[ARTICLE] Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke – Full Text

Abstract

Background

Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke.

Material/Methods

Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups.

Results

At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (p<0.05). However, postural balance and upper extremity function were significantly improved in the experimental group when compared with the control group (p<0.05).

Conclusions

Game-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs.

Background

The maintenance of the core or upper body control, is essential for maintaining posture and stability while changing positions, performing activities of daily living (ADL), and ambulating [1,2]. Patients who are undergoing physical rehabilitation following stroke, tend to deviate towards the affected side, as a result of postural instability, which induces both asymmetrical trunk movement and trunk muscle weakness. Upper body instability makes it difficult to maintain postural control when performing tasks and leads to functional disability [3]. The lack of postural stability also affects the balance of patients following stroke, increasing the risk of falls, and negatively impacting on patient independence and safety. For example, it has been reported that up to 73% of patients with stroke experience a fall within six months after leaving hospital [4]. Falls following a stroke can have severe consequences, including hip fractures and reduced physical activity due to fear of repeat falls [5]. Therefore, because these factors can have a negative impact on patient rehabilitation following stroke, the improvement of postural stability is an important goal of patient rehabilitation following stroke [6].

Sports that involve paddling with a single oar, such as canoeing and kayaking, are effective outdoor activities that improve postural stability and upper body stabilization [7]. Continuous body adjustment and compensation are required during the single-oar paddling motion to maintain balance during perturbations caused by the movement of the canoe or kayak and the paddle in the water [8]. Currently, canoe paddling training can be conducted using an ergometer to provide a training opportunity that is independent of outdoor conditions and to better control training progression [9]. A paddling ergometer has also been studied for rehabilitation training of patients with paraplegia and has been shown to be effective in improving postural control, balance, motor performance, and upper extremity strength [8,9].

Game-based virtual reality (VR) using gaming consoles is now used as a therapeutic approach for the rehabilitation of patients with stroke and provides an opportunity for patients to perform activities that are difficult in a clinical setting. Furthermore, VR programs are often designed to be more entertaining and enjoyable than traditional physical therapy tasks, thereby encouraging patients to participate in the rehabilitation program.

The use of VR equipment specifically designed for physical rehabilitation is not yet commonly available in clinical settings. Therefore, VR rehabilitation programs using a game-based, motion-controlled console that can be used in clinical settings and at low cost that can utilize a variety of gaming software are needed.

The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke.[…]

 

Continue —>  Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke

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Figure 2
Game-based virtual reality (VR) canoe paddling training.

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