wrist injuries caused by 
 fatigue at work or improper exercise are very common . for example , carpal tunnel syndrome , 
 cubital tunnel syndrome , stenosing tenosynovitis , stenosing tenosynovitis of the flexor 
 tendons , locked finger , thecal cyst , and other symptoms cause great trouble for patients , 
 because in in addition to receiving medical treatment , they have to undergo regular physical 
 therapy1,2,3,4,5,6 .
common exercises include wrist stretches , grip strengthening , wrist 
 extension , wrist radial deviation , wrist flexion , etc .
these exercises mainly enhance or 
 recover the patients range of motion of the wrist , including wrist radial and ulnar 
 deviation , flexion , and extension movements , as presented in fig .
although these simple wrist exercises are helpful for enhancing hand strength and 
 preventing future injuries , traditional rehabilitation exercises are quite boring , so 
 patients find it difficult to regularly perform the exercises , thus delaying full recovery . 

rehabilitation through physical therapy needs to be progressive and sustainable , and the 
 early success of physical therapy training often influences further training and 
 recovery .
chang et al . stated that recovery of hand function is the most desired outcome for stroke 
 patients , and that wearing a dynamic hand splint for home - use as a supplementary training 
 program in addition to hospital - based rehabilitation can effectively increase the muscle 
 strength of hemiplegic hands7 .
kim et al . 
 reported that passive range of motion exercise in the early stage can improve the function 
 of the upper extremities and activities of daily living of patients with acute stroke8 .
chang et al . investigated the jebsen - taylor 
 hand function test , and found that task performance with the cock - up splint was slower than 
 without the splint for all items9 . in the current age of advancing information advancements and wireless technology ,
described a training method that combines a blobo bluetooth ball with music in cooperation 
 with hand gestures to control the game s character s motions in order to enhance subjects 
 motivation to participate in the activity .
other kinds of music can be added to make the 
 game even more appealing10 .
lin noted 
 that patients who have suffered strokes are motivated to participate in rehabilitation that 
 involves an audio - visual game controlled by a blobo bluetooth ball .
chen et al . reported that patients 
 intention to participate in physical therapy increased when the traditional words , digits , 
 and diagrams of the rehabilitation system were replaced by a game with a space shuttle 
 passing through obstacles , a 3d animation game integrated with a human - computer interactive 
 interface of the wrist joint motion rehabilitation system12 .
this study tested a newly developed lively game using a blobo bluetooth ball that can train 
 and evaluate the progress of wrist rehabilitation with the aim of evaluating its efficacy in 
 the recovery of wrist functions .
the hardware includes an rfid reader 
 ( including tag ) , blobo bluetooth ball , bluetooth device , etc .
the software includes 
 microsoft visual studio c # , microsoft sql server , adobe flash cs4 , etc .
visual studio c # is 
 the major program executive , while sql server is used to manage the rfid and store the data 
 of the motion of the blobo bluetooth ball .
flash files are plugged in under visual studio 
 c#. the blobo bluetooth ball was developed and manufactured by ball - it , finland13 .
multiple sensors are installed in the 
 sphere of the blobo : a g - sensor ( a triaxial accelerometer detecting g force and sphere 
 movement ) , a pressure sensor ( detecting whether the sphere is squeezed ) , an electronic 
 gyroscope ( calculating the inclination of the sphere ) , etc . for physical therapy ,
traditional movements such as wrist flexion , wrist extension , wrist 
 radial deviation , and wrist ulnar deviation , are performed by manipulating the blobo 
 bluetooth ball .
3.wrist training holding a blobo bluetooth ball demonstrates the movements of wrist flexion and wrist extension while holding a blobo 
 bluetooth ball ; figure 3 ( b ) shows the movements 
 of wrist radial deviation and ulnar deviation while holding a blobo bluetooth ball .
wrist training holding a blobo bluetooth ball to launch the system , the user has to throw the blobo bluetooth ball up into the air . once 
 the blobo bluetooth ball is wirelessly linked to a computer through bluetooth , it is ready 
 to be used .
the ball is held and moved back and forth horizontally , squeezed , and turned 
 ( clockwise , counterclockwise ) ; the actions are detected by the built - in electronic 
 gyroscope , pressure sensor and g - sensor , and are used to synthesize the motions ( swinging 
 horizontally , confirming , and whirling ) used within the computer game .
the data retrieved 
 from the game is stored in a sql server database for subsequent analysis of the training 
 effect .
the blobo 
 bluetooth ball is first activated by throwing it up or shaking it , which initiates the 
 computer link the blobo bluetooth ball .
the database for storing the data needs to be 
 created before authentication work can proceed .
the 
 administrator can add , delete , and amend data according to the electronic tags and identity 
 management in the database .
after authentication and selection of the level of difficulty ( easy , medium , or difficult ) 
 and the hand to be trained ( right or left ) , the user can play the manual music player game . 

