Szturm has been legally blind since the age of 10 from a rare eye disease that is usually caused by age-related deterioration. From a young age he was exposed to assistive technologies, such as video magnification systems and computer-based voice software.

This, he says, influenced his decision to explore emerging technologies and computer games to help people with physical and cognitive impairments.

“Technology certainly helped me,” he says. “So when I started my research, I thought about how we can take advantage of technology to provide engaging programs for people.”

Szturm was born in Thunder Bay, Ont. and earned degrees in biology and physical therapy at Western University. He began his career in Winnipeg as a physical therapist at Health Sciences Centre in 1980 and joined what was then UM’s School of Medical Rehabilitation in 1986.

From 1988 to 1994 he co-ordinated a physical therapy program for blind students at UM. Since then, he’s held roles as a professor in the department of physical therapy and adjunct professor in the Price Faculty of Engineering. His doctorate is in neurophysiology.

For the past several years, his research has focused on developing and testing a computer game-based rehabilitation platform, the first of its kind in Canada. It’s designed to help people with injuries or impairments improve the use of their arms or hands through “repetitive task practice.”

Szturm spent about two years working with SMK Electronics, a U.S.-based subsidiary of a Japanese tech firm, to miniaturize its Elite motion mouse, creating what is called the “therapy mouse.” The small (3 x 3.5 cm) wireless motion sensor can be attached to almost any object or utensil, such as a ball, a cup or a pair of tongs.

This transforms the object into a computer mouse that can be used to control an onscreen game. In this way, objects of various sizes, shapes, weights and functional demands can be used for therapeutic exercises.

The platform can use commercially available computer games. A client can practise motor skills and have fun at the same time, which is important for encouraging clients to stick with a rehab program, Szturm says.

“It’s tedious, hard work to learn how to use your hand again if, say, you’re a stroke client or someone with a spinal cord injury,” he says.

Tony Szturm

“Therapy is long-term. But people can’t afford to come to physio three times a week for months or years, so increasing accessibility is critical – and that means effective rehab programs that can work in the home.”

A computer game-based rehabilitation platform would be ideal for home use by people in remote and rural areas, he says. A health-care professional would need to set it up, but exercises could easily be done alone.

Assessments of the client’s progress could be performed via teleconferencing, or through automated records that are generated while a game is being played.

Szturm’s team has developed a game that performs assessments. “Commercial games can’t do assessments,” he says. “So we had to develop our own to automatically collect data on the client’s performance, for feedback and as an outcome measure.”

Dr. Tony Szturm tests a rehab platform that uses head movements to interact with a computer game as a client walks.

The team is also working on combining the use of computer games with a treadmill and pressure mat to treat balance, gait and cognitive impairments. This platform also uses the small motion sensor, but it’s placed on the client’s head.

“We can use head movements to interact with many different computer cognitive games while walking on a treadmill or performing various balance exercises,” Szturm says.

With Dr. Ji Hyun Ko from the department of human anatomy and cell science and Dr. Nariman Sepehri from the Price Faculty of Engineering, Szturm recently received $1.5 million from the Weston Brain Institute to test this platform in a study of patients with Parkinson’s disease.

He was also recently funded, along with Sepehri and postdoctoral student Anuprita Kanitkar [MSc/14, PhD/21], by Research Manitoba, First Steps Wellness Centre in Winnipeg and the national training and resource organization Mitacs to develop low-cost, intelligent robotic devices.

These devices, he says, can aid clients with spinal cord injuries and stroke in their rehabilitation of hand and arm function. The project is one of four the team is doing in collaboration with SDM University in Dharwad, India.

“Just by the nature of its population, India has many people who are impaired,” he says. “It might take us two years to find 20 participants in Canada, but in India we can get that in a half a year.

“The majority of India’s population is in rural areas, so again, affordability and accessibility are major concerns.”

Szturm says the key to these platforms’ success is that the games must be fun and something the clients will enjoy coming back to.

“Many clients have asked why this was not offered to them at the beginning of their rehab experience,” he says. “They often say the exercises are tough but very good, and that time flies by when they’re interacting with them.”

