For 25 Years, Therapy on the Slopes

DREAM Adaptive gives recreation opportunities to people with disabilities














DREAM Adaptive Recreation volunteer Bob Zahller, center, helps guide Phillip Sotello into a turn while descending Big Mountain under Chair Six at Whitefish Mountain Resort as Ryan McCoy follows closely behind. - Lido Vizzutti/Flathead Beacon

By Myers Reece, 01-12-10
WHITEFISH MOUNTAIN RESORT – The therapy is in the snow. It’s on the mountains, in the base lodge and on the bus rides.

Once a week during winter, high school students with disabilities head to Whitefish Mountain Resort to ski, train for the Special Olympics and, above all, have a lot of fun. For many of them, it’s unlike any other experience of their lives.

Their ticket to the mountain is DREAM Adaptive Recreation Inc., an organization established in 1985 to give disabled children and adults access to recreational opportunities in the Flathead Valley. DREAM stands for “Disabled Recreation and Environmental Access Movement.”

“There’s a huge amount of emotional therapy involved in being able to finally go out and finally access these things,” said Bruce Gibson, DREAM’s program director.

Twenty-five years ago, a small group of Flathead residents set out to expand accessibility to both recreational locations and activities for people with special needs. This was five years before the Americans with Disabilities Act of 1990.

Among the earliest leaders of this forward-thinking group were Dottie Maitland, Larry Dominick, Dennis Jones and Jane Lopp. They collaborated with the U.S. Forest Service and other agencies to create Glacier National Park’s Trail of the Cedars, a hiking trail that is conducive to disabled access, with a paved portion and a boardwalk.

In addition, they worked on accessibility surveys, along with projects at Foys Lake and Woodland Park, Lopp said. And they created perhaps their most defining legacy, the ski program at Whitefish Mountain Resort. Lopp is pleased to see Gibson continuing and expanding upon DREAM’s vision.

“I’m so glad Bruce is doing all he’s doing,” Lopp said.

The kids who traveled up to Whitefish Mountain Resort last week attend Glacier and Flathead high schools. They represent only a percentage of the total population that DREAM serves. The organization works with roughly 200 people with disabilities each year, Gibson said, about two-thirds of whom are kids.

The nonprofit assists people of many different disabilities, both physical and cognitive. The list includes cerebral palsy, autism, muscle degeneration, Down syndrome, amputees, paraplegics and others. Gibson is the only full-time staff member. The rest are volunteers.

“We have people that can work with about anyone,” Gibson said. “It’s pretty much across the board.”

DREAM Adaptive differs somewhat from the Bozeman-based Eagle Mount program, mostly in the area of professional therapy. Eagle Mount is more therapy based, while DREAM is more recreation based, Gibson said. But Gibson points out: “Therapy comes from getting out and skiing.”

“They’re structured a little bit differently, but for the most part they’re doing the same thing,” Gibson said.

The nonprofit also started a summer program in 2009 with water skiing, tubing and kayaking at Echo Lake. The program will continue, and perhaps expand, in future summers, Gibson said.

The “adaptive” skiing movement started in Colorado in the late 1970s, Gibson said. It has grown exponentially since then. There are adaptive programs in countries such as New Zealand and France, as well as in other states, but Gibson said “almost everything adaptive comes out of Colorado.” DREAM’s program was modeled after one in Winter Park, Colo.

DREAM Adaptive doesn’t charge for any of its services. It relies on community donations, grants and a large fundraiser held each year on the Friday before Valentine’s Day. The event, scheduled for Feb. 12 at the Hilton Garden Inn this year, features live big band music, dancing, dinner and auctions – both live and silent.

Also, the organization negotiates a yearly agreement with Whitefish Mountain Resort. It receives an unlimited amount of lower chairlift tickets for its participants and a fixed amount for the higher lifts. Volunteers who don’t have season passes get free tickets. When their volunteer time is done each day, they are free to use the rest of the day to ski.

The resort also provides DREAM with senior ski instructors and storage space. The required equipment list for skiers with disabilities is fairly large, including both bi and mono sit-skis, outriggers, gadgets that can either help spread legs or keep skis together, and more.

“Sometimes we just invent something based on individual needs,” Gibson said.

Volunteers must be intermediate skiers or better. Beyond that, they need no prior experience, Gibson said. After signing up, they take a training session. Then they are paired with skiers, with the advanced volunteers taking on more difficult tasks like guiding sit-skiers.

Gibson said his organization also seeks “off-snow” volunteers. These volunteers help with tasks such as grant writing and preparing for fundraisers. Donations are always needed as well, he said.

Last week was Chuck Cassidy’s first day as a ski volunteer, though he has followed the DREAM program for years. His son, Mark, has been skiing since 2004 and was one of the more accomplished skiers on the mountain on Jan. 7, if not the most enthusiastic. The gregarious 18-year-old Cassidy, a senior at Glacier High who has a learning disability, begins preparing for ski days a week ahead of time, his father said.

Cassidy, who saw many different school systems in his travels with the Navy, said the Kalispell school district has the best recreational program for kids with disabilities that he has seen. The district’s collaboration with DREAM is just one example, he said. There are also opportunities for activities such as softball, bocce, track and basketball.

“It’s really an awesome program,” Cassidy said. “The valley should be proud.”

Of the 13 high school students who skied last week, 12 were from Glacier and one was from Flathead, said Jodie McGough, who is the special education instructor at Glacier. A few of the regulars didn’t make the trip because of the cold.

The students ski with DREAM eight days per year to train for the Special Olympics, said Jenny Griswold, who teaches at Glacier and runs the Special Olympics program there.

“A lot of our kids never even have a chance to go fast in their lives,” Griswold said. “That’s why we’re up here when it’s 10 below.”

She added: “DREAM is the only way we have access to this.”

For more information on DREAM Adaptive Recreation Inc., and how to contribute, call (406) 862-1817, e-mail at dreamadaptive@yahoo.comor mail to P.O. Box 4084, Whitefish, MT 59937.

Amputees get Wii Fit

Amputees are using Nintendo Wii Fit equipment during training sessions as a way of improving their balance and stability.

Every Thursday patients from across the borough meet at Callaghan House in Heywood to go through a tailored exercise programme that improves their strength and stability after having an amputation.

Sharon Wright, Lead Physiotherapist for Amputee Rehabilitation, believes that using the Wii Fit has massive benefits for her patients. She said: “We work with patients for from four months to two years so it’s important that we find new ways of keeping them interested in their exercise and motivated to complete their training.

“After what has been a traumatic experience, the weekly sessions allow our patients to gain back some independence and meet others who know how they feel. Health professionals from the Manchester Disabled Services Centre (MDSC) also attend the sessions so patients don’t have to travel far for appointments, which can be difficult.”

Alan Carouthers, 71, from Rochdale, has been attending the sessions for five months. He said: “I first came with the hope of being able to walk again and started off doing lots of different exercises and physiotherapy. The Wii Fit is great. It is a challenge but using the slalom and football skills games has helped with my balance tremendously and of course it’s great fun.

“It’s really important to come to these sessions because you meet people who understand how you feel but can have a laugh at the same time. It has really built up my confidence and boosted my morale and I’ve been able to make some great friends.”

Heywood, Middleton and Rochdale Community Healthcare in conjunction with Rochdale Amputee Support Group purchased the Wii Fit equipment using a donation from charity Joining Hands for patients to use as part of their weekly exercise rehabilitation programme.

Help and support for amputees and their families can be found through the Greater Manchester Amputee Support Group, which was founded in 2004 by Malcolm Jones, from Rochdale. Malcolm founded the group after becoming an amputee himself and finding he needed more support. He said: “Having an amputation is a traumatic experience so it’s important that people have a support network once they leave hospital to help them and their families adjust.”

The group meets at Rochdale Infirmary on the second Tuesday of every month from 6:30pm in the Rochdale Infirmary outpatients waiting room.

Wii makes therapy more fun

by BARBARA TRAININ BLANK For The Patriot-News
Sunday July 26, 2009, 12:00 AM

Vince Cassaro
Lori Rice of HealthSouth helps Army Maj. Neal Stasny, 43, of Lebanon, work out with a Wii at the rehabilitation center in Wormleysburg. Stasny, who is the deputy chief of staff of information management at Fort Indiantown Gap, is recovering from a stroke. Miriam Dreibelbis had suffered from rheumatoid arthritis for many years. Knee surgery exacerbated the pain in her back, and the West Shore resident ended up in a wheelchair.

Seeking help at HealthSouth Hospitals and Outpatient Centers of Mechanicsburg, Dreibelbis found partial relief in "child's play."

HealthSouth is one of a growing number of outpatient and inpatient facilities that are incorporating Wiihabilitation into their physical therapy and rehabilitation regiments.

Wii (pronounced "wee") is an interactive Nintendo computer game that requires participants to move. A wireless remote connects the player to an on-screen digital icon, which mimics his or her movement in various sports and exercises.

