Let's Play: Making rehab fun - Flinders University

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When the research project began, it was children with cerebral palsy Dr David Hobbs from Flinders University set out to help. Cerebral palsy is caused by an injury to the brain in utero or shortly after birth and causes impairment to mobility, the senses (vision, hearing, touch), and cognition.

Most children with cerebral palsy have a dominant hand and a non-dominant hand which might be characterised by spasticity, weakness or impaired selective motor control. It can be hard to open a jar of vegemite or tie their shoelaces. While there’s no cure for cerebral palsy, rehabilitation can help to improve function. Even small improvements can have a major life impact.

Every 15 hours an Australian child is born with cerebral palsy.

For children with cerebral palsy, rehab is one of life’s unpleasant constants.
It’s boring, repetitive and necessary; something that David made sure Orby never was.

Designing assistive devices for rehabilitation

David is not the first person to think of gamifying rehabilitation for children with cerebral palsy. ‘Serious games’ (i.e. games where the primary purpose is not entertainment) have been used to improve the motor function of children with cerebral palsy since the late 1990s. When the Wii controller was released, many parents jumped at the chance for their child with cerebral palsy to play a video game on an even playing field. Without the buttons, the Wii made gaming more accessible. Some researchers wondered whether it could be used for rehabilitation—not just as a fun activity, but also as a way to improve function. The OrbIT accessible gaming device takes it one step further.

What was immediately clear is that children loved the OrbIT games. When David delivered Orby into a new family’s home, he would help set Orby up usually in the kitchen or living room; somewhere to ensure Orby was always visible. He’d sit down with the child and begin to teach them how to play, although most times the child would practically shove him out the way to get started playing with Orby. Orby is designed to be intuitive to use and David’s instructions were almost unnecessary.

All he needed to do was stand back and watch. He could see right away that children loved using Orby. As a researcher though, he’s not content to create a device he thinks will help; he needs to know it works.

“Rehab doesn’t work when the brain isn’t interested. For the human brain to be… actively involved in recovery or compensation it needs to be engaged because there is a person around that brain.”

— Professor Susan Hiller

What the research found

David and the team ran multiple clinical trials with the OrbIT gaming system; trials, that for once weren’t difficult to recruit for. Children were excited to among the first to try out a new gaming system.

Through the clinical trials, the researchers were able to show a link between the OrbIT gaming system and improvements in motor and sensory function in children with cerebral palsy. They weren’t monumental or dramatic improvements, but that’s not what he expected. Orby isn’t a fix-all or miracle device. It is a great tool in the toolbox for doctors, nurses, parents and patients. It brings rehab into the home and helps make it a habit of everyday life.

One of the project’s collaborators, neuroscientist Professor Susan Hiller explained, “Rehab doesn’t work when the brain isn’t interested. For the human brain to be… actively involved in recovery or compensation it needs to be engaged because there is a person around that brain.” She added, “It’s especially a challenge in children. For children with cerebral palsy, they’ve been having rehab their whole childhood, so they really do hit a brick wall. And so Orby offers the movements needed for rehab and it is coupled with meaning… they get pleasure, engagement and pay attention.”

When people enjoy rehab, they’re more likely to do it often or longer. They found children could potentially do what would take six months of therapy in a rehab clinic in six weeks at home. And as Orby was introduced into new homes, a series of ripple effects started to surface.

Volunteering at summer camps and interning at a rehabilitation facility in Canada, some of Dr David Hobbs’ earliest experiences set his path to working with and helping children. Read more about David’s journey.

“Sometimes you can’t do anything to change a disease, injury or disability. But there are functional things you can do to help,”
— Dr David Hobbs

A friend in Orby

Children with cerebral palsy are rarely on a level playing field with their siblings or peers. Because of the challenges they face, they’re unlikely to win a running race, shoot more goals, or reach a higher level on Fortnite. With Orby, that changed. For some children, it was the first time they were better than their siblings at something. And sometimes, that had unexpected effects.

“In one of the trials, there was a boy who was non-verbal. [With Orby] this was the first time he could play a game better than his little sister,” David recalls one of his fondest memories from the trial. “He needed to help teach her how to play and give her hints, tips and tricks to make it through the levels. And the quickest way for him to do that was to talk. So, he started to speak.”

“What continues to fascinate me about that story is if a room of people sat down to come up with something to help a child who was non-verbal to speak, I’m sure one of the last things to come to mind would have been a gaming controller. But Orby provided a non-pressured platform and an excuse to talk more with his sister.”

Another boy would proudly show Orby to visitors when they came to his home. His father said it was the first time his son had talked about cerebral palsy or how it affects him day-to-day. The boy would say, “This is Orby. The researchers at Flinders made it for me because I have cerebral palsy,” before launching into a conversation about how it helps him.

“Sometimes you can’t do anything to change a disease, injury or disability. But there are functional things you can do to help,” David explains. Value can be building a child’s independence, confidence and self-esteem. You can also provide a sense of fun and motivation to participate.

Parkinson’s disease has distinctly different symptoms and causes to cerebral palsy, yet the Orby controller offers potential in different ways. Learn more

03— The project levels up