A video game based hand grip system for measuring muscle force in children

Background: While new therapies are continuously introduced to treat muscular dystrophy, current assessment tests are challenging to quantify, cannot be used in non-ambulatory patients, or can de-motivate pediatric patients. We developed a simple, engaging, upper-limb assessment tool that measures muscle strength and fatigue in children, including children with muscular dystrophy. The device is a bio-feedback grip sensor that motivates children to complete maximal and fatiguing grip protocols through a game-based interface. Methods: To determine if the new system provided the same maximum grip force as what is reported in the literature, data was collected from 311 participants without muscle disease (186 M, 125 F), ages 6 to 30, each of whom played the four minute grip game once. We compared maximum voluntary contraction at the start of the test to normative values reported in the literature using Welch’s unequal variances t-tests. In addition, we collected data on a small number of participants with muscle disease to determine if the assessment system could be used by the target patient population. Results: Of the 311 participants without muscle disease that started the test, all but one completed the game. The maximum voluntary contraction data, when categorized by age, matched literature values for hand grip force within an acceptable range. Grip forced increased with age and differed by gender, and most participants exhibited fatigue during the game, including a degradation in tracking ability as the game progressed. Of the 13 participants with muscle disease, all but one completed the game. Conclusions: The study demonstrated the technical feasibility and validity of the new hand grip device, and indicated that the device can be used to assess muscle force and fatigue in longitudinal studies of children with muscular dystrophy.