Traditional games available on the Wii Sport software include bowling, tennis and golf. Another game attachment is the balance pad that goes with the Wii Fit software. Players stand on this pad to accomplish such things as walking a tightrope.

"Wii is part of a coordinated approach of physical, occupational and speech therapy at our outpatient facilities," says Laureen Martinelli, site coordinator for the HealthSouth center in Wormleysburg. "It has therapeutic benefits beyond 'straight' exercise. When patients come for outpatient therapy, they've already been through maybe months of conventional therapy. We need different tools to engage the brain, to use new muscles. The graphics of Wii are amazing."

The individuals who come for outpatient rehabilitation and physical therapy at the site include amputees and patients with brain injuries, strokes, Parkinson's disease and spinal cord injuries.

The Lebanon VA Medical Center has had Wii software for two years.

"Initially we introduced it to the long-term care, nursing units," says Jennifer Coy, supervisor of rehabilitation therapies at the VA. "Then we bought it for the rest of the units, including the physical therapy and acute behavioral health units."

According to Coy, Wii "has gone over very well" and brings a lot of benefits, especially for long-term care patients. "It's given them a sense of camaraderie and satisfies their need for competition," she says. "Many of the patients are games- and sports-oriented, especially as our demographic has gotten younger. Wii uses something current that's known to them."

Among the other benefits are that Wii can improve perception, balance and range of motion, the latter especially for physical therapy patients. It also enhances attention span.

One of the other advantages the VA has discovered, says Coy, is that Wii helps fight depression, even if the patient comes just to watch rather than actually participate.

"Wii Sport improves hand-eye coordination and gives the patient a little cardio workout," Martinelli says. "Wii Fit will indicate your body mass index."

For Dreibelbis, Wii was not only effective but "fun."

"It's a nice thing to do," she says. "Wii helps alleviate the tedium of physical therapy exercises and gives patients a sense of progress. Wii worked on my balance, which has always been a problem for me."

Dreibelbis also praised the psychological impact. "I realized I had more capabilities than I thought. It makes you forget about your inabilities," she says.

Like the VA, HealthSouth has found socialization an important part of Wii's appeal and effectiveness.

"It's true Wii means people watching a TV screen, but at least they're moving, and it's interactive," Martinelli says. "It's another tool to add to the therapists' bag of tricks."

Nordic Walking Poles Are Helping Many with Balance and Stability Issues - Including Many of Our Recovering War Heroes

When a thank you letter arrived from The American Red Cross for the one-piece Nordic Walking Poles that were donated to Walter Reed Veterans Hospital by SkiWalking.com and The American Nordic Walking System it was one of hundreds of confirmations that one-piece Nordic Walking poles prove to be safer, lighter and much more durable than twist-locking adjustable length/telescoping/collapsible poles.

Glen Arbor, MI, April 15, 2009 ---- Nordic Walking instructor, running and ski coach, Pete Edwards, discovered five years ago that Nordic Walking Poles were not just for expert skiers deprived of snow, but doubled as an aid for those with balance and stability issues. He started volunteering to host free Nordic Walking Clinics at Multiple Sclerosis (MS), Parkinson's (PD) and Diabetes support group meetings. A couple years later he donated dozens of pairs of durable one-piece Nordic Walking poles to Walter Reed Veterans Hospital in Washington, DC. He has also shipped free Nordic Walking poles directly to injured soldiers returning from Iraq and Afghanistan after talking to their spouses and/or parents. Family members, doctors and physical therapists have been amazed by the improvement in posture, balance, stability and gate thanks to the use of Nordic Walking Poles in the correct lengths.For over 25 years Edwards has been coaching runners and skiers. His skiers have been ski walking and hill bounding with poles during the warmer months when snow could not be found.

After a knee injury ended his marathon running career, his Nordic Walking Poles saved the day – allowing Edwards to Nordic Walk and even Nordic Run (running with poles) pain free.Using the perfect length Nordic Walking Poles helps us to automatically walk with a super straight back - better walking posture is biomechanically a good thing. This improved walking posture when combined with the unique 4-Wheel-Drive type action of walking with poles radically reduces the stress to the shins, knees, hips and back. Nordic Walking is low impact and yet provides a highly effective workout - burning more calories and working more muscle groups than regular walking.Nordic Walking has been the fastest growing fitness activity in Europe for several years. Over seven million Europeans are walking with poles - in the city, in the country and up in the mountains. Walking with poles helps to burn more calories than regular walking, improves balance/stability, radically reduces the stress to the weight bearing joints and provides a workout for your upper body by engaging your arms and legs – a lot like cross country skiing.Nordic Walking’s winning combination of improved posture, a unique 4-Wheel-Drive type action and shock absorbing benefits are helping many individuals to walk comfortably again.