PhD candidate Anuprita Kanitkar initiated the partnership after moving to Winnipeg to pursue a master’s degree in physical therapy at the College of Rehabilitation Sciences, Rady Faculty of Health Sciences in 2011. While studying with Dr. Tony Szturm, professor of physical therapy, Kanitkar became interested in his research into the use of video games as a rehabilitation tool.

Kanitkar said computer gaming can make rehabilitation exercises more interesting and engaging for patients.

“Right after my thesis defense, I returned to India to visit my family and spent some time with Dr. Sanjay Parmar and his graduate students at the SDM College of Physiotherapy and we discussed forming a collaboration with Dr. Szturm,” she said.

Szturm’s team uses a small 3 cm x 3.5 cm motion-detecting remote computer mouse that can be attached to any object – such as a ball, salad tongs or custom-made creations like a three-foot tall joystick – to target training to specific areas that need treatment.

“This one mouse allows us to instrument any physical object we want to play any computer game,” Szturm said, noting the objects have a broad range of properties like size, shape, weight, texture and functional demand. “This approach is directed towards recovery of manual dexterity.”

Anuprita Kanitkar demonstrates how objects like salad tongs can be used in the video game platform to target rehabilitation to specific areas that require treatment.

The team has access to over 300 games that can be used for therapy. Szturm and students from the Faculty of Engineering also developed their own game with inbuilt assessment and analysis software that can track mouse cursor movement. While the commercially available games are good for therapy, the purpose-built game can be used to measure patient progress, like response time, movement time and movement accuracy.

“The game is fully configurable for even the most severely affected individuals,” Szturm said.

Kanitkar came to the U of M one year after her husband, Vedant Sakhalkar, who also had studied with Szturm. She attained her master’s in 2014 and began working toward her PhD in 2015. For her PhD, she spent two four-month periods at SDM on clinical trials using Szturm’s platform.

While presenting her study at the Indian Association of Physiotherapists’ national conference in 2016, Kanitkar attracted the interest of SDM physiotherapy student Kavisha Mehta. After working for a year as a pediatric physiotherapist, Mehta moved to Winnipeg to join Szturm’s team and work toward her master’s degree.

Mehta is currently working on a study of the feasibility of using the games to treat children with balance and gait issues related to CP. During a recent exchange at SDM, she set up a training platform, conducted preliminary tests and recruited participants for a tele-rehab study.

Kavisha Mehta’s research into using games to treat children with balance and gait issues recently took top prize at a health and disability conference in Kolhapur, India.

In November 2019, she presented her study on computer game-aided balance rehabilitation at the National Conference of Commonwealth Association for Health and Disability in Kolhapur, India, winning first prize in the conference’s paper presentation category.

She hopes this designation will help attract funding to get the platform – which combines the game-aided technology with a treadmill and pressure mat – into remote clinics in India.

“The majority of India’s population resides in rural areas and most of the affected population comes from low socio-economic status, so affordability of the treatment is a major concern,” Mehta said.

Szturm said that because game-aided treatment is portable and can be inexpensive, it could go a long way helping people in northern and remote areas in Manitoba as well.

“That’s the goal, but we need to keep it affordable,” he said. “The beauty of this system is the technology is already in place, but it also needs to be monitored and supported. If we can prove this works, then third-party insurance companies and government will take notice.”

Funding for travel for Kanitkar was provided by a Mitacs Globalink Research Award and Queen Elizabeth Scholarship Travel Award. She and Mehta were partially funded by Faculty of Graduate Studies Conference Travel Grant for presenting their work at conferences in India.

One of the projects is aimed at creating a future where older adults will be able to live on their own longer thanks to sensors in their homes that track their health and help in their day-to-day lives. The other research team is developing a robotic device that patients with motor impairments will use to control a video game while simultaneously performing rehabilitation exercises.

The focus of the fund is on innovative collaborative research in the areas of telepresence, telehealth, telemonitoring and assistive technology.

CoRS research lead Dr. Jacquie Ripat  said that the two projects selected have the potential to be transformative. “They are innovative in terms of bringing teams together with a unique perspective that can make advancements on issues that people have identified as problematic,” Ripat said. “They’re innovative in terms of harnessing technology, harnessing the experience of computer science or engineering, along with health and rehab.”

