AU2020102546A4

AU2020102546A4 - Interactive gaming device for cerebral palsy intervention, treatment and management and its method thereof

Info

Publication number: AU2020102546A4
Application number: AU2020102546A
Authority: AU
Inventors: Vinayak Majhi; Vinay Kumar Pandey; Sudip Paul; Angana Saikia
Original assignee: Individual
Current assignee: Individual
Priority date: 2020-10-01
Filing date: 2020-10-01
Publication date: 2020-11-19
Anticipated expiration: 2028-10-01

Abstract

The present disclosure relates to an interactive gaming device for cerebral palsy intervention, treatment and management. The device is an integrated combination of different audio-visual games and demos for therapeutic intervention in different facial motor points in different condition like in resting position or in kinetic movement. This devise is capable of attracting child and bringing attention of the child in both active and passive condition. All activities are performed with different games in an order to attract child and withdraw their attention. The designed hardware captures an analogue data from the counter module and digitally send to the computing unit for processing and report generating through USB or Bluetooth. The device is equipped with a user interface for recording captured data, extracting different features from the recorded signals and also for showing the graph and pattern of the therapeutic performance. 29 LL .1ft mftw

Description

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INTERACTIVE GAMING DEVICE FOR CEREBRAL PALSY INTERVENTION, TREATMENT AND MANAGEMENT AND ITS METHOD THEREOF FIELD OF THE INVENTION

The present disclosure generally relates to cerebral palsy intervention and treatments. More particularly, the present disclosure relates to an interactive gaming device for cerebral palsy intervention, treatment and management and its method thereof.

BACKGROUND OF THE INVENTION

The brain and neurons are of plastic nature and can be molded in some extent as per requirement. Both brain and neurons can be molded as per requirement for normal way of living and thereupon changes with stimulus and experience, and working environment. Environmental enrichment affects more than normal environment in brain stimulation and modulation. The brain plasticity varies with time as a child grows, wherein neuronal connections are more in early childhood and as time passes some neuronal connections become stronger and some becomes very weak and disappears later on. Depending upon the usability of neuronal circuitry, the brain grows as weak, strong, active and inactive. When a child is born, the brain circuit is diverse and is much more complex and it reduces a little at adulthood. By utilizing the property of neural plasticity, a mild condition patient is brought into normal condition through the activation of various synaptic links via stimulation (Electrical, magnetic or therapeutic). The effect of early intervention is well established and well-known. From the perspective of speech and feeding dysfunctions in children with cerebral palsy, many of the children face challenge to be accepted at school and in public gathering owing to drooling and spill during feeding, which is initial stage of isolation from society. The drooling become severe if no action is to be taken to get inclusion in the same age group children, which leads a need for cranial nerve stimulation exercises to be done regularly even to an extent of three to five times a day. The same is often forced upon the child , there is a need to develop a set of cranial nerve exercises and link up the motor movements e.g. movement of tongue, cheek, jaw etc. with the computer in a game format, which aids the child to do it actively regularly and with interest. Synaptic connection and strength in child's brain are directly proportional to the usability. If a synaptic network is used more frequently thereupon becomes stronger than the rarely used connection. Neuronal transmissions from frequently used and stronger connection are fast and efficient than the weaker connections. Thus, exposure to various therapeutic activities and experiences may improve muscle strength and signal transmission to and fro from central nervous system and peripheral nervous system, which utilizes the neural plasticity characteristic of our brain.

Early yoga and physiotherapeutic activities are having the potential of healing small disturbances and able to bring movement and strength in sensory and motor connections. Early intervention can prevent from secondary deformities like muscle stiffness and contracture that are caused by soft tissues. Without early interventions, the child may suffer from severe cerebral palsy at later stage that may or may not be curable. The early interventions may reinforce neuronal synaptic connections and are helpful in effective, efficient and controlled movement of various body parts. The early interventions may give freedom to the individual in daily living by providing appropriate muscle strength for proper functioning. Regular and repetitive physiotherapeutic exercises can build strong neuronal network leading to good communicative skills and healthy individual.

However, the existing prior art solutions are very slow and time taking process. The existing method requires routine based daily exercises and yoga practice. Further, the existing method is boring and thereby the children forgets or does not like to practice. Furthermore, the existing methods are not so effective in curing the cerebral palsy.

In view of the foregoing discussion, there exists a need to have a method an interactive gaming device for cerebral palsy intervention, treatment and management of infants and adults.

SUMMARY OF THE INVENTION

The present disclosure generally relates to a method and a portable and low-cost interactive gaming device for cerebral palsy intervention, treatment and management of infants and adults portable along with bio-feedback report.

In an embodiment, an interactive gaming device for cerebral palsy intervention, treatment and management is provided, the device includes a jaw pressure calculating sensor for calculating biting force/jaw pressure of a user. The biting force/jaw pressure of the user is calculated upon biting the sensor with full force. The jaw pressure sensor is placed in between upper teeth and lower teeth for calculating biting force/jaw pressure.

The device further includes a hand gloves equipped with a grip strength sensor for analyzing grip strength of the user hand. The device further includes a spirometer for determining volume of air inhaled and exhaled by lungs of the user. The spirometer determines ventilation, the movement of air into and out of the lungs.

The device further includes a temperature sensor for examining temperature of a user's body and a sensation sensor is attached with the temperature sensor for detecting sensational value of the user. The device further includes a metallic pressure sensor for measuring retraction, protrusion, flexion, slugging and upholding capability of the user body.

The device further includes a computing unit interconnected with the jaw pressure calculating sensor, grip strength sensor, spirometer, temperature sensor, sensation sensor and the metallic pressure sensor for generating bio-feedback report upon receiving biting force/jaw pressure, grip strength, inhaled and exhaled by lungs, temperature, sensational value, retraction, protrusion, flexion, slugging and upholding capability of the user body.

The device further includes a user interface connected to the computing unit for showing the bio-feedback report using a display device. The device further includes a robotic arm in association with the computing unit for providing therapeutic interventions required in treatment and management of oral motor kind of cerebral palsy (CP). The robotic arm supports in restoring both sensory and motor functionality oral motor type of disability whether it is sensory cause or motor associated problem. The robotic arm is placed inside the hand gloves for cushioning effect.