Nordic Walking Poles are helping individuals with balance issues, knee issues or new knees, hip issues or new hips, back issues (including those with rods in their back), weight issues, multiple sclerosis (MS), parkinson’s disease (PD), neuropathy, arthritis, bursitis, scoliosis, lumbar stenosis, fibromyalgia, post polio, osteoporosis, stroke recovery, cancer recovery and other limitations to walking. Nordic Walking poles are helping thousands of Americans get off the couch, successfully get outside, start walking safely and effectively launch much needed walking campaigns.Individuals that use canes and/or walkers often find that Nordic Walking Poles are much more comfortable and stable than their canes or walkers. Individuals that find pushing a shopping cart comfortable find that Nordic Walking poles provide even more support and much improved balance, stability and versatility. The feedback from amputees, individuals with head trauma and others with balance issues is consistent – the poles really do improve balance and stability.From a fitness standpoint, walking with the correct length poles and proper technique can burn up to 40% more calories than regular walking. Walking with Nordic Walking Poles can turbo charge any walking campaign.Real Nordic Walking Poles are equipped with comfortable fingerless glove type straps, durable metal tips (for use on trails, the beach, snow and ice) and special rubber tips/paws that are removable and designed for use on pavement and other hard surfaces. All poles from http://www.skiwalking.com/ and The American Nordic Walking System are also equipped with patented straps (patented by the Salomon Ski Company).Thanks to the efforts of Pete Edwards, SkiWalking.com and The American Nordic Walking System, individuals of All ages and All fitness levels, are safely unlocking the calorie burning and aerobic benefits of walking, hiking, trekking and running with poles. These durable one-piece poles prove to be safer, lighter and much more durable than cheap twist-locking adjustable length/telescoping/collapsible poles. Nordic Walking Poles from SkiWalking.com and The American Nordic Walking System also includes a free Nordic Walking DVD and there are a variety of exertion options to choose from regardless of age, balance and/or fitness level.

APL Riff on Video Game Helps Prosthetic Patients

Iraq veteran Jonathan Kuniholm trains with the modified Guitar Hero system.
By Paulette Campbell Applied Physics Laboratory



Wii-habilitation" — using Nintendo's Wii video game system in rehabilitation therapy — continues to be popular with health care workers looking to help patients get through what some see as the pain and torture of physical therapy. Now two engineers in APL's National Security Technology Department have cranked that concept up a notch. Bobby Armiger and Jacob Vogelstein have rewired Nintendo's Guitar Hero III: Legends of Rock game to allow amputees to rock out and get valuable training with prosthetic prototypes at the same time.
Their gaming is part of the APL-led Revolutionizing Prosthetics 2009 effort, funded by the Defense Advanced Research Projects Agency, to develop a prosthetic arm that will be controlled and also feel, look and perform like a natural limb. So far the project has produced two prototypes and has leveraged a surgical technique, developed at the Rehabilitation Institute of Chicago by Todd Kuiken, that reroutes the nerves that once controlled an amputee's arm to remaining muscles. These "re- innervated" muscles naturally amplify the nerve signals so that electrodes placed against the skin can detect activity and control the prosthetic arm.
The surgery has enabled patients to control the first prototype arm and will eventually be used to control individual fingers of the final prosthetic design. But for the arm to operate correctly using these rerouted nerves, the system must learn to interpret the patient's muscle signals. The process is similar to training voice-recognition software where, for example, you are prompted to read the Gettysburg Address, except that instead of analyzing tones, the APL system records and classifies muscle twitches.
This training takes place in a Virtual Integration Environment, another RP 2009 innovation. "In the VIE, an animated on-screen arm mimics the patient's intended movements in real time, based on inputs from the electrodes attached to the user's residual muscles," Vogelstein explains. "For the training, a patient sits in front of a computer and an on-screen prompt tells them to 'flex your wrist,' 'extend your wrist,' 'close your fist,' etc."
Calibrating the mechanical limbs to recognize and respond properly to electrical signals in an amputee's residual muscles is an exhausting and draining process, says Armiger, who has been on the front lines of training the system to respond naturally to the patient. "There is no real interaction and no feedback," he says. "And there is no encouragement for the patient to do more or do it better."
The idea to adapt the game for amputees came to Armiger while he was playing Guitar Hero at a party. He and Vogelstein borrowed a colleague's copy of the game and modified the controller with a soldering iron to allow it to be controlled by the VIE. Then, button clicks were substituted with muscle contraction signals as picked up by the electrodes.
Last fall, Armiger and Vogelstein traveled to RP 2009 partner Duke University to test the rigged system on Iraq veteran Jonathan Kuniholm, who lost his right hand to shrapnel in 2005. With electrodes attached to what was left of his arm, Kuniholm was able to operate the frets using signals from his muscles.
The researchers found that playing a game is a far more intuitive way to speed up the tedious calibration process and make it more fun for volunteers. "It allows for large numbers of rapid, dynamic movements that are more natural and not stereotyped," Vogelstein says. "Ultimately we are going to get more input and longer training cycles out of patients — and that will translate to better and more natural limb control."
Armiger and Vogelstein next want to adapt a tennis game to train people with more radical amputations. "Eventually we want to make our software open source so that people can repurpose other games for rehabilitation," Armiger says.

