Game On

High-Tech Peg Measures Cerebral Palsy Patients' Dexterity

By Alex Orlando | August 25, 2014

On one side of the board, patients are tasked to move a small peg, comfortable enough for a 3-year-old to hold, over a hurdle and center it on the bulls-eye shaped target. On the flip side is a set of paths that the patient tracks with the peg, tracing across designs and shapes reminiscent of a coloring book. In spite of an exterior that resembles a game board rather than a clinical evaluation tool, there’s some serious intent behind a device designed by Rice University students to test the abilities of cerebral palsy patients.

At the heart of the DeXcellence platform is a simple peg—packed inside, there are enough electronics to inform a nearby computer, tablet or other Bluetooth-enabled device of how the cylinder is moving through space. In tandem with a board that directs the patient’s movements, the cylinder sends a steady stream of data to the computer. That data is analyzed by the design team’s software to give a therapist a clear picture of a patient’s progress in occupational therapy.

The DeXcellence device is the work of five Rice seniors who designed it at the Oshman Engineering Design Kitchen as their capstone project in collaboration with Shriners Hospital for Children, Houston, and Rice advisers Gary Woods, a professor in the practice of computer technology in the Department of Electrical and Computer Engineering, and Eric Richardson, a lecturer in bioengineering.

A synthesis of high and low technology, the Rice students’ efforts would complement the device that inspired them, a therapeutic evaluation tool known as a Functional Dexterity Test (FDT). A simple, low-tech pegboard that only quantifies the speed of hand dexterity, the FDT doesn’t provide any data about the patient’s quality or fluidity of movement. Gloria Gogola, M.D., pediatric upper extremity surgeon at Shriners, who has worked with Rice’s engineering program for several years, suggested that the team look into ways to quantify movement.

“There’s a huge gap in technology for the evaluation of movement patterns in [patients with] cerebral palsy,” explained Gogola. “At one end, we have clinical exams that are all visual, even relying on videotape exams to catch more subtle movements. The next step up in technology is Shriners’ high-tech motion analysis lab. This project aims for something in the middle—the peg the patient moves through the test provides a phenomenal output of data. They put a whole motion analysis lab in a peg!”

“There’s nothing comparable that we encountered,” said electrical and computer engineering major Vivaswath Kumar, a member of the team along with Sonia Garcia (bioengineering), Shaurya Agarwal (mechanical engineering), Allison Garza (mechanical engineering) and Andrew Schober (bioengineering and computational and applied mathematics).

“The DeXcellence device completely reimagines the way that pegs were being used in traditional dexterity tests—using time as a metric for success is pretty rough and imprecise,” added Kumar. He explained that the team installed an inertial measurement unit within the peg, which tracks patient motion, as well as a Bluetooth chip to transfer the motion data to be displayed visually on a graphical user interface. The quality of movement of the motion path is the new metric for success—an important factor in determining whether the patient needs more therapy or more surgery.

For mechanical engineering major Allison Garza, working with kids made the accessibility of the DeXcellence device an essential factor in the design process. “If you look at the design, you have targets on one side, because kids can really easily associate targets with being able to land as close to the center as possible,” she said. “It was the same with the trace paths—kids all know about tracing lines, and the bright color scheme of using red on black makes it very vibrant. It’s all about presenting it to patients not as a scary tool, but as something that’s fun. For them, it’s a game.”

“I think the possibilities for this are enormous,” said occupational therapist Dorit Aaron, former president of the American Society of Hand Therapists and a Shriners volunteer. “The device is different from the original FTD in the sense that it requires both gross motor as well as fine motor movements to accomplish the task. They have to manipulate the peg and they have to move it in space. That gives us infor- mation about the shoulder and elbow motion as well as the digits, and we can track it in the computer.”

The students worked hard to present a polished project. “We have the motion-capture technology with the peg, we have the exam itself, we built the software in the computer and we have the charger for the peg,” Agarwal said. “That’s what we set out to do. We wanted to give them the entire solution; not one part of it, but everything they needed to conduct an exam.”

The team’s success was recognized by all who watched the DeXcellence team demonstrate it at Rice’s annual George R. Brown Engineering Design Showcase and Poster Competition, at which the team won the grand prize of $5,000 in April. The team also placed second in the International Student Design Showcase at the University of Minnesota’s Design of Medical Devices conference in April.

To cap off their recognition and success, the team was thrilled to see their device in action. A week before graduation, the students gathered at Shriners to observe as Brandon Sierra, 15, put the device through its paces. Sierra underwent surgery on his right arm in April to help him improve motion in the arm that had been hindered by hemiplegic cerebral palsy.

Although the team will be parting ways after graduation, their device stands as a testament to interdisciplinary teamwork. “We had worked previously together in other classes and, fortunately, our professors paired us together,” said Kumar. “We had four different engineering majors on our team—I can’t think of collaboration more interdisciplinary in my experience at Rice. Four majors within one five person team is pretty out there.”

The project between the five students reflects the larger scale institutional collaboration between Rice and Shriners. “A device like this shows the power of the synergies that can happen between institutions like Rice and TMC,” said Kumar. “You’ve got a treasure trove of resources at Rice in the engineering field, and you have a treasure trove of clinically minded professionals at the TMC. We’re very thankful for both the support of Rice University and at Shriners. This project is very applicable to a wide variety of patients, which is something that drove us to make it better and better.”

Gogola envisions a future for the Rice invention extending beyond cerebral palsy therapy, capitalizing on the rich pool of resources within the medical center. “This device could be used in any situation where dexterity, or the fine motor movements of the hand, needs to be tested,” she said. “It could be used to evaluate patients being treated for stroke, Parkinson’s, spinal cord injuries, trauma—any situation where the ability to use their hands is affected. The potential for wider collaboration within the Texas Medical Center is massive. The ultimate goal is to better understand these disease processes so we can better understand and treat our patients.”

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