Development of an effective therapy and objective assessment for children with birth injuries Ákos Jobbágy a , Judit Schultheisz b , Márk Horváth a and Hanna Réfy Vraskóné b Sitting in a Huple, a patented hemisphere-like tool, permanently stimulates the vestibular system, thus improving the balancing ability of children with movement disorders. The Gézengúz Foundation for Children with Birth Injuries has been successfully applying this tool in therapy. By attaching x-Inertial Measurement Unit, a wireless three- dimensional orientation sensor, to the Huple, it can serve as an input peripheral for simple PC games. Children are thus motivated; they willingly perform balance training as well as participate in the game-like test. This improves the accuracy and reproducibility of the assessment. Knowing the actual state of the participants is an important element of feedback for the therapy. This paper describes in detail the development of the therapeutic and assessment method on the basis of the Huple: the definition of the movement pattern, the parameters characterizing the movement, and the algorithms used to rank children. Measurement series of 10 children with movement disorders validate the effectiveness of the game-like assessment. International Journal of Rehabilitation Research 39:354–360 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. International Journal of Rehabilitation Research 2016, 39:354–360 Keywords: birth injuries, disabled children, Huple, play therapy, postural balance, quantitative evaluation, rehabilitation, vestibular stimulation, virtual reality therapy a Department of Measurement and Information Systems, Budapest University of Technology and Economics and b Gézengúz Foundation, Budapest, Hungary Correspondence to Ákos Jobbágy, DSc, Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary Tel: + 36 146 32572; fax: + 36 146 34112; e-mail: jobbagy@mit.bme.hu Received 16 March 2016 Accepted 8 May 2016 Introduction Effective rehabilitation procedures and therapies have been reported for children with cerebral palsy (CP) (http://www.cerebralpalsy.org; Molnar, 1991; Ferrari and Cioni, 2005; Chan and Law, 2009; Mu et al., 2012; Novak et al., 2013; Gonkova et al., 2014; Kim et al., 2014; Yalcinkaya et al., 2014; Novak, 2015). (Bourelle et al., 2014) report significant differences in postural control of children between morning hours and afternoon hours. (Christy et al., 2014) analyzed the reliability and diag- nostic accuracy of clinical tests of vestibular function for children. Therapy for children with birth injuries is rather a habilitation process – they never possessed the abilities to be developed. (Only those who once had the ability that has been lost can be rehabilitated.) Every birth injury is unique (Birth Injury Guide, 2016). The Gézengúz Foundation (established in 1990) provides early interven- tion and complex therapy for children with movement disorders, mostly resulting from birth injuries. To aid the complex therapy for these children – and also to help healthy children improve their balance and coordination ability – a special therapeutic tool, the Huple (Fig. 1), was developed and patented (http://www.huple.org; Schultheisz, 2012; Schultheisz and Bacso, 2008). The hemisphere-shaped tool helps therapists in playfully improving and also assessing the balancing ability of children. Sitting in a Huple is a complex task requiring coordinated control of the muscles of the trunk, head, and around the pelvic girdle. This activity in itself has a beneficial effect. Nevertheless, only sitting soon becomes boring for the children. By attaching a three- dimensional (3D) orientation sensor to the Huple, it can be used as a PC input peripheral. This helps the habili- tation process and also makes the assessment more reli- able. On the basis of the tilt angle of the Huple, we can determine either the speed or the position of an object on the screen (tilt→speed or tilt→position). In the former case, the object can be directed to the requested position with different tilt angles. This is perfect for motivating children with various levels of disability to sit in a Huple for a longer period of time, but it would result in a low reproducibility during assessment. The movement coordination of children is usually ranked by therapists on the basis of human observation. Assessment of movement disorders, rating spasticity, and dystonia in children with CP have been reported in (Deon and Gaebler-Spira, 2010). Assessment of func- tional levels and gross motor functions are summarized in (Günel et al., 2014). (Bleyenheuft et al., 2015) describe a combined method using diffusion tensor imaging, tran- scranial magnetic stimulation, and functional MRI. (Saether et al., 2013) review tools used to assess balance in clinical practice in children. (Gordon et al., 2012) report that the Nintendo Wii has the potential for use as a rehabilitation tool in the management of children with CP. (Barton et al., 2013) report the efficient use of a vir- tual reality game in rehabilitation. 354 Brief research report 0342-5282 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MRR.0000000000000179 Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved.