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Video Gaming in Rehab

Virtual reality makes neurorehabilitation fun.

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The number of individuals diagnosed with neurological insults affecting strength, balance, and coordination is staggering, creating an overwhelming need for optimal rehabilitation intervention. Researchers are constantly seeking further understanding of the nervous system and the clinical application of each new discovery.

Much of the recent research has addressed the nervous system's ability to recover and compensate following an insult through experience-dependent neuroplasticity.1 Kleim and Jones1 describe ten principles that should be addressed with any neurorehabilitation program, including repetition and salience.

Clinicians often struggle with creating attended, goal-directed activities with traditional rehabilitation techniques that can become monotonous. As a result, clinicians are constantly searching for new interventions that create an engaging experience for patients to promote optimal neuroplasticity.

Virtual reality has been used to enhance patient participation and compliance, but the cost of such systems can be excessive and the operation of the software is often complex. With the fairly recent advancements made in gaming systems, allowing player motion to dictate activity on the game, these systems have the potential to yield comparable results to that of virtual reality at a fraction of the cost, while improving user friendliness.

This literature review is intended to discuss the effectiveness of video games on patient enjoyment, compliance, and recovery in neurorehabilitation.

Post-stroke

Much of the research regarding video games in neurorehabilitation has been with hemiparetic post-stroke populations and its effect on improving upper extremity (UE) function. Mouawad et al2 conducted a study assessing the effectiveness of the Nintendo Wii on a group of individuals post-stroke with hemiparesis versus a group of healthy individuals.

Participants played Wii Sports games including tennis, golf, boxing, bowling, and baseball for one hour per day for ten consecutive weekdays along with home practice increasing from 30 to 180 minutes per day.

Statistically significant improvements were found in the Wolf Motor Function Test (WMFT), the Fugl-Meyer Assessment upper limb section (FMA-UL), and UE range of motion (ROM) and strength indicating improved UE use and carry over into functional activities. Patients also reported more use of their affected UE in daily activities through increased scores on the Motor Activity Log Quality of Movement (MAL-QOM).

Wii ages were calculated by the game software, through assessment of performance in tennis, bowling, and baseball, following each onsite treatment session. No between group difference was found with pre and post-intervention Wii ages, confirming that the improvements observed in the post-stroke group were not due to "learning and improving Wii skills" alone.2 This two-week study conducted no follow-up testing to determine whether long-term improvements could be made and maintained.

In a similar study of patients post-stroke, Saposnik et al3 compared the use of Wii video games, including tennis, bowling, and Cooking Mamma, to recreational therapy (RT), including playing cards, bingo, or "Jenga." Results showed significant improvement in the WMFT scores in the Wii group compared the to the RT group. The authors also looked at the safety and feasibility of the Wii, finding no adverse effects and no significant difference in the time of intervention implementation between the two groups.

One limitation of using off-the-shelf video games in neurorehabilitation is the software was designed for use by healthy populations. Hijmans et al4 took this limitation into consideration and conducted a repeated measures study using a system to allow bimanual exercise, permitting the less involved UE to support and assist the more involved one.

The participants, all at least six months post-stroke, played games on a computer using a "CyWee Z game controller," similar to the Nintendo Wii, "incorporated into a custom-made handlebar" to allow bimanual movement.4 The handlebar also forced full UE movement rather than just wrist motion to participate in the game. Categories of games that patients were allowed to choose from included stationary and moving target-hitting games, sports games, casual games, and puzzle games.

A significant increase in the FMA-UL scores was found following the two and half week intervention period indicating improvement at the structural level. No significant changes were found in the more functional based WMFT and the Disabilities of Arm, Shoulder, and Hand (DASH) tests. Again, the short time frame of the study presents a limitation of unknown long-term results.

The lack of improvement noted at a functional level may be due to inadequate time lapse for patients to apply structural improvements to activity schema and performance.


Video Gaming in Rehab

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