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Updated 8:30 AM April 16, 2007




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At-home project connects adults with cerebral palsy
to virtual trainers

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 has grown older, Gable has noticed the pain, stiffness and other motor effects 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," Gable says. "Very simple things that a lot of people don't think are hard, are becoming really difficult for me."

While physical and occupational therapy bring relief, many adults with cerebral palsy find juggling busy work and family schedules leaves little time to attend regular therapy sessions outside the home. And 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 homes? Using an Internet connection and a home computer interface, a new program developed by experts at the U-M Health System and the Division of Kinesiology aims to make movement-based training more convenient and accessible.

This joint research and movement therapy project—called the Upper Limb Training and Assessment Program, or ULTrA—is 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 Dr. Edward Hurvitz, chair of the Department of Physical Medicine and Rehabilitation at UMHS. "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.

"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, director of the Motor Control Lab at the 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," Brown says.

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," Brown says.

ULTrA has helped Gable 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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