In an embodiment, the therapeutic and physical parameters measured by the device will produced in the form of biting force, amplitude, time elapsed in the therapeutic session and frequency of the exercise. The different forms of therapy in interactive gaming forms is provided by the robotic arm, the different forms of therapy comprises massage over forehead, massage over chin focussing trigeminal nerve stimulation, whistle blowing, lip closure exercises, cheek massage in circular motion to stimulate facial nerves, tongue and pharyngeal exercises in order to stimulate glossopharyngeal nerve, jaw up down movement and lip massage for vagus nerve stimulation, and tongue tapping stimulate hypoglossal nerves.

The device further includes a piezoelectric sensor placed into an inner side of finger tips of the hand glove for stimulation of various motor points of face, wherein pressure exerted in the therapy varies in a range provides various activities in the games as the variable voltage sequence is related to an appropriate function.

In another embodiment, a method for cerebral palsy intervention, treatment and management is provided, the method comprising, calculating biting force/jaw pressure of a user upon biting a jaw pressure calculating sensor with full force. The method further includes analyzing grip strength of the user hand. The method further includes determining volume of air inhaled and exhaled by lungs of the user. The method further includes examining temperature and sensational value of a user's body.

The method further includes measuring retraction, protrusion, flexion, slugging and upholding capability of the user body. The method further includes generating bio-feedback report upon receiving biting force/jaw pressure, grip strength, inhaled and exhaled by lungs, temperature, sensational value, retraction, protrusion, flexion, slugging and upholding capability of the user body.

The method further includes showing the bio-feedback report by means of a user interface over a display device. The method further includes providing therapeutic interventions required in treatment and management of oral motor kind of cerebral palsy (CP) and thereby restoring both sensory and motor functionality oral motor type of disability whether it is sensory cause or motor associated problem.

An object of the present disclosureis to develop a method and an interactive gaming device for cerebral palsy intervention, treatment and management of infants and adults.

Another object of the present disclosure is to provide plurality of forms of therapy comprises massage over forehead, massage over chin focusing trigeminal nerve stimulation, whistle blowing, lip closure exercises, cheek massage in circular motion to stimulate facial nerves, tongue and pharyngeal exercises in order to stimulate glossopharyngeal nerve, jaw up down movement and lip massage for vagus nerve stimulation, and tongue tapping stimulate hypoglossal nerves.

Another object of the present disclosure is to facilitates in restoring both sensory and motor functionality oral motor type of disability whether a sensory cause or a motor associated problem.

Another object of the present disclosure is to develop interactive device that attracts concentration of the child and provides demo of the therapeutic activities to the child and adult patients.

Another object of the present disclosure facilitates improving respiratory function, improving muscle strength, improving motor control and coordination, improving range of motion (Degree of freedom) and preserving muscle strength and joint flexibility.

Yet another object of the present disclosure is to develop low cost and user-friendly device for cerebral palsy intervention, treatment and management.

To further clarify advantages and features of the present disclosure, a more particular description of the invention will be rendered by reference to specific embodiments thereof, which is illustrated in the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope. The invention will be described and explained with additional specificity and detail with the accompanying drawings.

BRIEF DESCRIPTION OF FIGURES

These and other features, aspects, and advantages of the present disclosure will become better understood when the following detailed description is read with reference to the accompanying drawings in which like characters represent like parts throughout the drawings, wherein:

Figure 1 illustrates a block diagram of an interactive gaming device for cerebral palsy intervention, treatment and management in accordance with an embodiment of the present disclosure; Figure 2 illustrates a flow chart of a method for cerebral palsy intervention, treatment and management in accordance with an embodiment of the present disclosure; Figure 3 illustrates an architecture diagram of an interactive gaming device for cerebral palsy intervention, treatment and management in accordance with an embodiment of the present disclosure; and Figure 4 illustrates an exemplary graph of a bio-feedback report in accordance with an embodiment of the present disclosure.

Further, skilled artisans will appreciate that elements in the drawings are illustrated for simplicity and may not have been necessarily been drawn to scale. For example, the flow charts illustrate the method in terms of the most prominent steps involved to help to improve understanding of aspects of the present disclosure. Furthermore, in terms of the construction of the device, one or more components of the device may have been represented in the drawings by conventional symbols, and the drawings may show only those specific details that are pertinent to understanding the embodiments of the present disclosure so as not to obscure the drawings with details that will be readily apparent to those of ordinary skill in the art having benefit of the description herein.

DETAILED DESCRIPTION

For the purpose of promoting an understanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated system, and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.

It will be understood by those skilled in the art that the foregoing general description and the following detailed description are exemplary and explanatory of the invention and are not intended to be restrictive thereof.

Reference throughout this specification to "an aspect", "another aspect" or similar language means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the present disclosure. Thus, appearances of the phrase "in an embodiment", "in another embodiment" and similar language throughout this specification may, but do not necessarily, all refer to the same embodiment.

The terms "comprises", "comprising", or any other variations thereof, are intended to cover a non-exclusive inclusion, such that a process or method that comprises a list of steps does not include only those steps but may include other steps not expressly listed or inherent to such process or method. Similarly, one or more devices or sub-systems or elements or structures or components proceeded by "comprises...a" does not, without more constraints, preclude the existence of other devices or other sub-systems or other elements or other structures or other components or additional devices or additional sub-systems or additional elements or additional structures or additional components.

Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. The system, methods, and examples provided herein are illustrative only and not intended to be limiting.

Embodiments of the present disclosure will be described below in detail with reference to the accompanying drawings.

Referring to Figure 1, a block diagram of an interactive gaming device for cerebral palsy intervention, treatment and management is illustrated in accordance with an embodiment of the present disclosure. The system 100 includes a jaw pressure calculating sensor 102 for calculating biting force/jaw pressure of a user. The biting force/jaw pressure of the user is calculated upon biting the sensor with full force. The jaw pressure calculating sensor 102 is placed in between upper teeth and lower teeth for calculating biting force/jaw pressure. The jaw pressure calculating sensor 102 is capable of calculating the bite force of a user in various measuring unit. The various measuring unit includes newtons (N), pounds (LBS), or kilograms (KG). The average bite force of a human being is around 126 pounds per square inch (PSI).

