOL 52
http://www.nhlbi.nih.gov/health/dci/Diseases/cf/cf_signs.html
Why Forced Expirations? Fink JB, RESPIRATORY CARE • 2007 VOL 52
<ul><li>Hypothesis :  game playing increases forced expirations & alters PFTs </li></ul><ul><li>Design:  within-subjects  ...
Study Procedures <ul><li>subjects received spirometer, computer (games vs control setup) </li></ul><ul><li>both games and ...
 
 
 
 
 
 
 
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 % ...
Summary <ul><li>FE count did not differ (10-12/day)  but apparently exceeded baseline </li></ul><ul><li>Players were more ...
Conclusions <ul><li>Visual breath biofeedback can engage CF patients with FEs in a research setting    … but for how long?...
Acknowledgements <ul><li>Families and Subjects with Cystic Fibrosis </li></ul><ul><li>Jason Bates  </li></ul><ul><li>Sarah...
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Bingham peter

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Games For Health - Spirometer Game Talk

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Bingham peter

  1. 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. 4. Competitive Apnea
  3. 5. Spirometer Game Applications <ul><li>Training Breathing Muscles (exercise) </li></ul><ul><li>Reinforce breath technique(s) </li></ul><ul><li>Breath Awareness (“ symptom detection ” proprioception training) </li></ul>
  4. 6. Somatization www.tonysteelemorgan.co.uk/gallery.php?sort =f ...
  5. 7. Respiratory Interoception – can it be learned?
  6. 8. Game Technology <ul><li>Digital spirometer, Software plots air flow on vertical axis </li></ul><ul><li>Points added every second the player keeps the ball on target </li></ul>
  7. 9. … learning an eye-breath control game …
  8. 10. Training “eye-breath” coordination in CF patients: <ul><li>Distance to target: </li></ul>Bingham et al Clin Peds 2010 49:337
  9. 11. What I’m Playing... www.myspace.com/ lokum music
  10. 12. Neural Processing- Primary Breathing Sensors <ul><li>Mechanoreceptors </li></ul><ul><li>Nociceptors </li></ul><ul><li>chemoreceptors </li></ul>
  11. 14. Neural Processing of Breath– High Roads and Low Roads <ul><li>  Cognitive —spatial, temporal and intensity components (medullary nuclei, pons, thalamus, somatosensory, motor cortex) </li></ul><ul><li>Emotional —dyspnea (amygdala, anterior cingulate, insular cortex) </li></ul><ul><li>Convergent: </li></ul><ul><li>Thalamus, insular cortex, anterior cingulate cortex, amygdala </li></ul>
  12. 15. Anterior Insula mediates ‘sense of self’ Craig, Nat Neurosci Rev 10 2009
  13. 16. Fink JB, RESPIRATORY CARE • 2007 VOL 52
  14. 17. http://www.nhlbi.nih.gov/health/dci/Diseases/cf/cf_signs.html
  15. 18. Why Forced Expirations? Fink JB, RESPIRATORY CARE • 2007 VOL 52
  16. 19. <ul><li>Hypothesis : game playing increases forced expirations & alters PFTs </li></ul><ul><li>Design: within-subjects randomized crossover trial [ A (game) -B (control) or B – A] </li></ul><ul><li>13 subjects, 7-12 yo </li></ul><ul><li>repeated measures analysis (days used) </li></ul>Outcomes: average FEs per day used Change in pulmonary function measures (FEV1, VC) Reinforcing Breath Technique – CF
  17. 20. Study Procedures <ul><li>subjects received spirometer, computer (games vs control setup) </li></ul><ul><li>both games and control software incite the player to perform forced exhalation maneuvers </li></ul><ul><li>weekly phone contact; “no nagging” policy </li></ul>
  18. 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
  19. 29. Summary <ul><li>FE count did not differ (10-12/day) but apparently exceeded baseline </li></ul><ul><li>Players were more engaged with the game than the control software (minutes/day used ~5 vs. ~2) </li></ul><ul><li>Game days increased Vital Capacity (p=.03) and FEV1 (0.01) </li></ul>
  20. 30. Conclusions <ul><li>Visual breath biofeedback can engage CF patients with FEs in a research setting … but for how long? </li></ul><ul><li>Game based visual feedback may improve PFTs </li></ul><ul><li>… improved test technique? </li></ul><ul><li>… formal clinical trial planned </li></ul>
  21. 31. Acknowledgements <ul><li>Families and Subjects with Cystic Fibrosis </li></ul><ul><li>Jason Bates </li></ul><ul><li>Sarah Waterman, Amanda Woods, Gwen Fitz-Gerald, Jackie Swartz </li></ul><ul><li>Vermont Children’s Hospital – Nurses/Staff </li></ul><ul><li>R.W. Johnson Foundation </li></ul><ul><li>NIH SBIR 103370 </li></ul>

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