Archive for category Video Games/Exergames




To analyze the literature on the effectiveness of exergames in physical education classes and in the acquisition and development of motor skills and abilities.

Data source:

The analyses were carried out by two independent evaluators, limited to English and Portuguese, in four databases: Web of Science, Science Direct, Scopus and PubMed, without restrictions related with year. The keywords used were: “Exergames and motor learning and motor skill” and “Exergames and motor skill and physical education”. The inclusion criteria were: articles that evaluated the effectiveness of exergames in physical education classes regarding the acquisition and development of motor skills. The following were excluded: books, theses and dissertations; repetitions; articles published in proceedings and conference summaries; and studies with sick children and/or use of the tool for rehabilitation purposes.

Data synthesis:

96 publications were found, and 8 studies were selected for a final review. The quality of the articles was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale and the Physiotherapy Evidence Database (PEDro) scale. Evidence was found on the recurring positive effects of exergames in both motor skills acquisition and motor skills development.


Exergames, when used in a conscious manner – so as to not completely replace sports and other recreational activities -, incorporate good strategies for parents and physical education teachers in motivating children and adolescents to practice physical exercise.


As an indispensable factor for success in sports activities, games and other physical activities, basic motor skills in childhood are determinant for a healthy and active lifestyle. 1 On the other hand, physical inactivity in childhood may result in the inability to acquire and develop motor skills and abilities, which leads to posterior deficit in learning and in the perfection of specialized motor abilities. 2Some variables make it difficult to practice physical activity in school environments, such as: limited time, large number of students per class and lack of adequate spaces. Besides, throughout the years there has been a change in the behavior of children, leading to the removal of games that involve the movement of several body segments, and to the approximation with technology and entertainment using a screen. Facing this phenomenon, new strategies are required to keep the children motivated for the practice of physical activity. 3

Aiming at allying technology and physical activity, the active games came up – or exergames, name given to the technologies that require the whole body to move, combining physical exercises and videogames. 4 These tools convert the real movements to the virtual environment, allowing the users to be more active 5 , practicing virtual sports, fitness exercises and/or other ludic and interactive physical activities, using movements that are similar to real life tasks. 6 The exergames are different from sedentary videogames 7 due to the physical effort and motor skills and abilities required during the games. 5

The insertion of exergames in the daily life may help children and adolescents to reach the recommended levels of physical activity, and, probably, have a positive impactive on the lives of children, since this is a useful way to acquire and develop motor skills and abilities. 4 , , , 10 Even if exergames are a reality in the lives of children and adolescents – and some researchers have been studying their applicability for the motor performance -, identifying evidence in the scientific literature that indicates the successful or little efficient initiatives in relation to their use for the acquisition and development of motor skills and abilities is essential to formulate new proposals for its broad application in the school context.

In this context, the objective of this study was to analyze the literature as to the efficacy of the use of exergames in Physical Education classes and in the acquisition and development of motor skills and abilities.[…]



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[WEB SITE] Virtual reality games to help patients’ rehabilitation in UAE

The AI system is already in use in Ras Al Khaimah Physiotherapy and Sports Centre and will be rolled out soon in all ministry hospitals.

A therapist will always be present to monitor these sessions of patients.

Games developed specially for rehabilitation in physiotherapy for patients of stroke, cerebral palsy and similar conditions, will be used by the Ministry of Health and Prevention (Mohap) as it rolls out use of artificial intelligence (AI) and virtual reality (VR) in hospitals.

The AI system is already in use in Ras Al Khaimah Physiotherapy and Sports Centre and will be rolled out soon in all other ministry hospitals. “Games are developed for rehab of such patients, for both children and adults, especially those suffering from cerebral palsy and motor delay conditions,” Dr Yousif Mohammed Al Serkal, assistant undersecretary for the hospital sector, told Khaleej Times.

“The AI system is composed of three parts – a TV set, a sensory kinetic bar and an X-Box linked with these. Specific games are used to assess how cognitive a patient is,” he said.

A therapist will always be present to monitor these sessions of patients and will assess their conditions accordingly, he added.

He also explained the advantages of VR using AI in physiotherapy to provide treatment. “This will allow the patient to complete the treatment at his/her home with the possibility of remote rehabilitation,” he said.

“In the treatment of stroke, the virtual reality system evaluates and enhances the recovery of the affected upper parts, in addition to the training for the walking device used for rehabilitation.

“The patient moves at a speed on the motion platform with changing virtual environments being displayed on the front screen to simulate daily activities. In the treatment of the balance disorder, virtual reality is a safe and effective alternative to conventional therapy to improve the balance in patients,” he said. “Patients have reported that they enjoyed VR therapy without suffering from side effects, and with increased motivation.