when the blobo bluetooth ball is rotated or swung , it activates the music playing function 
 in c#. if the user stops the motions , it arrests the music function in c#. depending on the 
 patient s symptoms , the way the patient holds the blobo bluetooth ball will vary for 
 flexion , extension , ulnar deviation , and radial deviation .
the subjects swung the blobo bluetooth ball horizontally and rotated it clockwise 
 ( counterclockwise ) to play the music while squeezing and patting it to turn the volume up or 
 down .
the system records and analyzes 
 the length of time taken and the occurrence of pauses for clinical reference .
the experiment consisted of two trials separately involving subjects with normal wrist 
 function , and subjects with impaired wrist function .
eight subjects with normal wrist 
 function were invited to participate in 10 training sessions and tests for this study to 
 determine whether the same evaluation effect is generated in terms of the dominant hand to 
 validate the stability and repeatability of the system14 , 15 .
eight subjects with impaired wrist function also participate in training and tests twice a 
 week for eight weeks ( three rounds / time ) .
they signed the taipei medical university hospital 
 institutional review board - approved informed consent form prior to participating in this 
 study .
each subject was initially interviewed to obtain participant s background 
 information , and exercise habits .
the assessments of the design of the game and analysis of the subject s behavior were based 
 on the original length of the music ( sec ) , the length of time taken to play the music ( sec ) , 
 and the occurrence of pauses ( occurrence ) . with the cooperation of the joints , muscles , and bones , hands are able to complete a 
 variety of complicated motions .
wrists make the following motions : flexion , extension , ulnar 
 deviation , and radial deviation .
this study used the range of motion ( rom ) of these four 
 motions as indicators . prior to the test , the subjects practiced once and then performed the 
 test twice .
the outcome measures were examined before the 
 start of the study , at the end of the fourth week , and at the end of the eighth week .
the hand rehabilitation training device developed for testing in the study was verified 
 using subjects with normal wrist function and subjects with impaired wrist function .
table 1table 1.the basic characteristics of the subjects with normal wrist functionparticipantsr1r2r3r4l1l2l3l4gender ( m / f)mfmfmmfmage4235285356483528height ( cm)170159180162168183155175weight ( kg)8058845072854873dominant siderightleft shows the 10 training sessions and tests performed by the eight subjects with 
 normal wrist function ( r1r4 had dominant right hands while l1l4 had dominant left hands ) . 

table 1 shows the averages of the 10 training 
 sessions for either hand performed by the subjects with normal wrist function at the easy , 
 medium , and difficult levels of difficulty ( the original lengths of the music were 247 sec , 
 245 sec , and 237 sec , respectively ) .
based on the length of time taken to play the music and 
 the number of pauses , the subjects all performed better with their dominant hand 
 ( p<0.05 ) .
table 2table 2.the basic characteristics of the subjects with impaired wrist functionparticipants ( p1p8)8 ( male:5 , female:3)age41.357.52height ( cm)163.82  6.95weight ( kg)62.519.38dominant side3 ( left)5 ( right)affected side ( left)21affected side ( right)14 shows the basic information of the eight subjects with impaired wrist function 
 ( p1p8 ) .
the subjects participated 
 in training sessions and tests twice a week ( three sets / session ) .
the subjects were asked to 
 train repeatedly by holding the blobo bluetooth ball and making flexion , extension , ulnar 
 deviation , and radial deviation movements .
p1p8 advanced to the next level of difficulty in the eight - week training when the average 
 length of time taken to play the music and the average number of pauses / fell below threshold 
 values determined the performance of the subjects with normal wrist function : an average 
 time within 120% of the original length of the music , and an average number of pauses in 
 easy ( medium ) of less than 100 ( 120 ) times .
table 
 3table 3.performance measures of the subjects with impaired wrist function in the training 
 of process performanceweeksubject & item
p1p2p3p4p5p6p7p8wk-2leveleeeeeeeea.u.t.285.611.8289.315.2308.318.6316.620.7318.918.5291.518.5293.621.3321.519.6a.p.78.277.485.893.6102.395.2883101.8skip levelyynnnyynwk-4levelmmeeemmea.u.t.308.715.5312.518.3289.515.7299.320.3309.616.2311.519.3298.517.2313.616.8a.p.87.585.382.987.385.7109.797.696.4skip levelnnynnnnnwk-6levelmmmeemmea.u.t.283.615.8282.320.8315.519.1292.511.5295.312.1302.617.2287.315.4296.115.7a.p.78.772.678.583.778.398.285.388.5skip levelyynyynyywk-8levelddmmmmdma.u.t.301.718.9298.615.5302.320.3318.521.3321.520.3298.516.6293.713.4323.721.3a.p.89.283.677.480.785.692.899.7108.6wrist sidedominant rrrrrlllaffected rrrrlllrlevel : e : easy , m : medium , d : difficult . a.u.t . :
r : right , l : left indicates the performance of the subjects with impaired wrist function during 
 the training .
