1. Introduction
Cerebral Palsy is “a group of disorders that affect movement, muscle tone and posture that is caused by damage that occurs to the immature, developing brain, most often before birth”. Symptoms of Cerebral Palsy (CP) include impaired movement associated with abnormal reflexes, floppiness and rigidity of the limbs, abnormal posture, tremors or involuntary movements, unsteady walking, favoring one side of the body over the other, lack of balance or muscle coordination, difficulties with speech and excessive drooling, or some combination of the above. [1] The severity of one or more of these symptoms can vary significantly from one patient to the next, though they often appear in early childhood. It can be classified in several different ways, such as by severity level (mild, moderate, severe), by topographical distribution (the body parts affected), by motor function (spastic or non-spastic), or by gross motor function classification system (GMFCS). [2]
In the case of treatment, medications and surgery can be used when necessary, but a more active treatment form exists in the form of the various therapies available for these patients. Examples of this include physical therapy, occupational therapy, speech and language therapy and recreational therapy. [3] Music therapy is an alternative method of treatment which can help in addressing the physical, emotional, cognitive and social needs of an individual. It serves as a way for them to relieve stress, express themselves creatively, develop social skills through group performance and improve communication and language skills. Due to the fact that traditional music instruments demand high levels of sensori-motor coordination and precision, it can make them hard to control, thus affecting the efficacy of music therapy, so alternate instruments or systems should also be considered.[4] Another additional form of therapy is play therapy which provides the children with the skills they need and allows them to build social connections while having fun and playing. It incorporates the child’s physical abilities, cognitive functioning levels and emotional needs in a safe, supportive environment that uses play to help them develop a better sense of inclusion using both directed and non-directed play. [5]
The Spastic Children’s Association of Selangor & Federal Territory (SCAS&FT) is an NGO that was established in 1960 for the purpose of educating, rehabilitating and caring for children with Cerebral Palsy, with a full-time staff of 35 and assisted by large group of volunteers. It manages a Spastic Centre that provides numerous services, facilities and activities that are used to care and treat people with cerebral palsy. Children can be admitted as soon as they are diagnosed and there is no exit age when they stop providing service. These services are also provided free of charge and have an extensive range from the traditional treatment of physiotherapy, speech therapy, occupational therapy and hydrotherapy to arts and handicraft, recreational and competitive sports, vocational training and sheltered workshops. They also provide special education for the children there and teach them independent living skills. [6]
1.1 Problem Statement
With the struggles that they face in their everyday lives, there is an additional risk of stress and depression in children with cerebral palsy. During my observation of the children when I was volunteering at Spastic Children’s Association of Selangor and Federal Territory, I noticed that the children have to complete various tasks for a certain period of time such as typing and painting alongside their physical exercises. Due to the symptoms that come with cerebral palsy, such as lack of coordination, sensation and balance, these tasks tend to become repetitive, tiresome and time-consuming. Because of this, it leads to a general lack of enthusiasm and disengagement in learning activities among them.
There also weren’t many activities that they could do together, given that their schedules are quite irregular and the severity of their cerebral palsy also varied. They all follow their own schedule of therapy treatment that interrupts their daily learning activities. The difference of severity of their cerebral palsy can be seen visually, since some of them are wheelchair bound and some of them have limited mobility but are able to walk by themselves, and can be ascertained from their Gross Motor Function Classification System (GMFCS). The GMFCS level defines a 5-level classification system that describes the gross motor function of children with cerebral palsy from the ages of 2-18, specifically on the basis of their self-initiated movement with particular emphasis on sitting, walking, and wheeled mobility. Distinctions between levels are based on functional abilities, the need for assistive technology, including hand-held mobility devices (walkers, crutches, or canes) or wheeled mobility, and to a much lesser extent, quality of movement. [7] The GMFCS scale ranges from Level I, where children are able to walk up the stairs without using the railing, and run and jump (with limited speed, balance and coordination), to Level V where children are transported in a manual wheelchair in all settings and are limited in their ability to maintain “antigravity head and trunk postures” and control their leg and arm movements.[8]
Thus, there are certain limitations to this project since the needs and abilities of each child are quite different. Consequently, a plan must be made so that these children with different conditions and capabilities can get some physical, mental and/or social rewards from interacting with the musical therapy system.
The main aim is to develop a musical interactive system for multiple users that can serve as both therapy and rehabilitation and change the learning experience for children with cerebral palsy at the Spastic Children’s Association Of Selangor & Federal Territory (SCAS&FT). This system is intended to attract the children into expressing themselves through music and relieve stress as well as encourage social interaction between them and their peers.