In an embodiment, a hand gloves 104areequipped with a grip strength sensor 106 for analysing grip strength of the user hand. The grip strength sensor 106detects amount of pressure applied while griping/holding the grip sensor. The gloves protect and comfort hands against cold or heat, damage by friction, abrasion or chemicals, and disease or in turn to provide a guard for what a bare hand should not touch. The material of gloves is selected according to requirement, comfort and availability of the user. The material is selected from the groups of leather, cloth, latex, nitrile rubber or vinyl.

In an embodiment, a spirometer 108 is used for determining volume of air inhaled and exhaled by lungs of the user. The spirometer 108 determines ventilation, the movement of air into and out of the lungs. The spirogram identifies two different types of abnormal ventilation patterns, obstructive and restrictive. The spirometer 108 is used for basic pulmonary function tests (PFTs). Lung diseases such as asthma, bronchitis, and emphysema are examined from the tests. In addition, a spirometer 108 is used for finding cause of shortness of breath, assessing the effect of contaminants on lung function, the effect of medication, and evaluating progress for disease treatment.

In an embodiment, a temperature sensor 110 is used for examining temperature of a user's body. The temperature sensor 110 is an electronic device that measures the temperature of the body and thereby converts into electronic data to record, monitor, or signal temperature changes. In an embodiment, a sensation sensor is used for detecting sensational value of the user. The sensation sensors are data acquisition devices, or transducers, that are designed to sense a diversity of properties via direct physical contact.

In an embodiment a metallic pressure sensor 114 is usedfor measuring retraction, protrusion, flexion, slugging and upholding capability of the user body. The metallic pressure sensor 114 measure retraction, protrusion, flexion, slugging and upholding capability of the user body upon manual bending of the metallic pressure sensor 114. In an embodiment a computing unit 112is interconnected with the jaw pressure calculating sensor 102, grip strength sensor, spirometer 108, temperature sensor, sensation sensor and the metallic pressure sensor 114for generating bio-feedback report upon receiving biting force/jaw pressure, grip strength, inhaled and exhaled by lungs, temperature, sensational value, retraction, protrusion, flexion, slugging and upholding capability of the user body.

In an embodiment, a user interface 120 is connected to the computing unit 112 for showing the bio-feedback report using a display device. The display unit includes laptop, mobile, personal computer and the like. In an embodiment, a robotic arm 116is in association with the computing unit 112 for providing therapeutic interventions required in treatment and management of oral motor kind of cerebral palsy (CP). The robotic arm 116 supports in restoring both sensory and motor functionality oral motor type of disability whether it is sensory cause or motor associated problem. The robotic arm 116 is placed inside the hand gloves 104 for cushioning effect. The robotic arm 116 includes plurality of motors and fingers for applying pressure over the muscle of the user in order to massage the user's body. The hand gloves 104provide physical therapy-initiated games in different gaming formats. The mechanism measures the different parameters along with active and passive therapy.

In an embodiment, the therapeutic and physical parameters measured by the device is produced in the form of biting force, amplitude, time elapsed in the therapeutic session and frequency of the exercise. The different forms of therapy in interactive gaming forms is provided by the robotic arm, the different forms of therapy comprises massage over forehead, massage over chin focussing trigeminal nerve stimulation, whistle blowing, lip closure exercises, cheek massage in circular motion to stimulate facial nerves, tongue and pharyngeal exercises in order to stimulate glossopharyngeal nerve, jaw up down movement and lip massage for vagus nerve stimulation, and tongue tapping stimulate hypoglossal nerves.

In an embodiment, a piezoelectric sensor 124 is placed into an inner side of finger tips of the hand glove for stimulation of various motor points of face, wherein pressure exerted in the therapy varies in a range provides various activities in the games as the variable voltage sequence is related to an appropriate function.

In an embodiment, the computing unit 112 generates an analogue data from the counter module and thereupon digitally sends to the computing unit 112 for processing and report generating through a USB or Bluetooth 122. In an embodiment, a battery 118 is connected with the device for providing electrical energy to the device.

Figure 2 illustrates a flow chart of a method 200 for cerebral palsy intervention, treatment and management in accordance with an embodiment of the present disclosure. At step 202, the method 200 includes calculating biting force/jaw pressure of a user upon biting a jaw pressure calculating sensor 102 with full force. The biting force/jaw pressure is calculated by using a jaw pressure calculating sensor 102.

At step 204, the method 200 includes analysing grip strength of the user hand by employing a grip sensor. At step 206, the method 200 includes determining volume of air inhaled and exhaled by lungs of the user. At step 208, the method 200 includes examining temperature and sensational value of a user's body.

At step 210, the method 200 includes measuring retraction, protrusion, flexion, slugging and upholding capability of the user body. At step 212, the method 200 includes generating bio-feedback report upon receiving biting force/jaw pressure, grip strength, inhaled and exhaled by lungs, temperature, sensational value, retraction, protrusion, flexion, slugging and upholding capability of the user body.

At step 214, the method 200 includes showing the bio-feedback report by means of a user interface 120 over a display device. At step 216, the method 200 includes providing therapeutic interventions required in treatment and management of oral motor kind of cerebral palsy (CP) and thereby restoring both sensory and motor functionality oral motor type of disability whether it is sensory cause or motor associated problem.

Figure 3 illustrates an architecture diagram of an interactive gaming device for cerebral palsy intervention, treatment and management in accordance with an embodiment of the present disclosure. Figure 3 includes a jaw pressure calculating sensor 102, a grip strength sensor, a spirometer 108, a temperature sensor, a sensation sensor, a metallic pressure sensor 1l4sensor, a computing unit 112 and a display unit.

In an embodiment, a complete solution for all kind of oral motor disability found in different facial and motor positions within a single hardware module along with data transmission facility. Plurality of forms of therapy is provided by the device. The plurality of forms of therapy is provided in interactive gaming forms. The plurality of forms of therapy comprises massage over forehead, massage over chin focussing trigeminal nerve stimulation, whistle blowing, lip closure exercises, cheek massage in circular motion to stimulate facial nerves, tongue and pharyngeal exercises in order to stimulate glossopharyngeal nerve, jaw up down movement and lip massage for vagus nerve stimulation, and tongue tapping stimulate hypoglossal nerves.