level : e : easy , m : medium , d : difficult . a.u.t . :
r : right , l : left as presented in table 3 , all of the eight 
 subjects advanced to the next level of difficult during the eight - week training .
p1 , p2 , and 
 p7 advanced to the difficulty level in week 8 because their dominant hand was the affected 
 hand .
although their dominant hand was 
 the affected hand , because their diagnosis was stenosing tenosynovitis , their ability to 
 hold the blobo bluetooth ball was worse than that of the subjects with carpal tunnel 
 syndrome .
therefore , they could not 
 manipulate the blobo bluetooth ball easily and only achieved the medium level of difficulty 
 in week 8 .
the performance evaluation was measured at the limit when subjects did not feel pain in 
 flexion , extension , ulnar deviation , and radial deviation .
table 4table 4.outcome measures testing results of the patientsindicators & subjectsflexion ( deg)extension ( deg)ulnar deviation ( deg)radial deviation ( deg)premiddlepostpremiddlepostpremiddlepostpremiddlepostp1 ( r , r)404653303440282828161617p2 ( r , r)374349273136272828181818p3 ( r , r)7172726263651516186911p4 ( r , r)707171606163161718579p5 ( r , l)333641283135282828161717p6 ( l , l)7373736262631516165710p7 ( l , l)384551283238272728171818p8 ( l , r)343844242831272828171717(r , l ) means the dominant hand is the right ( r ) while the affected hand is the left 
 ( l ) , and vice versa .
pre : at the start of the intervention , middle : at the end of week 4 , post : at the end 
 of the intervention shows that the rom of the eight subjects with impaired wrist function improved 
 by 813 in flexion ; by 710 in extension ; by 13 in ulnar deviation ; and by 45 in 
 radial deviation .
( r , l ) means the dominant hand is the right ( r ) while the affected hand is the left 
 ( l ) , and vice versa .
pre : at the start of the intervention , middle : at the end of week 4 , post : at the end 
 of the intervention
traditional wrist rehabilitation is repetitive , monotonous , and boring , and the training 
 progress can not be automatically stored and analyzed .
this study introduced and tested an 
 interactive multimedia training game using a blobo bluetooth ball with the aim of providing 
 a diversified and lively physical therapy method for wrist rehabilitation .
the motivation to 
 participate in training can be enhanced through a fun interactive multimedia device , making 
 traditionally tedious and boring training or health enhancement activities more interesting . 

the introduction of the rfid technique in this study for identification and authentication 
 allows rapid recording , retrieval , and analysis of data acquired by the rehabilitation game , 
 including training dates , length of time , etc .
the system developed for this study automatically collects the data regarding the 
 participants performance , and computes increases in levels of difficulty based on the 
 length of time taken to play music during the training . after the training , all the 
 participants wrist rom
were performed better than at the beginning of the physical therapy , 
 proving that wrist rehabilitation with the blobo bluetooth ball has positive effects and is 
 worthy of further study .
 [ purpose ] the introduction of emerging technologies such as the wireless blobo bluetooth 
 ball with multimedia features can enhance wrist physical therapy training , making it more 
 fun and enhancing its effects . [ methods ] wrist injuries caused by fatigue at work , 
 improper exercise , and other conditions are very common . 
 therefore , the reconstruction of 
 wrist joint function is an important issue . 
 the efficacy of a newly developed integrated 
 wrist joint rehabilitation game using a blobo bluetooth ball with c # software installed 
 was tested in wrist rehabilitation ( flexion , extension , ulnar deviation , radial 
 deviation ) . 
 [ results ] eight subjects with normal wrist function participated in a test of 
 the system s stability and repeatability . after performing the blobo bluetooth ball wrist 
 physical therapy training 
 , eight patients with wrist dysfunction experienced approximately 
 10 improvements in range of motion ( rom ) of flexion extension , and ulnar deviation and 
 about 6 rom improvement in radial deviation . 
 the subjects showed progress in important 
 indicators of wrist function . 
 [ conclusion ] this study used the blobo bluetooth ball in 
 wrist physical therapy training and the preliminary results were encouraging . in the 
 future , 
 more diverse wrist or limb rehabilitation games should be developed to meet the 
 needs of physical therapy training . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION