University of Southern California
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
Redesigning Lives Globally
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Faculty

Faculty

Rachel Proffitt OTD, OTR/L

Rachel Proffitt

Assistant Professor of Clinical Occupational Therapy

Room: CHP 101A
Phone: (323) 442-2888
.(JavaScript must be enabled to view this email address)

Biography

Rachel Proffitt is an Assistant Professor of Clinical Occupational Therapy in the USC Chan Division of Occupational Science and Occupational Therapy and leads the Game Based Rehabilitation Lab at the USC Institute for Creative Technologies. The interdisciplinary team she leads is focused on developing customized, game-based, virtual reality technologies for rehabilitation. Dr. Proffitt's primary focus in both her research and clinical practice is neurological rehabilitation. She is conducting pilot clinical trials with traumatic brain injury, stroke, amputee and healthy aging populations using the developed games and systems.
 
Dr. Proffitt recently completed a T32 Postdoctoral Fellowship with training emphasis on conducting rehabilitation efficacy and effectiveness trials and was subsequently awarded a K12 career development award to provide protected research time for her research activities and further investigation of her primary research interests. Dr. Proffitt also teaches the Assistive Technology class within the occupational therapy master’s program and provides patient care at Keck Medical Center of USC. She earned her Doctorate of Occupational Therapy degree from Washington University School of Medicine in St. Louis.

Education

Postdoctoral Fellow in TREET: Training in Rehabilitation Efficacy and Effectiveness Trials NIH T32 Postdoctoral Training Program
University of Southern California
2014

Doctorate of Occupational Therapy (OTD)
Washington University School of Medicine in St. Louis
2010

Bachelor of Science (BS) in Biology and Dance
Randolph-Macon Woman's College
2007

Publications

Books

Clark, F. A., Blanchard, J., Sleight, A., Cogan, A., Eallonardo, L., Florindez, L., Gleason, S., Heymann, R., Hill, V., Holden, A., Jackson, J. M., Mandel, D. R., Murphy, M., Proffitt, R., Niemiec, S. S., Vigen, C., & Zemke, R. (2015). Lifestyle redesign: The intervention tested in the USC Well Elderly Studies (2nd ed.). Bethesda, MD: The American Occupational Therapy Association, Inc. Link to full text Abstract →← Abstract 

Reorganized, expanded, and updated, this new edition of the award-winning Lifestyle Redesign gives practical guidance in this preventative occupational therapy program for independent-living older adults. The work integrates the concept of the USC's landmark Well Elderly Studies, which determined that preventive occupational therapy greatly enhances the health and quality of life of independent-living older adults.
 
Twelve modules, including those on longevity, stress, home safety and navigating health care, illustrate how to incorporate the program into practice. Includes a flash drive with program handouts.

Journal Articles

Proffitt, R., Sevick, M., Chang, C. Y., & Lange, B. (2015). User-centered design of a controller-free game for hand rehabilitation. Games for Health Journal, Advance online publication. doi:10.1089/g4h.2014.0122. Link to full text Abstract →← Abstract 

OBJECTIVE: The purpose of this study was to develop and test a hand therapy game using the Microsoft (Redmond, WA) Kinect sensor with a customized videogame.
 
MATERIALS AND METHODS: Using the Microsoft Kinect sensor as an input device, a customized game for hand rehabilitation was developed that required players to perform various gestures to accomplish a virtual cooking task. Over the course of two iterative sessions, 11 participants with different levels of wrist, hand, and finger injuries interacted with the game in a single session, and user perspectives and feedback were obtained via a questionnaire and semistructured interviews.
 
RESULTS: Participants reported high levels of enjoyment, specifically related to the challenging nature of the game and the visuals. Participant feedback from the first iterative round of testing was incorporated to produce a second prototype for the second round of testing. Additionally, participants expressed the desire to have the game adapt and be customized to their unique hand therapy needs.
 
CONCLUSIONS: The game tested in this study has the potential to be a unique and cutting edge method for the delivery of hand rehabilitation for a diverse population.

Proffitt, R., & Lange, B. (2015). Considerations in the efficacy and effectiveness of virtual reality interventions for stroke rehabilitation: Moving the field forward. Physical Therapy, 95, 441-448. Link to full text Abstract →← Abstract 

In the past 2 decades, researchers have demonstrated the potential for virtual reality (VR) technologies to provide engaging and motivating environments for stroke rehabilitation interventions. Much of the research has been focused on the Exploratory Phase and jumps to Intervention Efficacy trials and Scale Up Evaluation have been made with limited understanding of the active ingredients in a VR intervention for stroke. The rapid pace of technology development is an additional challenge for this emerging field, providing a moving target for researchers developing and evaluating potential VR technologies. Recent advances in customized games and cutting-edge technology used for VR are beginning to allow for researchers to understand and control aspects of the intervention related to motivation, engagement and motor control and learning. In this paper, we argue for researchers to take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of the data that can be obtained, and utilize measurement tools in order to design effective VR interventions for stroke rehabilitation that can be assessed through carefully designed efficacy and effectiveness trials. This paper is motivated by the recent calls in the field of rehabilitation clinical trials research for carefully structured clinical trials that have progressed through the phases of research.

Proffitt, R., Lange, B., Chen, C., & Winstein, C. (2015). A comparison of older adults' subjective experiences with virtual and real environments during dynamic balance activities. Journal of Aging and Physical Activity, 23, 24-33. doi:10.1123/japa.2013-0126. Link to full text Abstract →← Abstract 

The purpose of this study was to explore the subjective experience of older adults interacting with both virtual and real environments. Thirty healthy older adults engaged with real and virtual tasks of similar motor demands: reaching to a target in standing and stepping stance. Immersive tendencies and absorption scales were administered before the session. Game engagement and experience questionnaires were completed after each task, followed by a semistructured interview at the end of the testing session. Data were analyzed respectively using paired t tests and grounded theory methodology. Participants preferred the virtual task over the real task. They also reported an increase in presence and absorption with the virtual task, describing an external focus of attention. Findings will be used to inform future development of appropriate game-based balance training applications that could be embedded in the home or community settings as part of evidence-based fall prevention programs.

Proffitt, R., & Lange, B. (2013). User centered design and development of a game for exercise in older adults. The International Journal of Technology, Knowledge, and Society, 8(5), 95-112. Link to full text Abstract →← Abstract 

Thirty percent of older adults fall every year. One of the most effective methods to help prevent falls is participation in a regular fitness or exercise program to build and maintain capacities. Few exercise programs for older adults utilize the advances in technology and gaming for fitness. Fifteen older adults currently involved in a fitness program for seniors at California State University–Fullerton participated in focus groups. The focus groups explored perceptions of health and wellness, the use of and access to technology, and ideas for the development of a game for fitness. The data were analyzed using open coding and the themes that emerged from the data were used in the design of a prototype game. Nineteen older adults participated in an iterative user testing process of the prototype game. The iterative user testing process in- volved several cycles of user testing and changes to the prototype. The feedback from the user testing process as well as the focus groups will be summarized and explored in this paper. Details of a preliminary game will be presented with a focus on access to technology for older adults, participation as means for prevention and building capacities.

Proffitt, R., Kelleher, C., Baum, M. C., & Engsberg, J. (2012). Using Alice 2.0 to design games for people with stroke. Games for Health Journal, 1(4), 303-307. doi:10.1089/g4h.2012.0029. Link to full text Abstract →← Abstract 

Computer and videogames are gaining in popularity as rehabilitation tools. Unfortunately, most systems still require extensive programming/engineering knowledge to create, something that therapists, as novice programmers, do not possess. There is software designed to allow novice programmers to create storyboard and games through simple drag-and-drop formats; however, the applications for therapeutic game development have not been studied. The purpose of this study was to have an occupational therapy (OT) student with no prior computer programming experience learn how to create computer games for persons with stroke using Alice 2.0, a drag-and-drop editor, designed by Carnegie Mellon University (Pittsburgh, PA). The OT student learned how to use Alice 2.0 through a textbook, tutorials, and assistance from computer science students. She kept a journal of her process, detailing her successes and challenges. The OT student created three games for people with stroke using Alice 2.0. She found that although there were many supports in Alice for creating stories, it lacked critical pieces necessary for game design. Her recommendations for a future programming environment for therapists were that it (1) be efficient, (2) include basic game design pieces so therapists do not have to create them, (3) provide technical support, and (4) be simple. With the incorporation of these recommendations, a future programming environment for therapists will be an effective tool for therapeutic game development.

Proffitt, R. M., Alankus, G., Kelleher, C. L., & Engsberg, J. R. (2011). Use of computer games as an intervention for stroke. Topics in Stroke Rehabilitation, 18(4), 417-427. doi:10.1310/tsr1804-417. Link to full text Abstract →← Abstract 

Current rehabilitation for persons with hemiparesis after stroke requires high numbers of repetitions to be in accordance with contemporary motor learning principles. The motivational characteristics of computer games can be harnessed to create engaging interventions for persons with hemiparesis after stroke that incorporate this high number of repetitions. The purpose of this case report was to test the feasibility of using computer games as a 6-week home therapy intervention to improve upper extremity function for a person with stroke. One person with left upper extremity hemiparesis after stroke participated in a 6-week home therapy computer game intervention. The games were customized to her preferences and abilities and modified weekly. Her performance was tracked and analyzed. Data from pre-, mid-, and postintervention testing using standard upper extremity measures and the Reaching Performance Scale (RPS) were analyzed. After 3 weeks, the participant demonstrated increased upper extremity range of motion at the shoulder and decreased compensatory trunk movements during reaching tasks. After 6 weeks, she showed functional gains in activities of daily living (ADLs) and instrumental ADLs despite no further improvements on the RPS. Results indicate that computer games have the potential to be a useful intervention for people with stroke. Future work will add additional support to quantify the effectiveness of the games as a home therapy intervention for persons with stroke.