In an embodiment, developmental delay is very significant symptoms for identifying and monitoring cerebral palsy (CP) in early childhood stage. The CP can affect different body parts of a patient and identification of oral motor disability among CP patients is a challenging task which requires continuous monitoring of activities of the child. To tackle the oral motor disability among CP kids, early intervention and treatment plays a crucial role in treatment and management of motor disability. The device is an integrated combination of different audio-visual games and demos for therapeutic intervention in different facial motor points in different condition like in resting position or in kinetic movement. The device is capable of attracting child and bringing attention of the child in both active and passive condition. All the activities are performed with different games in an order to attract child and withdraw their attention. The device captures the analogue data from the counter module and thereupon digitally sends to the computing unit 112 for processing and report generating through USB or Bluetooth 122. With the designed device, the user interface 120 also developed for recording captured data, extracting different features from the recorded signals and also for showing the graph and pattern of the therapeutic performance.

In an embodiment, the aim of the device is to give the different kind of therapeutic intervention that is required in cerebral palsy treatment and management. The cerebral palsy is caused by developmental delay and other neurological conditions leading to different kind of CP. Four major symptoms of physical disability (PD) are delayed motor response, muscle tone variation, delayed speech, muscle spasticity and coordination problems. All the symptoms may have present in a CP in together or individually depending upon the severity of the patient. But, from the early stages of CP coordination, control and muscle weakness has been seen among most of the CP patients. So, muscle strengthening exercises are very much essential in respect to the treatment and management. In a common CP patient's muscle weakness and paralysis can occur in different body parts like oral musculature, hand and legs. Most common type of CP is spastic which occurs in growing stage or developmental stage. Some stiffness that creates problem in control and movements.

In an embodiment, the device provides most of the therapeutic interventions that is required in treatment and management of oral motor kind of CP. The device aids in restoring both sensory and motor functionality oral motor type of disability whether a sensory cause or a motor associated problem. The therapeutic and physical parameters measured by the device is produced in the form of biting force, amplitude, time elapsed in the therapeutic session and frequency of the exercise. The device also produces graph and report of the various parameters.

In an embodiment, the device is consisting of two different modules. One is the main computing unit 112 and other is the sensor inbuilt hand gloves 104. The hand gloves 104provide physical therapy-initiated games in different gaming formats. The mechanism measures the different parameters along with active and passive therapy.

Figure 4 illustrates an exemplary graph of a bio-feedback report in accordance with an embodiment of the present disclosure. At least two therapeutic activities are focused for each cranial nerve. At present, 15 selected activities are performed in eight sessions and a result is shown in Table 1 in terms of lip strength, tongue, loudness, duration and sentence completion.

Table 1: Therapeutic intervention of different parameters for plurality of sessions.

Sessions 1 2 3 4 5 6 7 8 Lips (kPa) 21 24 21 26 32 33 35 39 Tongue(kPa) 56 59 61 57 56 64 61 61 Ah Loudness 50 48 51 54 57 59 62 63 (dB SPL) Ah 5.0 5.4 5.0 5.6 7.1 7.8 7.1 7.4 Duration(Sec) Sentences 73 73 74 76 74 74 75 75 (dB SPL)

In an embodiment, Table 1 illustrates therapeutic intervention of different parameters for plurality of sessions and time elapsed by the patients in different activities. For session 1, the value of lips (kPa) is 21, tongue (kPa) is 56, Ah loudness (dB SPL) is 50, Ah duration(Sec) is 5.0 and sentences (dB SPL) is 73. For session 2, the value of lips (kPa) is 24, tongue (kPa) is 59, Ah loudness (dB SPL) is 48, Ah duration(Sec) is 5.4 and sentences (dB SPL) is 73.For session 3, the value of lips (kPa) is 21, tongue (kPa) is 61, Ah loudness (dB

SPL) is 51, Ah duration(Sec) is 5.0 and sentences (dB SPL) is 74.For session 4, the value of lips (kPa) is 26, tongue (kPa) is 57, Ah loudness (dB SPL) is 54, Ah duration(Sec) is 5.6 and sentences (dB SPL) is 76.For session 5, the value of lips (kPa) is 32, tongue (kPa) is 56, Ah loudness (dB SPL) is 57, Ah duration(Sec) is 7.1 and sentences (dB SPL) is 74.For session 6, the value of lips (kPa) is 33, tongue (kPa) is 64, Ah loudness (dB SPL) is 59, Ah duration(Sec) is 7.8 and sentences (dB SPL) is 74.For session 7, the value of lips (kPa) is 35, tongue (kPa) is 61, Ah loudness (dB SPL) is 62, Ah duration(Sec) is 7.1 and sentences (dB SPL) is 75.For session 8, the value of lips (kPa) is 39, tongue (kPa) is 61, Ah loudness (dB SPL) is 63, Ah duration(Sec) is 7.4 and sentences (dB SPL) is 75.

Table 2: Result of single word intelligibility

Listeners 1 2 3 4 5 6 7 8 Avg

(SD) Pre 24% 20% 32% 22% 28% 28% 30% 10% 24%

(7%) After 68% 74% 78% 70% 68% 78% 72% 74% 73%

(4%) Lip and lingual pressure exerted Lip 27.68 45.08 34.68

(kPa) (6.03) (4.55) (4.82) Lingual 47.66 61.75 62.10

(kPa) (18.71) (2.75) (1.93)

In an embodiment, Table 2 illustrates result of single word intelligibility for plurality of sessions and time elapsed by the patients for lip and lingual parameter. The Table 1 is illustrated for plurality of listeners for pre-treatment and post-treatment of CP. For pre treatment, the pressure values, for listener 1 is 24%, for listener 2 is 20%, for listener 3 is 32%, for listener 4 is 22%, for listener 5 is 28%, for listener 6 is 28%, for listener 7 is 30%, for listener 8 is 10% and avg is value is 24 % for SD of 7%. For post-treatment, the pressure values, for listener 1 is 68%, for listener 2 is 74%, for listener 3 is 78%, for listener 4 is 70%, for listener 5 is 68%, for listener 6 is 78%, for listener 7 is 72%, for listener 8 is 74, and avg is value is 73 % for SD of 4%.