Playing is an essential part of every child’s life, it could even be said to be an instinct for them. It allows children to explore the world in their own way, to use their creativity while developing their imagination, dexterity, and physical, cognitive and emotional strength. Thus, it is even more important for children with cerebral palsy. Though they may have difficulty acting on the impulse to play, playing can bring them just as much benefit, providing them with the skills they need to have fun and build valuable connections. [9]
Children with cerebral palsy face many problems in their daily lives, which leads to the increased risk of stress or depression. With that in mind, playing can also serve as an outlet for stress relief as well as creative expression. In addition, given the lack of socialization they have playing can encourage social interaction between them and their peers, and help them in building ties to people outside their families.
Thus, in the hopes of improving their experience, a rewards-based system was implemented with the idea of rewarding system interaction through music to aid in their therapy. This system would provide audio and visual feedback as a ‘reward’ upon completion of tasks. Through this, it would hopefully improve their moods, relieve stress, encourage social interaction and creative expression while fulfilling their rehabilitation needs.
3. Related work
Over the course of my research, I have not come across many interactive systems, especially musical ones, that have been implemented in the rehabilitation process for people who have cerebral palsy. One that I have encountered so far however is the ‘Interactive Music and Bubble Effect in Arduino’ which is the most similar to this project, even using the same platform. It was used to investigate the training of the index finger press ability, and upper/lower limb straightening and pressing ability for two children with CP. [10]
Another one was TouchTone, an electronic musical instrument designed for children with hemiplegic cerebral palsy that was executed during the Master Design for Interaction at the faculty of Industrial Design Engineering, TU Delft. It was designed to help them develop musical ability, develop bimanual coordination and increase social participation of children with hemiplegia. TouchTone uses pressure-sensitive pads to trigger pitches, alongside an LED indicator associated with each pad so the children can follow along.[11]
Another musical system that was implemented for cerebral palsy in particular is the Augmented Reality Musical System for Children with Cerebral Palsy Rehabilitation which uses colored cards with graphic symbols to replace the music keyboard. Using this system the therapist can print cards of different sizes and place them in various ways, according to the desired motor exercise and each card represents a different musical note in the timbre of a given musical instrument and is attached to a colored virtual cube. [12]
4. Description of the work
4.1 Methodology
The Multi-user Musical Therapy System will be created primarily through the use of the Bare Conductive Touch Board and Electric Paint, as well as other conductive materials such as aluminium foil. Using the Arduino IDE platform, the Touch Board’s 12 electrodes can be transformed into sensors that trigger sounds like MP3 tracks or MIDI notes. The Bare Conductive paint is electrically conductive, allowing it to be used to design graphical sensors in an attractive way as well as providing a way to connect to connect the Touch Board electrodes to those sensors. The MicroSD card provided in the kit can store MP3 sound files for the Touch Board’s mini MP3 player and also allows for changes and modifications in the MP3 files via computer through the use of a MicroSD Card Reader. [13]
The Bare Conductive Touch Board will also be used as a medium for projection mapping, a modern projection technique that allows for objects to be turned into display surfaces for video projection. These projections will be triggered by touch, similar to the sensors that allow music to be played via the Touch Board’s 12 electrodes.
An ethnographic research approach will be conducted for the project to gather data and results, accompanied by interviews, surveys and questionnaires, with the permission of their parents/guardians (via signed consent forms). Throughout the ethnographic study, observation of the users will be carried out as they test out the prototype and videos may be recorded (if permission is granted) for further review to see if the prototype has successfully met the children’s requirements and if there is any improvement after using the prototype. Two separate data gathering sessions will be conducted, the first being only one user interacting with the prototype and the second being two users interacting with the prototype at the same time.
4.2 Design
The basic inspiration for the design of the mid-fidelity prototype came from observation during my week of volunteering at SCAS&FT as well as prior examples that had been given before. With additional suggestions from my supervisor, Dr Marina, after her approval was gained, I started the implementation phase.
A folding table was used so that the height could be adjusted and it could be placed onto a table to make it more accessible for wheelchair-bound users. Aluminium foil and nails were chosen as conductors to maximize the touchable regions that could be pressed to trigger the music, thus enhancing the usability of the music board.
Disney was chosen as a theme due to its popularity in the hopes that it would appeal to the target audience and attract users to play more and longer. Longer songs/choruses were chosen to attract their attention and allow them to remember them easier and the pictures chosen were bright and colorful to make it easier for them to see and touch the board to trigger the music. The placement of each picture/musical element was carefully considered and spread out so the users would have to stretch their arms out more for certain pictures.
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