For those without hands, there's Air Guitar Hero

20 November 2008—Rehabilitation specialists have taken to Nintendo’s Wii game console as a way to help motivate patients during physical therapy and rehabilitation. The latest addition to the Wii-hab phenomenon is perhaps its coolest—Air Guitar Hero. Researchers at Johns Hopkins University have made the popular Guitar Hero game into a tool for amputees who are being fitted with the next generation of artificial arms. With a few electrodes and some very powerful algorithms, amputees can hit all the notes of Pat Benatar’s “Hit Me With Your Best Shot” using only the electrical signals from their residual muscles.

The new research, which will be presented this Friday at the IEEE Biomedical Circuits and Systems Conference, in Baltimore, is one component of a program sponsored by the U.S. Defense Advanced Research Projects Agency (DARPA). The Revolutionizing Prosthetics (RP) 2009 project, spread over 30 research institutions worldwide and led by the Johns Hopkins University Applied Physics Laboratory (APL), in Laurel, Md., is developing a mechanical arm that closely mimics the properties of a real limb.

Besides developing two prototype mechanical arms, the project has also pioneered a nerve surgery for controlling the limbs. The nerves that once controlled an amputee’s arm are still intact even after the limb is lost. By rerouting these nerves into the chest muscles and affixing electrodes to pick up the electromyographic (EMG) signals, the RP 2009 researchers were able to use those signals to control a mechanical arm. As a result, the user feels as if he were controlling his own arm.

Though the surgery has worked so far to move an arm with six degrees of freedom, that arm still cannot enable individual finger movement—the ultimate goal of the project.

Dexterous motion of individual fingers poses a tricky software problem. To establish a clear link between mind and machine, the software that translates between EMG signals and the mechanical arm must be trained to understand what the different muscle signals mean. Pattern-recognition algorithms have to be trained by correlating input signal patterns (from muscle contractions) with the intended outputs (opening the mechanical index finger).

The amputee does this training with the help of what’s called a Virtual Integration Environment (VIE)—a virtual-reality training tool in which an onscreen animated arm mimics the user’s intended movements in real time, based on inputs from multiple electrodes attached to the user’s residual arm.

For the training, you sit in front of a screen and obey repeated commands to “close ring finger,” “open index finger,” “close middle finger,” and so on, to get the machine to create an accurate map of your singular myoelectric control mechanisms. What the algorithms and training programs are there to do is to map the subjective experience of the amputee flexing a ring finger to the movements of the virtual arm in the VIE.

That’s a lot harder than it might seem. The trouble comes when the myoelectric impulses of one finger need to be separated from the others. Press your thumb against your middle finger, and you’ll see the problem. If you can’t even easily actuate separate fingers with your native hand, how exactly is an algorithm supposed to figure out an amputee’s intentions from muscles in the chest or upper arm? And, because a movement might be slightly different every time you do it, it needs to be repeated countless times during training for the control algorithm to latch onto the essential signal.

That calibration and training process is as tedious as it is discouraging. “By 3 p.m.,” says APL engineer Robert Armiger, “[DARPA volunteer and double amputee] Jesse [Sullivan] has had lunch, and he’s tired, just like you and I are tired after working all day. It’s hard for him to keep his concentration up.” Further motivation was needed.

The researchers had experimented with games before, notably a variation on Pong. You could move the Pong paddle by “opening and closing” your virtual hand, but that movement is not relevant to opening and closing individual fingers. Though playing the game worked better than simply obeying repetitive commands, Armiger says it was useless for calibrating fine motor control. He also wanted a game with metrics that were a bit more real-world compatible. In the context of prosthetics, that would mean activating muscles to open and close “fingers” in real time, reacting quickly to a stimulus.

