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Surface EMG-Driven, Smartphone-Integrated Therapeutic Gaming System for Rehabilitation of Muscle Weakness
Yusha Liu, MD, PhD1, David Meece, BS2, Jacob A. Baudin, MD, PhD1, Colin Morris, MS2, Jung Kim, BS2, Jessica Zistatsis, MS2, Jeffrey B. Friedrich, MD, MC1, Dennis S. Kao, MD1, David A. Boone, MPH, PhD2 and Aaron E. Bunnell, MD1, (1)University of Washington, Seattle, WA, (2)Orthocare Innovations, Edmonds, WA

INTRODUCTION
Severe muscle weakness may result from peripheral nerve and spinal cord injury or stroke; although therapy is critical for regaining function, patients with profound weakness are unable to perform standard exercises. We created an innovative system for therapeutic gaming using a simple video game that is controlled by input from surface electromyography (sEMG). Preliminary testing with our initial wired sEMG prototype device was promising, with patients easily engaging in gameplay and finding the system motivating, enjoyable, and usable. We sought to further optimize and refine both the hardware and software components to maximize usability for future clinical applications.
METHODS
Our new, custom-built wireless sEMG device features stainless steel button electrodes, a 3D-printed, two-part clamshell housing, and an electronic design that combines a printed circuit board with an ARM Cortex processor embedded in a U-Blox NINA Bluetooth module, a wireless charging circuit and coil receiver, and a lithium polymer battery (Figure 1). To adapt our video game to become smartphone-compatible, software was written with the cross-platform mobile application development library Flutter.
RESULTS
We successfully created a novel sEMG device that is completely wireless and Bluetooth-enabled to interface with our therapeutic gaming app on any mobile device which can be calibrated to each patient's muscle strength (Figure 2). Our sEMG device has a compact design and can be comfortably worn with a removable elastic strap, giving flexibility in its placement to target different muscles of interest. The battery lasts for at least three hours of continuous use and charges wirelessly. The electronic components are fully encased in a waterproof housing, allowing for the exterior surfaces to be cleaned with standard hospital sanitizing wipes. Finally, the raw cost of production is less than $40 per unit.
CONCLUSIONS
Surface EMG-driven therapy has tremendous potential particularly with severe muscle weakness in the earliest stages of recovery, as nascent signals from muscle activation are detectable on EMG long before significant limb movement is observed, allowing for earlier initiation of active therapy. Therapeutic gaming also promotes patient engagement, motivation, and adherence to exercises. We have engineered a commercially viable, wireless, Bluetooth-enabled sEMG device and integrated this with a video game running on a mobile platform compatible with smartphones and tablets. Our upgraded wireless and mobile app-based design will maximize accessibility for all patients, with the hope that patients of all ages, socioeconomic statuses, and communities may benefit from this innovative, personalized approach to rehabilitation.


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