To be eligible for CIRF funding the teams must include one CoRS full-time faculty member and student, and at least one full-time faculty member and student from the faculties of science, engineering or architecture. Funding support is from CoRS and the other faculties.

Smart suite

One research team is working to create a computer platform that they hope will one day help adults live on their own well into old age.

The computer platform is for the Smart Suite that’s being constructed by University of Manitoba researchers. The Smart Suite is a replica of living quarters and will be equipped with a variety of sensors to monitor the activities of people in the space.

Sensors inside the Smart Suite will include, for example, Doppler radar, motion sensors and smart floor mats equipped with pressure sensors. The sensors can monitor activities like time spent standing in the kitchen, frequency of hand-washing  and the distances walked at home on an average day.

The research team is creating a computer platform to compile and analyze all the data from the sensors in the Smart Suite, said Dr. Amine Choukou, assistant professor of occupational therapy, CoRS. 

“We’re building the brain of the Smart Suite,” he said.

After completing studies in the Smart Suite, the goal is to move the technology into people’s homes, Choukou said. The data collected in one’s home will train the computer to spot anomalies in a person’s behaviour, like if they stop bathing or cooking. The system could also alert emergency services and caregivers if a person falls.

“This is a huge market and a huge health cost reduction for the government,” Choukou said. “If we keep people at home, they can live independently for as much time as possible and we will avoid sending them inappropriately to long-term care facilities.”

Choukou also sees a future where doctors will gain access to the data collected in someone’s smart home. The doctor could review sleep patterns or look at how much time is spent standing or sitting down in front of the TV or computer and make recommendations, he said. Activity monitoring should be considered as a medical prescription preceding any decision to relocate an older adult to a long-term care facility, Choukou said.

The team, which received $50,000 in funding, includes Dr. Rasit Eskicioglu, associate professor of computer science, Faculty of Science; Dr. Pourang Irani, professor of computer science, Faculty of Science; and Dr. Ahmed Ashraf, assistant professor of electrical and computer engineering, Faculty of Engineering. 

Video game-assisted rehabilitation

Another team that was awarded CIRF funding is developing a robotic device, called a manipulandum, which enables a patient with limited hand or finger mobility to control a video game while performing rehabilitation exercises.

Dr. Tony Szturm plays a video game using a pair of kitchen tongs as a controller. The movement acts as a rehabilitation exercise. His team is working on a robotic device people will use to control a video game while performing hand and finger exercises.

The robotic device being developed will connect to a computer. The patient – who could have suffered a stroke or spinal cord injuries, or have multiple sclerosis or Parkinson’s disease – will use the robotic device to do hand or finger exercises. Each movement they make with the robotic device will control the video game on a screen. The robotic device will assist the patient with the movements if it is too difficult or give resistance to make the movement harder. Over time, the robotic device will learn about the patient’s progress and increase the resistance as they improve.

Dr. Tony Szturm, professor of physical therapy, College of Rehabilitation Sciences, said that by adding a gaming element, rehabilitation exercises become more interesting and engaging for the patient. When rehabilitation regimes are prescribed at home, adherence is often low because the exercises are uninteresting and tedious, he said, adding that people could be doing the exercises for 20 minutes per day for anywhere from three weeks to three years.

“I think the idea of having a smart manipulandum controller is very novel,” Szturm said. “It applies to a lot of different patient populations. The arm and hand function is really important for people and I think it’s something that is neglected otherwise.”

Szturm said another advantage of using video games as part of rehabilitation is the data generated from game play. The data can reveal patient progress like response time, movement time and movement accuracy. These stats could support changes to the rehabilitation regime.

The goal is to create an affordable model that patients will turn to in their homes, he said.

“As we prove that people will actually use this at home, then insurance companies and the government are going to say ‘OK, let’s do it.’ If patients don’t do this and if they don’t get better, we have to provide them home care which is way more costly for years and years and years,” he said.

Szturm is a member of the research team, which received $32,000 in CIRF funding, alongside Dr. Nariman Sepehri, professor of mechanical engineering, Faculty of Engineering; and Dr. Rasit Eskicioglu, associate professor of computer science, Faculty of Science.