An ULTrA idea Connect adults with cerebral palsy to virtual trainers at home

Forty-one-year-old Laura Gable has lived her entire life with cerebral palsy, a neurological disorder that appears in infancy or early childhood, and permanently affects body movement and posture. As she's grown older, Gable has noticed the pain and stiffness, and other motor affects associated with her cerebral palsy have worsened.

"When I get stiff, I have a hard time reaching in the cupboard for dishes, putting on my clothes and even tying my shoes," says Gable. "Very simple things that a lot of people don't think are hard, becoming really difficult for me."

While physical and occupation therapy bring relief, many adults with cerebral palsy like Gable find juggling busy work and family schedules leaves little time to attend regular therapy sessions outside the home. Adding to that, some insurance companies do not cover physical and occupational therapy for adults with cerebral palsy.

But what if patients could complete regular therapy exercises from the comfort of their home? Using an Internet connection and an at-home computer interface, that's exactly what a new program developed by experts at the University of Michigan Health System and the U-M Division of Kinesiology aims to do: Make movement-based training more convenient and assessable to adults with cerebral palsy.

This joint research and movement therapy project - called the Upper Limb Training and Assessment Program, or ULTrA - is specially designed to aid adults with cerebral palsy who have upper limb and hand impairment.

"Physical and occupational therapy are the most important treatments for cerebral palsy," says  Edward Hurvitz, M.D., chair of the Department of Physical Medicine and Rehabilitation at the U-M Health System. "The ULTrA program works with the idea of bringing therapy into the home to allow adults to do their therapy at a time that's convenient for them."

Using the Internet and streaming video, the ULTrA program allows adult patients to connect to "virtual trainers" and real-life experts at the U-M motor control lab via their home computer to complete movement-based therapy programs. The project also collects data to determine how well the in-home therapy is working.

"We're targeting a growing, yet neglected segment of the population using the Internet and streaming video to essentially bring our lab and experts into the patients' homes to engage them in a movement-based training program," says Susan Brown, Ph.D., director of the Motor Control Lab at the U-M Division of Kinesiology.

ULTrA, a three-year study funded by the National Institute on Disability and Rehabilitation Research through the U.S. Department of Education, consists of 40-minute training sessions done five days a week for eight weeks. Each patient's home is equipped with a computer-based upper limb training unit, a high-speed Internet connection, and a training CD.

"The computer interface in the individual's home includes computer-generated images of people stretching, and we also have people in our lab who are able to coach and provide encouragement to participants via web cameras," says Brown. "Being connected to the patients allows us to modify their program as needed, without them coming into the research lab or clinic. The streaming video basically allows us to be there with them in a virtual sense."

The Internet connectivity also lets Brown and her colleagues gather data and analyze each patient's progress. Preliminary research shows ULTrA is making a difference in patients' lives.

"Apart from rehabilitation, I think there's real potential to use this technology to open up the world for people who have mobility issues," notes Brown.

For Gable, ULTrA has helped to improve her fine motor and sensory skills. Beyond her own physical improvement, she hopes ULTrA will encourage others in the medical field to find more innovative ways to support adults with cerebral palsy.

"The ULTrA project is a step toward moving cerebral palsy treatment into the 21st century," she says. "There's the potential to figure out how to improve range of motion and daily quality of life for people with CP. Now, there's a way for me to keep physically moving and mobile for the rest of my life."

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