In an embodiment, more therapeutic activities are included in curative application of such type of oral motor and speech disorders. The disclosed method and treatment procedure are concluded with the points including standardization of games with therapeutic application is one of the complex tasks as exposure and intervention. The intervention result shows that the device is best suited for children as they are unwilling for manual therapy. Some of the therapeutic activities are more acceptable, enjoyable and engaging to the children. More exploration is needed in this field to make it frequent in professional therapeutic set up and also in occupational therapeutic practices. Efficacy of gaming therapy is tested on other parameters including attention, distraction, ease, reliability and emotional expression status. Therapeutic gaming is promising, reliant and effective with better outcome. The device having the benefit of less costly, easy to use, reduces frequent visit to hospitals and can be given by direct and indirect ways too. Therapeutic treatment in form of interactive gaming improves muscle strength, coordination and motor sensory activities by minimizing muscle spasticity. If all the activities are performed in a regular manner within home premises or in any clinic then it can save the child and disabled. On the other hand, the device brings the child and disabled in main streams of living by recovering their muscle strength. Later this can make whole the family happy with the normal and independent living of the child.

Table 3: Activity with impact on motor points and advantage

Nerve Exercise or Motor points Advantage Type of Biofe activity Exercise edbac k

Trigeminal Nerve

Origin: Pons Clenching of Masseter, Increase oral Active Yes teeth Mandibuler, pressure Itislargestcranial nerve of head and Orbicularis face. It is a kind of Oris mixed nerve i.e. provides both motor andsensory function. Opening the Mantalis, Improves oral Active/Pas Yes jaw against Quadratuslab feeding sive resistance iiinferioris,

Masseter

Upper and Mandibuler Increase Passive Yes lower cheek and buccal range of stretch motion of jaw, cheeks, lips and tongue

Jaw rotation Mantalis, Improvement Passive Yes Quadratuslab in iiinferioris, Mastication Orbicularis Oris, Masseter and mandibuler

Side by side Mandibuler, Increase Passive Yes anterior Buccal and muscle cheek stretch Masseter strength

Cheek Trunk, Increase Passive Yes rotation Masseter, muscle Mandibular, strength buccaland orbicularis oris

Interior cheek Quadrature Improve Passive Yes stretch Labiisuperior motion of is vocal cavity

Facial Nerve Side by side Quadrature Able to show Passive Yes lip twisting Labiisuperior facial is, expression Origin: Pons Quadratuslab iiinferioris, It controls the orbicularis muscles of facial ori expression. Puffing Trunk, Taste Active Yes ntio rn cheeks Masseter, sensation and motor Buccal, coordination Mandibular and orbicularis oris

Upper Mandibular Muscle Passive Possib posterior and strength ly cheek stretch orbicularis oris

Upper and Quadrature do Passive Possib lower lip Labiisuperior ly stretch is, Quadrature Labiiinfiriori s orbicularis oris

Lip Closure Quadrature Active/Pas Yes Labiisuperior sive is, Quadrature Labiiinfiriori s and orbicularis oris

Both the side Trunk, Increase Passive Yes cheek stretch Masseter, range of Buccal, motion and Mandibular muscle and strength orbicularis oris

Glossopharyngeal *

Nerve

Tongue Increases Passive Yes Origin: Medulla tapping taste Oblongata sensation and gag reflex It innervates the oropharynx carotid body and sinus, posterior one third of the tongue, middle ear cavity and Eustachian tube.

Function: Both(sensory and motor)

Vagus Nerve Reading task * Better Active Yes

understandin

Origin: Medulla g Oblongata Articulation * Increases Passive Yes

Ithaswidest drill swallowing distribution in the ability body passes through Lower chin * Improves Passive Yes neck and thorax. rotation phonation

Function: Motor and and speaking sensory ability

Spinal Accessory Slugging and * Able to move Active Possib Nerve upholding headand ly shoulder

Protraction * Shoulder Active Possib Origin: Spinal roots and retraction movement ly Ithasapurely Elevation and * Head and Passive/A Possib somatic motor function. depression neck ctive ly movement Function: Sensory

Hypoglossal Nerve Pushing * Increase Passive Possib tongue tongue ly against strength Origin: Medulla resistance Oblongata Tongue * Increase Active Possib It innervates the extension and tongue ly sternocleidomastoid retraction movement and trapezius Tnusd muscles. Tongue side* Increase Active Possib to side inside tongue ly Function: Motor and strength and sensory coordination

Tongue push * Increases the Active Yes up strength back ofthetongue

Tongue pops * Active Possib ly Tongue push * Increase Active Possib side to side tongue ly strength

Vestibulecochlear Head * Improve eye Active/Pas Possib Nerve movement movement sive ly coordinated with eye Origin: movements

Cerebellopontine Total body * Balancing Active/Pas Possib angle movements and sive ly and balance coordination It emerges from the tasks pons and exits the inner skull via the Habituation * Active/Pas Possib internal acoustic exercises for sive ly meatus in the vestibular temporal bone. system

Function: Sensory adaptation

Relaxation * Active/Pas Possib exercises sive ly

Aerobic * Increases Active Possib dancing/slide balanceand ly and step coordination program

In an embodiment, in program strategy for different activities includes clenching of teeth, opening jaw against resistance, musical games for tongue tapping, puffing cheeks, jaw rotation and side by side lip stretch, upper and lower cheek stretch, cheek rotation, and upper and posterior cheek stretch, lip twisting and lip closure are some of the selected activities that are performed and all other including these are given in the Table 3.

In an embodiment, recent methods and advancing world of medical electronics changed lots of traditional therapeutic intervention and approach for the management and treatment of several disorders. In the same line of approach, the way of treatment of cerebral palsy is also changing more or less with recent advancement in clinical research. The clinical advancement gives a new pathway in the understanding of CP, early detection and prevention with primary care and a new opportunity to treat CP with the combination of both modern approach as well as the traditional therapeutic approach. Implementation of modern therapeutic electronics with enriched environment plays a vital role in treatment and management of CP. The child and therapist both are much interested and enjoy a lot when the therapy is given from modem devices like computer, tablet, mobile phones in the form of interactive gaming to achieve a variety of therapeutic goals. Use of electronic and software gaming specifically designed for therapeutic purposes may adjunct to manual therapy. The games in recovery of oral motor strength in rehabilitation settings are showing more enjoyable and acceptable for growing children and adults too.

In an embodiment, plurality of goals of early therapeutic interventions includes improving respiratory function, improving muscle strength, improving motor control and coordination, improving range of motion (Degree of freedom) and preserving muscle strength and joint flexibility.