Inspired by Wii-hab, Armiger and colleague Jacob Vogelstein borrowed a colleague’s copy of Guitar Hero and attacked the controller with a soldering iron. They rewired the standard guitar-shaped controller to take instructions from the VIE.

Next they substituted muscle contractions for button presses. In particular, they had to rejigger the inputs. Two-handed gamers normally play by using one hand to press colored “fret” buttons to correspond to the correct notes while using the other hand to push a “strum” button in time with the note. Onscreen, these same five colored buttons scroll down the display in time with the notes the players are supposed to hit. To correctly play a note, the player must press the right color fret button and the strum button with the opposite hand.

But Vogelstein and Armiger wanted to use the game to train an amputee. So first they needed to make the game’s controls one-handed. They did that by wiring the two controls together so that an input from a muscle contraction would be read by the VIE as a simultaneous “fret” and “strum.”
For the research reported this week, Armiger and Vogelstein used three normally limbed volunteers, and only three of the five fret keys were used: red, green, and yellow. Once the skin on the subjects’ upper arms was wired up with about 10 electrodes, the subjects could control the keys by moving their fingers: for the red key, they pressed the tip of their index finger to the tip of their thumb; for the green key, the middle finger; and for the yellow key, the ring finger. After five trials, the three research subjects scored between 50 and 70 percent on the game’s “easy” setting.

In mid-October, Armiger and Vogelstein traveled to RP 2009 partner Duke University, in Durham, N.C., to test the system on its target demographic, in this case Iraq veteran Jon Kuniholm. Kuniholm’s right hand was lost to shrapnel three years ago. About to finish his Ph.D. at Duke’s Center for Biologically Inspired Materials and Material Systems, Kuniholm has been a volunteer for the DARPA program for the past two years and is the outspoken founder of the Open Prosthetics Project, an open-source Web site, independent of DARPA, that aims to make prosthetic-arm technology as open source and collaborative as Linux and Firefox.

With electrodes attached to his residual arm, Kuniholm was able to operate the frets using signals from the muscles there. “It’s fun,” says Kuniholm, who achieved the highest score reported by the experimental subjects: 70 percent. Kuniholm says that while Air Guitar Hero is the only game so far that requires individual finger movement to train an amputee to deal with those muscles again, the real success is in striving for a realistic goal. “You’re doing something simple,” he says. “It’s not rocket science. But you have to do it fast and you have to time it right.”

Kuniholm has big plans for Air Guitar Hero. He and Armiger want to use it to train people who use less advanced commercially available artificial arms. Kuniholm’s goal with the Open Prosthetics Project is to create tools that will prime the pump of prosthetics innovation but “won’t consist of several thousand dollars of computing equipment.” In fact, DARPA is in the process of making the APL-created video-game interface software open source, Kuniholm says, “so that we can all begin hacking away.” He hopes to have the source code available for prosthetics control beginning in January. “We’re in the process of getting some more data and experience with it,” he says. The next step is finding lead users at Walter Reed Army Medical Center. “But Air Guitar Hero is just a demo,” he insists. “We want to get this platform out there so people can start downloading it and start modifying other games.”

For their next game-interface modification, the APL team is eyeing Wii Tennis so that people with more radical amputations can also benefit from the motivating powers of the Wii. “We want Jesse to be able to play, too,” says Vogelstein.

The real goal is to get the software into as many hands as possible, Kuniholm says. And in that sense, the story of Air Guitar Hero mirrors the larger Revolutionizing Prosthetics project. In the end, DARPA and Johns Hopkins want to make both the arm’s hardware and the interface software, including the VIE, open source so that prosthetic-arm research innovation can evolve organically.

Technology a key part of paralympic sports

Watch the Paralympics for any length of time and you will quickly see that technology plays an integral part in the event.

When athletes with disabilities compete, there is a need to provide some support in most sports.

From the need to adapt wheelchairs for use in racing, basketball, tennis and wheelchair rugby, to the Flex Feet prosthetics made famous by the "Blade Runner" Oscar Pistorius of South Africa, the range of technological aids for Paralympic athletes is growing all the time.

Associate Professor Lachlan Thompson from the school of aeronautics and mechanical engineering at the Royal Melbourne Institute of Technology says advances like the Flex Feet - prosthetics fitted in place of amputated legs using carbon fibre and titanium for strength, light weight and extra flexibility - "very clearly are used to help people achieve quite exceptional performances".

RMIT has eight professional researchers, lecturers and professors plus 20 post-graduate students, all intent on engineering the next advance for Olympic and Paralympic sport, including motor sports for disabled people. They form part of a national and international quest to develop new sporting technology.

"It's a challenge, it's the most rewarding part of my career I've ever had," Professor Thompson says. "I've seen athletes with bicycles I've designed get on the dais. I've seen Paralympians get on the dais. When you develop technology and the athletes using it win or do a personal best, it's addictive, it's like running the race yourself."

How do scientists go about changing the way athletes compete in their sports? "You read the rules first. You say to yourself this is what we can't do [legally]. Now let's start working out how to make this person go faster."

In addition to the Flex Feet, the introduction of new wheelchair technology in time for Atlanta and Sydney - with many chairs made from titanium or aircraft aluminium - led to improved performances, but the criticism from some quarters was that the new technology was just not widely enough available.

It is true that in comparison, say, with the new Speedo swimsuit, the latest Paralympic technology is not as widely available. Almost every swimmer at the Olympics had the new suit, where many people could not afford the latest high-tech wheelchairs or carbon fibre Flex Feet, or other advances.

Professor Thompson acknowledges the ability to spread the technology is largely a matter of dollars and cents. "If it became trendy tomorrow for people to wear prosthetic feet, and everybody wanted one, they would have to be mass produced and you would get economies of scale," he says.

"We know that with this technology we can give [disabled] people a better quality of life - there's a social benefit that flows from having this technology at the Paralympics."

He believes the spread of technology is definitely improving. "The fact that people can now get Flex Feet [commercially] in Sydney or Melbourne, rather than having to go to a clinic, is great."

Professor Thompson says the age of technological improvement has not stalled since the days of 1996-2000. "It's still improving, it's going ahead in leaps and bounds,'' he says.

"In the past there was a lot of trial and error. Now there is such a database [of knowledge] built up, that we can design something for all types of athletes. [However] it gets very hard to produce technology that gives a dominant edge to a particular athlete."



Finger-strengthening gloves

One area of technological improvement is in production of gloves. "For people who have poor finger strength, they get gloves that have small carbon fibre inserts. If you need the ability to have a high drawback [of a string] in archery, for example, the gloves give added strength for the fingers."

Another area of improvement is in clothing, not just swimwear. "One of the big problems for athletes is they often below the waist don't have the sense of feeling which means they can't tell when they are getting very cold."

This means when athletes are waiting between rounds or for their turn to compete, they can get extremely cold, which reduces their ability to perform at their optimum.

Some of the new clothing allows athletes to remain warm until they are actually performing, at which point activity is sensed prompting the release of excess heat.

Flex Foot technology initially was fairly limited, suitable only for certain types of amputees. These days, however, it doesn't matter whether an athlete's leg has been amputated at the knee or the ankle, the technology is available to fit.

Professor Thompson says that while there are questions of equity in Paralympic sport, the widening of availability will not only have an effect on times and performances in Beijing, but will also improve levels of general competition.

"I think what we're going to see is that where in the past you had one athlete who had the in-built advantage from the technology [and with significant ability] now you are going to see two or three athletes in particular events with that advantage.

"The fact that someone else is pounding along half a metre behind you is going to motivate you. The prospect of being beaten is going to motivate you. You will see this reflected on the times and the performances, and it means that races and competitions will be closer [than before].

"I think there will always be occasions you will have an outstanding athlete whether it's Olympics, world championships or Paralympics. There will always be one or two people who will dominate sports, but it [their time at the top] will be for two to three years, not two or three Paralympics. People will be working harder to catch up."

A look behind the Paralympics

Britain's hopefuls in Beijing

In 1948, Dr Ludwig Guttmann, a neurologist at Stoke Mandeville hospital in Buckinghamshire, launched the forerunner of the Paralympic Games. He believed sport was vital to the recovery of war veterans injured in World War Two and organised a competition to coincide with the 1948 London Olympics.

Since the 1988 games in Seoul, Paralympics have taken place at the same venues as the Olympics. In today's competitions a classification system operates, similar to that used in boxing, where athletes are grouped according to their functional ability. There are five groups: amputee, cerebral palsy, visual impairment, spinal cord injuries and other disabilities ("les autres"). These groupings aim to ensure fair competition between athletes with similar degrees of disability.

At the 2004 Paralympics in Athens, Britain achieved the second highest number of gold medals, 35. This year the British squad hopes to improve on this with 205 athletes competing in 18 of the 20 sports.

Drugs and Dishonesty

But as with other sporting competitions, the Paralympics are open to cheating. At the Sydney games in 2000, the Spanish basketball team won gold in a competition for athletes with intellectual disabilities. Ten of the 12-man squad were later found to have no disabilities. As a result, the International Paralympic Committee suspended the category of "athletes with an intellectual disability" - a decision that learning disability charities, such as Mencap, hope will be overturned in time for the London 2012 Paralympics.

