ACTIVE Video Game Makes it More Fun for Patients to Monitor Their Motor Function

A video game called ACTIVE could be used to monitor changes in motor function in people with spinal muscular atrophy (SMA) types 2 and 3, according to a new study.

The video game’s measurements aligned with standard tests used to monitor people with SMA, but require less expertise to administer than these traditional assessments.

The study, “ACTIVE (Ability Captured Through Interactive Video Evaluation) workspace volume video game to quantify meaningful change in spinal muscular atrophy,” was published in the journal Developmental Medicine & Child Neurology.

ACTIVE works by using an algorithm developed for the Microsoft Kinect camera to track players’ movements. A player must sit in a chair and, by moving their torso and arms, are asked to squish spiders, for example, or dig for gemstones.

The game tracks the player’s movements to measure workspace volume — the area around a person with which they can physically interact. This is a particularly useful measurement in SMA: players are encouraged to lean and reach to earn a higher score, which requires using core muscles that are typically weak in SMA patients.

This score is scaled based on the player’s height, since taller people typically have longer reach.

The researchers had 62 people with SMA type 2 or type 3 (average age was 11 years, ranging from 2 to 24), as well as 362 age-matched controls, play the ACTIVE game. SMA patients were also assessed via other traditional means, although not every patient underwent every assessment.

As expected, ACTIVE scores for SMA patients were much lower than those of controls, and they correlated with scores on established measurements of SMA functionality: the Brooke Scale, Hammersmith Functional Motor Scale Expanded, and Revised Upper Limb Module. This correlation suggests that the video game is effective at monitoring motor function in SMA patients, the study stated.

Additionally, an expert neurologist usually needs to be present to conduct the standard tests, and there can be some subjectivity to the results. However, ACTIVE doesn’t require any significant expertise, which makes it an attractive alternative to these tests.

“A simplified set-up complete with a manual and tutorial instructions, an in-game video tutorial with standardized instructions, and a 15-minute assessment time all reduced the burden of testing, making implementation of this outcome logistically possible in clinics and research trials worldwide,” the researchers wrote.

ACTIVE scores also lined up with patient-reported measurements of disease, as assessed through the Patient Reported Outcomes Measurement Information System.

The researchers also attempted to test whether ACTIVE could effectively measure improvements in SMA patients undergoing treatment with Spinraza, since evidence of its therapeutic benefit is often required by insurance companies. Although nine out of the 11 patients on the medication showed an improvement, the small sample size made it difficult to draw a reliable conclusion — but data collection is ongoing.