In an embodiment, in improve respiratory function, the life expectancy has been improved from last few decades all over the world. Specifically, aging and related problems are primarily caused by poor degradation of lung functionality occurs due to the improper functioning respiratory muscles and decreased thoracic motility along with diminished pulmonary function efficiency. Profound changes occur at old age, which is associated with cardiovascular system consisting of changes in heart rate variability (HRV) and spontaneous baroreflex gain. Changes result in poor adaptation and control of various functionalities like cardiorespiratory systems, cardiovascular system etc. Characteristic changes of natural aging process may lead to reduced life expectancy and reduced quality of life.

In an embodiment, it has been seen from ancient days that breathing exercises plays important role in proper functioning of various body organs. The breathing exercises are having direct impact on brain functioning and also on respiratory systems. The breathing exercises is able to recover blunt sympathetic excitatory pathways by repetitive and regular practice. The breathing exercises are simple, cost effective intervention technique, easy to learn and can be practiced in regular routine within home premises resulting beneficial in respiratory and cardiovascular systems for both young aged people and also for old aged people. Kapalbhati and Bhastrika pranayams are exclusively and comprehensibly breathing/respiratory yoga exercises include exhalation and inhalation. Bhastrika pranayama makes balance in vata, pitta and kapha. Bhastrika pranayama is well known to generate heat in the body by engaging chest and lungs. There are several benefits of Bhastrika like brain oxygenation, good for nervous and motor systems, energizes the body and mind, reduces anxiety and depression, helps in fibrosis, strengthen immunity etc.

In an embodiment, in improve muscle strength, while talking about muscle strengthening exercises, people think that exercise is required for body builders and sports person. There is much ignorance that it is required to the person having locomotors disability and to the disable population. The exercises are much needed to the disabled people than the body builders and sportsman to live comfortable life. A person having arm paralysis or leg paralysis uses walking aids in the form of wheel chair either manual or automatic. Even though if a disabled person wants to move himself with wheelchairs, he requires strengthened arm to shift from one place to another place. Such type of paralysis occurs due to many factors like developmental delay, malnutrition, decreased bone density etc. The problems can be tackled by various muscle strengthening exercises. In fact, muscle strengthening exercises allows to build neuronal connection and also promotes to increase bone density. Muscle strength training is having no importance after a certain level and also it is not having any importance be a threshold value. Strengthening above threshold value are having great importance in terms of functional recovery and day to day living by improving present performance at functional activity levels. The functional activities that are commonly addressed are siting, standing, walking, stair climbing, balancing in straight and curved positions. Independence in siting and standing maneuvers are much needed physical component related with weight transfer and knee extension force (10). In some cases, people use their hands in sitting and standing processes. Although knee extensors strength on each side are correlated along with body weight in sit to stand procedure.

In an embodiment, in improve motor control and coordination, the people having difficulties in performing fine and gross motor skills are seeing lacking everywhere in terms of performance either in classroom or in day to day living. The level of sensory and motor skill level below age specific level may degrade academic and interpersonal skills. Additionally, several comorbid problems are seen in these people like social isolation, low confidence, behavioral problems etc. The therapeutic approaches that are dealing to overcome such disabilities can be grouped into three categories as conventional physical therapy, process oriented and task oriented. One more grouping that are added may be patient centric and individualized depends on specific symptoms and etiology. The exercises are specifically prescribed to correct impairment, restoring functional activities, improve musculoskeletal strength and maintaining art of physical well-being. The exercises are specific and patient oriented or can be general and vigorous to regain functional activity. There is a strong connection among therapy and physical well-being that engages at any level of exercise in a disciplined manner is always beneficial in improving motor function and mobility. Physician and physiotherapist is able to improve mobility of a disease by combining medicine and physical exercises to improve thinking, cognition, memory and reduced risk of falls.

In an embodiment, in improve range of motion (Degree of freedom), the decreased range of motion restricts the degree of freedom of a person. Flexible hand, leg, knee and joint impacts functional efficiency and gaming capability of human being. To provide treatment to a loss of movement, physical exercises are necessary for efficient movement. Degree of freedom are viewed as the amount of joint range of motion (ROM) and flexibility is known as degree of extensibility of connective tissues. There are various factors that limits ROM and flexibility of arm, leg, shoulder, knee etc. These factors may include joint effusion, tissue structure, bone architecture and alignment of articular surfaces. Other factors that affects are muscles and their tendons, skin, adipose tissues and neural tissues. All the factors are basically involved in restriction of basic three types of movement.

In an embodiment, in preserving muscle strength and joint flexibility, in our body joints are connected with ligament and combination of muscle provides stability. Layered tissues of articular cartilage at the terminal sections of bones providing great help in compression and expansion of muscles during our movement. Healthy joints are symbol ofperfect cartilage to support active lifestyle and daily activities including sport and exercise.

In an embodiment, the exercise plays a big role in keeping joints healthy with strong muscle strength. Due to the lack of flexibility in movement of different joints and inappropriate muscle strength a person may not be able to perform daily activities like sitting, bending, standing, movement etc. Different exercises tackle such type of problems without having any side effects.

In an embodiment, in selection of nerve stimulation activities converted in gaming format, there are twelve pair of cranial nerves that are involved in speech, language, swallowing, hearing, vision and all other motor and sensory activities of mouth and head. These nerves are of great importance for speech language pathologist as they are directly link brain with our oral musculature like head, neck and trunk. Out of the 12 pairs, six pairs are of more focused on speech, swallowing, pharynx, larynx and other (including special senses including taste, hearing and sensation) oral motor functions. All the pairs of muscles are motor muscles or sensory muscles or mixed kind of muscles which are involved in either motor function or sensory function or in both. Functional ability of a person is dependent on the oral musculature and nerve ability including the neuronal circuitry. Jaw pressure, blowing strength, biting force and other parameters define how much a person is capable in performing daily activities. The description and name of cranial nerves are based on their location of origin and their types includes Olfactory-I, Optic-II, Oculomotor-II, Trochlear IV, Trigeminal-V, Abducens-VI, Facial-VII, Vestibulocochlear-VIII, Glossopharyngeal-IX, Vagus-X, Accessory-XI, and Hypoglossal-XII.