Paralympic organisers share the Olympic movement's fight against drugs, but face additional problems such as "boosting" - a practice where athletes with spinal cord injuries attempt to stimulate their bodies by sitting on pins or ball bearings. While they will feel no pain, their nervous system reacts and increases their blood pressure. Boosting to improve performance, like doping, is illegal in competition.

One of Britain's best-known wheelchair racers, Daniel Sadler, was banned from competitions in 2002 when it was discovered that he was not disabled. He protested, saying that he had never claimed to have a disability. Although banned by the International Paralympic Committee, some disabled athletes defended Sadler as they felt he had no obvious advantage over disabled competitors.

Promoting sport

The Olympics aim to leave a legacy for the host country. The Paralympics are no different, but in this case the focus will be on promoting disability sport and improved physical access to public buildings.

In the run-up to the 2012 London Paralympics, the "Inclusive and Active" strategy has been developed to help local authorities increase opportunities for disabled people to participate in sport and physical activity.

Having signed up to the strategy, the London Borough of Southwark is hoping to build on its existing range of sports activities for disabled people, which includes specialist coaches for football, gymnastics, swimming, sailing and tennis. Southwark also plans to start work on a coaching ­programme to train disabled adults as qualified coaches.

Glyn Newberry, a sports development officer for Southwark, coaches the Millwall disabilities football team. He says: "The team has a wide range of disabilities, including spinal problems, cerebral palsy, deafness, epilepsy and behavioural issues. None prevents them playing superb football. They love coming here, whatever the weather. We hope to increase the rate of participation for people with disabilities. And, who knows, some of the young people we encourage today may be our Paralympians of the future."

Britain's Medal Hopes

● Sarah Storey, cyclist

Former Paralympic swimmer Sarah Storey will be cycling in Beijing, her fifth Paralympic Games. Her preparation involves a gruelling training regime: "Between now and Beijing I will be racing every Wednesday evening at local club 10-mile road time trial events. My training schedule also includes two or three track sessions a week, as well as two or three road rides of about 80km," says Storey. "I hope to bring home medals in my pursuit and road time trial."

● Simon Munn, wheelchair basketball player

Simon Munn, 40, will also be travelling to his fifth games as the veteran of the men's wheelchair basketball team. He says: "My career highlight was winning silver in Atlanta. Getting the bronze in Athens [in 2004] was just as good though because, although it was a step down, the standard has come along a lot since then."

● Josie Pearson, wheelchair rugby player

Wheelchair rugby is perhaps the most aggressive Paralympic event, but this has not deterred Josie Pearson, who will make history by becoming the first woman to represent Britain at the sport. Pearson remains unfazed being the lone female in the team: "To be the first female ever selected for the Paralympic GB rugby team is a real honour. I don't feel any different for being the only female in the sport because when you get on court you have a role to play and you're so focused on what you're doing, nothing else matters."

Events to watch out for

● Boccia

Boccia evolved from an ancient Greek ball game and became a Paralympic sport at the 1992 Barcelona games. Men and women compete together in teams or in individual events. The aim is to throw leather balls as close as possible to the jack, a white target ball.

● Cycling

Cycling is a relatively new discipline for disabled athletes. Blind or visually impaired cyclists compete on tandem bicycles with a sighted team-mate. Amputees and riders with other permanent disabilities use standard racing bicycles, but specific adaptations are permitted to improve safety.

● Swimming

Swimmers compete in freestyle, backstroke, butterfly, breaststroke, individual medley and relay using a variety of starting positions - in the water, a sitting dive or a standing start. South African swimmer Natalie Du Toit, a former Paralympic competitor, hopes to become the first amputee to gain a medal at the summer Olympics 10k open water swimming event.

● Wheelchair basketball

Teams are comprised of five players and seven substitutes. A player is not allowed to touch the playing surface with his or her feet while in possession of the ball. As in able-bodied basketball, players must bounce the ball when moving with it.

● Wheelchair rugby

Wheelchair rugby was invented in the 1970s in Canada by people who had become quadriplegics as a result of spinal cord injuries. Collisions are frequent in this explosive game, originally known as murderball, as players try to stop their opponents crossing the goal line. Wheelchair rugby is open to male or female athletes, with teams of four players and eight substitutes.

●The Beijing 2008 Paralympic Games take place between 6 and 17 September. Highlights will be shown on BBC Two on weekdays between 7pm and 8pm, with live coverage on weekends between 12.50am and 4.30pm.