In
Rehabilitation
Originally
designed as a device to improve the visuomotor skills
of athletes, the Dynavision 2000 Light Training Board
has been adapted to provide the same training benefits
to persons whose visual and motor function has been compromised
by injury or disease. For persons with visual and visuomotor
impairment the apparatus is used to train compensatory
search strategies, improve oculomotor skills such as
localization, fixation, gaze shift, and tracking, increase
peripheral visual awareness, visual attention and anticipation,
and improve eye-hand coordination and visuomotor reaction
time. For persons with motor impairment it can be used
to increase active upper extremity range of motion and
coordination, muscular and physical endurance and improve
motor planning. It has been successfully used to improve
function in children and adults with limitations from
stroke, head injury, amputation, spinal cord injury and
orthopedic injury. Currently there are over 100 units
in rehabilitation hospitals across the United States.
The
design of the Dynavision board in terms of size, button
configuration, and number of program options enables
the device to be used in treatment with a variety of
age groups and rehabilitation conditions. The simplicity
and straightforwardness of the response required (striking
the button) enables persons with limited comprehension
to understand the demands of the task. The ability to
limit presentation to the inner ring of lights, coupled
with the ability to lower the position of the board allows
it to be used by persons with restricted upper extremity
range of motion, wheelchair users, and children. Although
precision in the striking the button is required, the
button can be struck with any part of the hand such as
the palm, fingers, or back of the hand. This allows persons
with limited prehension due to conditions such as quadriplegia,
hemiplegia or amputation to successfully work the board.
Presentation
of exercise drills as games of skill makes the Dynavision
exercises fun while challenging users to give their best
effort. Ability to select different speeds of stimulus
presentation from the self-pacing of mode A to the automatic
presentation of mode B enables use with persons with
varying speeds of information processing. The Board in
mode A can be used to facilitate visual scanning and
increase visual reaction time in persons who have difficulty
executing adequate search patterns due to oculomotor
impairment, visual inattention and neglect, and hemianopsia.
Mode B and the digit flash option can be used to challenge
high functioning persons who must demonstrate rapid information
processing and mental flexibility in order to resume
demanding tasks such as driving, engaging in sports activities
and work. Varying the length of the presentation from
30 seconds to 240 seconds allows the therapist to prevent
fatigue in persons with limited scanning ability and
also challenge sustained attention in persons who have
difficulty maintaining vigilance. Both modes A and B
can be used by persons with upper extremity limitations
to increase active range of motion and coordination.
The
most unique and important contribution of the Dynavision
to rehabilitation is its capacity to challenge the peripheral
visual system. Peripheral visual attention is needed
to protect an individual from potential dangers in the
environment, and speed in searching the peripheral visual
field is critical to safety in environments involving
rapid visual changes such as is encountered in driving.
The size of the Dynavision board automatically elicits
a combination of head turning and eye movement which
is the natural scanning strategy initiated when attending
to peripheral visual stimuli. The light buttons also
are identical which eliminates the need for discrete
identification and instead elicits the more automatic
response of visual localization which is compatible with
the function of peripheral attention. This capacity enables
the Dynavision to challenge the peripheral attention
skills needed for driving, and orientation to and negotiation
of the environment at a level few clinical activities
can achieve.
Effectiveness
of Dynavision Training:
Because of the relatively recent introduction of Dynavision
into rehabilitation centers, the published research literature
supporting the validity of the apparatus in rehabilitation
is limited. Klavora et al, have published several articles
on the use of the Dynavision (Klavora and Warren, 1998, Klavora,
Gaskovski & Forsyth, 1995, Klavora, Gaskovski, Heslegrave,
Quinn, &Young, 1995, Klavora, Gaskovski,1994), including
an article demonstrating the effectiveness of the device
in rehabilitation of driving performance in persons post
stroke (Klavora et al, 1995).
Room
Requirements:
Because it is likely that the Dynavision will be used in
inpatient and outpatient treatment by both physical and occupational
therapy, and with persons with neurological and musculoskeletal
impairments, it should be centrally located between departments.
Although absolute quiet is not required for performance,
the room should be reasonably free of extraneous noise and
distraction. Training on the Dynavision is done under minimal
to low lighting conditions to ensure the visibility of the
lights. The selected room should have the capability for
rheostat controlled lighting either through overhead lighting
wired to a dimmer switch or by using a 300 watt torchiere
halogen floor lamp. The apparatus requires approximately
six feet of wall space and six feet of space in front of
the board. The Dynavision is constructed of steel and aluminum
and weighs 286 pounds. And is usually mounted on an interior
wall using the wall mount system included.
Maintenance:
Minimal maintenance is required to keep the apparatus operational
and can be performed by a therapist The most frequent
need is replacement of the printer paper and ribbon or
an occasional burnt out bulb. The experience of therapists
using the device in rehabilitation settings has been
that even with heavy usage (several hours per day) these
replacements are needed only every five to six months."
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