In an embodiment, the olfactory-Iis a special nerve for smell or olfaction of food and beverages. The olfactory-I consists of olfactory bulb, epithelium and rhinencephalon expanded up to mucous membrane via nasal cavity through olfactory region. The olfactory-I acts as a chemical sensor in detection various flavors and also plays an important role in nutrition and safety. Smell and taste sensation are transmitted through special visceral afferent fibers. The dysfunction of olfactory nerve leads to anosmia, dysosmia, cacosmia, phantosmia, hyperosmia, agnosia and other smell and odor related disorders.

In an embodiment, the optic-II is anoptic nerve processes visual stimulus through special somatic afferent fibers. Photo sensation enters to retina via photoreceptors rod and cones. The electrical signal is transmitted to other cells in order to process and integrate motor and sensory information (Mainly Sensory). The photoreceptor sends electrical signal to the ganglion neurons residing retinal region.

In an embodiment, the oculomotor-II plays an important role in tracking, controlling and movement involving somatic motor component part of CN III. In an embodiment, the trochlear-IV is one among motor nerves. The anatomy oftrochlear-IV is basically divided into four parts consisting of nucleus and an intraparenchymal portion, cisternal portion, cavernous sinus portion, orbital portion.

In an embodiment, the trigeminal-Vis responsible for transmitting sensation from face to brain and brain to mouth, teeth, face and nasal cavity. The trigeminal-V controls the muscle used for chewing and biting. Due to improper functioning of CN V, inadequate jaw pressure, jaw deviation, can't differentiate sensation of sharp and dull objects at face, can't differentiate sensation of cold and warm objects and can't differentiate sensation of soft touch.

In an embodiment, the abducens-VI is originated from abducens nuclei in the pons region of human brain. The abducens-VI comes under the category of somatic nerve performing motor functions of lateral rectus muscle. The lateral rectus attaches to the anterolateral part of sclera. In an embodiment, the facial-VII controls the muscle of facial expression and provides taste sensation from anterior of tongue, pressure sensation of face. Dysfunction of CN VII may cause problems in comeal reflex, eyelid closure, smile, lip movements, nasal movements, puffing of cheeks, chin movements and assisting grimace.

In an embodiment, the vestibulocochlear-VIII functions are related to hearing, balance and eye movement. Head movement coordinated with eye movement, total body movements and balance tasks, habituation exercises for vestibular system adaptation, relaxation exercises, aerobic dancing and step program to reduce balance and coordination deficits.

In an embodiment, the glossopharyngeal-IX provides information for the gag reflex, taste sensation, parasympathetic innervations to parotid gland, innervates the stylopharyngeus muscle of the pharynx that elevates the larynx during swallowing, provides sensory innervations to middle ear and internal surface of the tympanic membrane and Eustachian tube.

In an embodiment, functions of vagus-X nerve are speech, voice, gag reflex, swallowing, phonation, involuntary muscle and gland control, visceral sensibility, taste and cutaneous sensibility. Vagus nerve are activated through swallow maneuvers (effortful swallow, chin tuck, supra glottic swallow), breathing exercises, articulation drill, reading task, lower chin rotation, jaw up down movement, tongue rotation and folding inside, lip massage and sucking.

In an embodiment, functional activities of accessory-XI (CN XI) are shoulder shrugging, head neck movement. Slugging and upholding, protraction and retraction, elevation and depression and transcutaneous are the nerve stimulation exercises that can recover its functionality.

In an embodiment, the hypoglossal-XII helps in movement of tongue, articulation, swallowing-bolus formation, drawing the head back so as the face is upward by the trapezius nerve, elevation of shoulder by trapezius nerve, flexion of the neck by stemocleidomastoid muscle and rotation of head away from the side of the contracting sternocleidomastoid muscle. To stimulate cranial nerve involved in speech and swallowing there are some well established activities like clenching of teeth, opening the jaw against resistance, upper and lower cheek stretch, jaw rotation, side by side anterior cheek stretch, cheek rotation, interior cheek stretch for trigeminal nerve; side by side lip twisting, puffing cheeks, upper posterior cheek stretch, upper and lower lip stretch, lip closure, both the side cheek stretch for facial nerve; tongue tapping for glossopharyngeal nerve; reading task, articulation drill, lower chin rotation for vagus nerve; slugging and upholding, protraction and retraction, elevation and depression is for spinal accessory nerve, pushing tongue against resistance, tongue extension and retraction, side by side tongue movement, tongue push up, tongue pops for hypoglossal nerve; head movement coordinated with eye movements, total body movements and balance tasks, habituation exercises for vestibular system adaptation, relaxation exercises andaerobic dancing for vestibule cochlear nerve.

In an embodiment, in validation of selected activities, the above selected activities are implemented on mild and severely disabled children. Much more improvement in the functional activities of mild and moderately disabled children as compared to the severely disabled children is observed.

In an embodiment, in tongue dynamics exercises, one mild and one severely disabled child is selected who is unable to produce speech whereas the earlier case was able to produce speech but it was not intelligible to the common person except his family member and people who are in his regular touch. Both the participants are having the same age group of 6-8 years. There is no family history of speech and language disorder in both the cases. The word pronunciation test is done in both Hindi and English language to test articulation skills and to get phonation ability. Both children are not able to pronounce word like 'RAM' and in place of ram they were pronouncing 'LAM'. In the same both children pronounce 'Lala' in place of 'Mala'. Such types of different word are tested and recorded for further analysis. The children are having problems in production of /t/, /d/, /r/, /j/ etc.

In an embodiment, a Dr. Speech user interface 120 and hardware systems are installed and connected along with a personal computer (PC), which is used for analysis purpose with a frame size of 40 frames per second. An audio input sample rate is set at a 22 KHz. A microphone and a transducer are connected to PC via cable and kept just below the chin of the child. To overcome all problems physical therapy is provided to the children for a period of three months of having different- different session structures.