Alankus, G., Proffitt, R., Kelleher, C., & Engsberg, J. (2011). Stroke therapy through motion-based games: A case study. ACM Transactions of Accessible Computing (TACCESS), 4(1), 3:1-3:35. doi:10.1145/2039339.2039342. Link to full text Abstract →← Abstract 

In the United States alone, more than five million people are living with long term motor impairments caused by a stroke. Video game-based therapies show promise in helping people recover lost range of motion and motor control. While researchers have demonstrated the potential utility of game-based rehabilitation through controlled studies, relatively little work has explored longer-term home-based use of therapeutic games. We conducted a six-week home study with a 62 year old woman who was seventeen years post-stroke. She played therapeutic games for approximately one hour a day, five days a week. Over the six weeks, she recovered significant motor abilities, which is unexpected given the time since her stroke. Through observations and interviews, we present lessons learned about the barriers and opportunities that arise from long-term home-based use of therapeutic games.

Lange, B., Flynn, S., Proffitt, R., Chang, C. Y., & Rizzo, A. S. (2010). Development of an interactive game-based rehabilitation tool for dynamic balance training. Topics in Stroke Rehabilitation, 17(5), 345-352. doi:10.1310/tsr1705-345. Link to full text Abstract →← Abstract 

Conventional physical therapy techniques have been shown to improve balance, mobility, and gait following neurological injury. Treatment involves training patients to transfer weight onto the impaired limb to improve weight shift while standing and walking. Visual biofeedback and force plate systems are often used for treatment of balance and mobility disorders. Researchers have also been exploring the use of video game consoles such as the Nintendo Wii Fit as rehabilitation tools. Case studies have demonstrated that the use of video games may have promise for balance rehabilitation. However, initial usability studies and anecdotal evidence suggest that the current commercial games are not compatible with controlled, specific exercise required to meet therapy goals. Based on focus group data and observations with patients, a game has been developed to specifically target weight shift training using an open source game engine and the Nintendo Wii Fit Balance Board. The prototype underwent initial usability testing with a sample of clinicians and with persons with neurological injury. Overall, feedback was positive, and areas for improvement were identified. This preliminary research provides support for the development of a game that caters specifically to the key requirements of balance rehabilitation.

Other Articles

Proffitt, R., & Foreman, M. (2014). Low-cost virtual reality and game-based technologies in rehabilitation. AOTA Technology Special Interest Section Quarterly, 24(3), 1-3. Link to full text

Proffitt, R. (2014). A virtual reality approach to lower extremity rehab. ler: Lower Extremity Review, 6(6), 41-45. Retrieved from http://lermagazine.com/article/a-virtual-reality-approach-to-lower-extremity-rehab. Link to full text

Conference Proceedings

Kelleher, C., Tam, S., May, M., Proffitt, R., & Engsberg, J. (2011). Towards a therapist-centered programming environment for creating rehabilitation games. In Proceedings of the 16th International Conference on Computer Games (CGAMES). (pp. 240-247). doi:10.1109/CGAMES.2011.6000346. Link to full text Abstract →← Abstract 

Stroke is the leading cause of disability in the developed world. Motion based video games show promise in helping people with hemiparesis (or partial paralysis) due to a stroke recover motor abilities. However, commercially available games are typically only playable by a minority of people with hemiparesis. Custom games can address the needs of a broader group of people with hemiparesis, but are expensive and time consuming to build. Environments that enable therapists to quickly create motion-based games tailored to individuals with hemiparesis may enable faster research exploration of the rehabilitation game design space and, ultimately, wider use of games in stroke recovery. This paper presents guidelines for and research challenges in the design of programming tools for therapists drawn from two studies. In the first study, we asked ten therapists to describe the relationship between players performing therapeutic motions and the motions of objects within the game world. Based on the language study results, we augmented an existing novice programming environment with support to detect and react to therapy motions. A second study, in which we asked pairs of therapists to design and build a therapeutic game, suggests guidelines for supporting therapists in programming games. These include including focusing on the player rather than input devices and using a mixture of events and constraints to capture player motion.

Alankus, G., Proffitt, R., Kelleher, C., & Engsberg, J. (2010). Stroke therapy through motion-based games: A case study. In ASSETS '10: Proceedings of the 12th international ACM SIGACCESS conference on computers and accessibility. (pp. 219-226). doi:10.1145/1878803.1878842. Link to full text Abstract →← Abstract 

In the United States alone, more than five million people are living with long term motor impairments caused by a stroke. Video game-based therapies show promise in helping people recover lost range of motion and motor control. While researchers have demonstrated the potential utility of game-based rehabilitation through controlled studies, relatively little work has explored longer-term home-based use of therapeutic games. We conducted a six-week home study with a 62 year old woman who was seventeen years post-stroke. She played therapeutic games for approximately one hour a day, five days a week. Over the six weeks, she recovered significant motor abilities, which is unexpected given the time since her stroke. Through observations and interviews, we present lessons learned about the barriers and opportunities that arise from long-term home-based use of therapeutic games.