The aim of the work carried out as part of this project is to design a rehabilitation tool for people with Parkinson’s disease (PD), enabling precise, quantified online assessment of motor symptoms (rigidity, bradykinesia). It is then possible to precisely quantify the evolution of the disease or the effectiveness of rehabilitation sessions. At present, clinical assessment of disease symptoms is mainly based on scales, the most widely used being the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale (MDS – UPDRS). However, this type of assessment is subjective and imprecise. To obtain an objective and unbiased assessment, a serious game – called RehaBEElitation – was developed, tested and used with a population of PD patients. The first step was to develop the serious game during the COVID19 pandemic, through regular videoconference meetings.
Secondly, its usability was assessed using questionnaires such as the System Usability Scale (SUS), Game Experience Questionnaire (GEQ) and Short Flow State Scale (SFSS). Videos showing participants interacting with the game were analyzed by four evaluators using the Serious Game Usability Evaluator (SeGUE) instrument to identify usability problems. This highlighted problems with the game’s interface and design, as well as with the controls used. Major improvements were made, and statistical tests were used to confirm the differences between the two versions of the serious game.
The control interface is based on an inertial measurement unit (IMU). The device tracks and estimates hand movement and sends this information to a computer running the serious game, in order to control a virtual object. Prior to its use in rehabilitation, it was necessary to validate the accuracy of the data acquired. The results obtained are good compared with the goniometer (standard reference), showing good precision (standard deviation error < 2°) and moderate accuracy (error between ±5°).
In order to understand the user’s perception and feelings, we carried out a study aimed at identifying the user’s perception when interacting with the serious game, with or without the supervision of a healthcare professional for 2 groups of people: 15 people with PD and 15 healthy people. The parameters evaluated were as follows: Circumplex Model of Affect (CMA); Short Flow State Scale (SFSS); Activity Evaluation Scale (Activation and Sensation) (AES); Multidimensional Boredom State Scale (MBSS); State-Trait Anxiety Inventory (STAI); Self Manakin Assessment (SAM). To check the significance of the results, the Wilcoxon-Mann-Whitney test was applied for these different parameters. The results show that for the MP group, support from the healthcare professional can influence interaction with the RehaBEElitation system. Initial tests revealed a number of problems which led to the design of a new interaction system.
Bradykinesia is the main motor symptom of PD, while tremor is usually the first and most troublesome motor symptom of the disease. Both symptoms were objectively assessed using signals recorded by the glove during users’ interaction with the game. Fifteen people with PD (experimental group – EG) and 15 healthy people (control group – CG), matched for age and gender, took part in the study. Data were collected in the ON and OFF states of medication for the experimental group. Bradykinesia was assessed by detecting the trend (voluntary movement) of gyroscope signals using Singular Spectrum Analysis (SSA), a time-series decomposition method. The response time and angular velocity of participants during the RehaBEElitation game were then estimated. . In most phases, GC participants achieved the best results for response time and angular velocity, followed by GE ON and GE OFF participants. Tremor was detected by removing the trend from the original signal and was assessed by estimating the characteristics of the gyroscope signals that accurately describe this symptom (mean absolute value, root mean square and power spectral density). In general, GE participants in the OFF condition exhibited more tremor than those in the ON condition. It was concluded that the serious game RehaBEElitation is an alternative tool for objectively and playfully assessing bradykinesia and tremor in people with Parkinson’s disease.
Another objective was to investigate and assess the severity of rigidity in individuals diagnosed with Parkinson’s disease, both with and without the influence of medication, and to compare the results to those from individuals without the disease.
To achieve the research objectives, the following goals were defined:
- Develop an innovative method to objectively assess rigidity in patients with Parkinson’s disease.
- Establish a data collection protocol involving patients with Parkinson’s disease (in both “on” and “off” medication states) and healthy individuals, enabling comparative analysis of the results.
- Objectively assess rigidity through two distinct protocols:
(i) using EMG and IMU, and
(ii) employing a serious game (SG) approach. - Obtain insights into the mechanisms of wrist rigidity in patients with Parkinson’s disease using data collection and signal processing techniques.
- Compare the results obtained from different assessment protocols and determine the most effective method for evaluating rigidity.
- Finally, correlate experimental data to discern the different manifestations of rigidity and their underlying factors.
The Brazilian and French teams collaborated in a balanced manner, with missions carried out in both directions (Brazil–France and France–Brazil), and with the active participation of researchers and students from both countries. The research activities were conducted jointly and in a coordinated way, ensuring that both teams contributed equally to the progress and outcomes of the project. This symmetry was essential to the success of the project, as it enabled knowledge exchange, shared responsibilities, and complementarity of expertise between the partner institutions.