The present disclosure offers several advantages. Among other advantages, the device disclosed herein is user friendly and thereby can be operated by a user of any age. The disclosed device provides plurality of forms of therapy comprises massage over forehead, massage over chin focusing trigeminal nerve stimulation, whistle blowing, lip closure exercises, cheek massage in circular motion to stimulate facial nerves, tongue and pharyngeal exercises in order to stimulate glossopharyngeal nerve, jaw up down movement and lip massage for vagus nerve stimulation, and tongue tapping stimulate hypoglossal nerves.The device aids in restoring both sensory and motor functionality oral motor type of disability whether a sensory cause or a motor associated problem. The therapeutic and physical parameters measured by the device is produced in the form of biting force, amplitude, time elapsed in the therapeutic session and frequency of the exercise. The device also produces graph and report of the various parameters. The device is interactive and thereupon attracts concentration of the child and provides demo of the therapeutic activities to the child and adult patients. The device is small in size and is light weighted. The device is portable, low cost, and battery powered. The device also facilitates improving respiratory function, improving muscle strength, improving motor control and coordination, improving range of motion (Degree of freedom) and preserving muscle strength and joint flexibility.

The drawings and the forgoing description give examples of embodiments. Those skilled in the art will appreciate that one or more of the described elements may well be combined into a single functional element. Alternatively, certain elements may be split into multiple functional elements. Elements from one embodiment may be added to another embodiment. For example, orders of processes described herein may be changed and are not limited to the manner described herein. Moreover, the actions of any flow diagram need not be implemented in the order shown; nor do all of the acts necessarily need to be performed. Also, those acts that are not dependent on other acts may be performed in parallel with the other acts. The scope of embodiments is by no means limited by these specific examples. Numerous variations, whether explicitly given in the specification or not, such as differences in structure, dimension, and use of material, are possible. The scope of embodiments is at least as broad as given by the following claims.

Benefits, other advantages, and solutions to problems have been described above with regard to specific embodiments. However, the benefits, advantages, solutions to problems, and any component(s) that may cause any benefit, advantage, or solution to occur or become more pronounced are not to be construed as a critical, required, or essential feature or component of any or all the claims.

Claims

We Claim 1. An interactive gaming device for cerebral palsy intervention, treatment and management, the device comprising: a jaw pressure calculating sensor for calculating biting force/jaw pressure of a user, wherein the biting force/jaw pressure of the user is calculated upon biting the sensor with full force, wherein the jaw pressure sensor is placed in between upper teeth and lower teeth for calculating biting force/jaw pressure; a hand gloves equipped with a grip strength sensor for analyzing grip strength of the user hand; a spirometer for determining volume of air inhaledand exhaled by lungs of the user, wherein the spirometer determines ventilation, the movement of air into and out of the lungs; a temperature sensor for examining temperature of a user's body, wherein sensation sensor is attached with the temperature sensor for detecting sensational value of the user; a metallic pressure sensor for measuring retraction, protrusion, flexion, slugging and upholding capability of the user body; a computing unit interconnected with the jaw pressure calculating sensor, grip strength sensor, spirometer, temperature sensor, sensation sensor and the metallic pressure sensor for generating bio-feedback report upon receiving biting force/jaw pressure, grip strength, inhaledand exhaled by lungs, temperature, sensational value, retraction, protrusion, flexion, slugging and upholding capability of the user body; a user interface connected to the computing unit for showing the bio-feedback report using a display device; and a robotic arm in association with the computing unit for providing therapeutic interventions required in treatment and management of oral motor kind of cerebral palsy (CP), wherein the robotic arm supports in restoring both sensory and motor functionality oral motor type of disability whether it is sensory cause or motor associated problem, wherein the robotic arm is placed inside the hand gloves for cushioning effect.

2. The device as claimed in claim 1, wherein the therapeutic and physical parameters measured by the device will produced in the form of biting force, amplitude, time elapsed in the therapeutic session and frequency of the exercise.

3. The device as claimed in claim 1, wherein different forms of therapy in interactive gaming forms is provided by the robotic arm, the different forms of therapy comprises massage over forehead, massage over chin focussing trigeminal nerve stimulation, whistle blowing, lip closure exercises, cheek massage in circular motion to stimulate facial nerves, tongue and pharyngeal exercises in order to stimulate glossopharyngeal nerve, jaw up down movement and lip massage for vagus nerve stimulation, and tongue tapping stimulate hypoglossal nerves.

4. The device as claimed in claim 1 and 3, comprising a piezoelectric sensor placed into an inner side of finger tips of the hand glove for stimulation of various motor points of face, wherein pressure exerted in the therapy varies in a range provides various activities in the games as the variable voltage sequence is related to an appropriate function.

5. A method for cerebral palsy intervention, treatment and management, the method comprising: calculating biting force/jaw pressure of a user upon biting a jaw pressure calculating sensor with full force; analysing grip strength of the user hand; determining volume of air inhaled and exhaled by lungs of the user; examining temperature and sensational value of a user's body; measuring retraction, protrusion, flexion, slugging and upholding capability of the user body; generating bio-feedback report upon receiving biting force/jaw pressure, grip strength, inhaled and exhaled by lungs, temperature, sensational value, retraction, protrusion, flexion, slugging and upholding capability of the user body; showing the bio-feedback report by means of a user interface over a display device; and providing therapeutic interventions required in treatment and management of oral motor kind of cerebral palsy (CP) and thereby restoring both sensory and motor functionality oral motor type of disability whether it is sensory cause or motor associated problem.

Jaw Pressure Grip Strength Calculating Hand Gloves 104 Sensor 106 Sensor 102 Temperature Computing Unit Spirometer 108 Sensor 110 112

Metallic Pressure Robotic Arm 116 Battery 118 Sensor 114

Piezoelectric User Interface Bluetooth 122 Sensor 124 120

Figure 1 calculating biting force/jaw pressure of a user upon biting a jaw pressure calculating sensor with full force 202

204 analyzing grip strength of the user hand

206 determining volume of air inhaled and exhaled by lungs of the user

208 examining temperature and sensational value of a user’s body

210 measuring retraction, protrusion, flexion, slugging and upholding capability of the user body

generating bio-feedback report upon receiving biting force/jaw pressure, grip strength, inhaled and exhaled by lungs, temperature, 212 sensational value, retraction, protrusion, flexion, slugging and upholding capability of the user body

214 showing the bio-feedback report by means of a user interface over a display device

providing therapeutic interventions required in treatment and management of oral motor kind of cerebral palsy (CP) and thereby 216 restoring both sensory and motor functionality oral motor type of disability whether it is sensory cause or motor associated problem

Figure 2

Figure 3

Figure 4