“This technique is also used to treat children with developmental disorders, including positive developments in both perceived and performance capabilities in areas of daily activities including social activities that they have not been able to do before.”

The virtual therapy also assists cerebral palsy patients in the reorganisation of the brain and movement ability and visual cognitive skills, in addition to social participation and personal factors.

More about VR with AI

The UAE Strategy for Artificial Intelligence (AI) is a project within the Centennial Plan 2071. The plan will also include virtual reality (VR) rehabilitation in physiotherapy for stroke patients, patients suffering from balance disorder and children with development disorders, cerebral palsy and Parkinson’s syndrome.

VR rehabilitation technology makes use of virtual world simulation to meet various requirements for effective medical intervention to achieve the best results using the video game controller and the moving sensor. Scientific studies have proven the effectiveness of this innovative technique in the rehabilitation and treatment of many such cases.


AI boost to healthcare

Healthcare industry stands to gain significantly by inducting artificial intelligence into various processes. The technology can take the fear out of procedures and make treatments more effective. The UAE has been experimenting on this front and results are encouraging so far. Innovation through AI is becoming more meaningful with its human-centric approach, and the medical experts are now looking at expanding its scope.


via Virtual reality games to help patients’ rehabilitation in UAE – Khaleej Times

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[ARTICLE] Cooperative Cooking: A Novel Virtual Environment for Upper Limb Rehabilitation – Full Text PDF


Motor rehabilitation technologies commonly include virtual environments that motivate patients to exercise more often or more intensely. In this paper, we present a novel virtual rehabilitation environment in which two people work together to prepare meals. The players’ roles can be fixed or undefined, and optional challenges can be added in the form of flies that must be swatted away. A preliminary evaluation with 12 pairs of unimpaired participants showed that participants prefer cooperating over exercising alone and feel less pressured when cooperating. Furthermore, participants enjoyed the
addition of flies and preferred not to have defined roles. Finally, no significant decrease in exercise intensity was observed as a result of cooperation. These results indicate that cooperation could improve motor rehabilitation by increasing motivation, though the virtual environment needs to be evaluated with participants with motor impairment.

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[ARTICLE] Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study – Full Text HTML


Objective: To investigate the efficacy of Nintendo Wii Fit®-based balance rehabilitation as an adjunctive therapy to conventional rehabilitation in stroke patients.

Methods: During the study period, 70 stroke patients were evaluated. Of these, 23 who met the study criteria were randomly assigned to either the experimental group (n = 12) or the control group (n = 11) by block randomization. Primary outcome measures were Berg Balance Scale, Functional Reach Test, Postural Assessment Scale for Stroke Patients, Timed Up and Go Test and Static Balance Index. Secondary outcome measures were postural sway, as assessed with Emed-X, Functional Independence Measure Transfer and Ambulation Scores. An evaluator who was blinded to the groups made assessments immediately before (baseline), immediately after (post-treatment), and 4 weeks after completion of the study (follow-up).

Results: Group-time interaction was significant in the Berg Balance Scale, Functional Reach Test, anteroposterior and mediolateral centre of pressure displacement with eyes open, anteroposterior centre of pressure displacement with eyes closed, centre of pressure displacement during weight shifting to affected side, to unaffected side and total centre of pressure displacement during weight shifting. Demonstrating significant group-time interaction in those parameters suggests that, while both groups exhibited significant improvement, the experimental group showed greater improvement than the control group.

Conclusion: Virtual reality exercises with the Nintendo Wii system could represent a useful adjunctive therapy to traditional treatment to improve static and dynamic balance in stroke patients.



Stroke is one of the leading causes of disability (1). In stroke patients, balance can be affected by various factors, such as muscular weakness, abnormal muscle tone, deficits in visual and sensory function or disturbances in vestibular mechanisms (2). Since balance dysfunction is associated with increased risk of falling, balance exercises are a critical component of the rehabilitation of stroke patients.

Recent years have seen growing interest in the use of new technologies, such as virtual reality (VR), in stroke rehabilitation. Clinical results indicate that the use of VR technologies improves motor functioning (3–5). VR can be used to improve upper limb function, gait and balance, global motor function and cognitive function in stroke patients (6). However, VR equipment is usually complex and expensive, and may be available only in specialist centres with the help of experienced therapists. As a consequence, there has been an increase in the number of studies on the efficacy of commercial gaming programs in stroke rehabilitation. PlayStation, Wii, and Xbox, along with Kinect, are the game consoles most commonly used in stroke rehabilitation. Wii (Nintendo, Kyoto, Japan) is a game console used to improve balance, strength, flexibility and fitness. It provides a relatively simple and inexpensive opportunity for VR treatment (7).

Several randomized controlled studies have evaluated the effect of Wii-based balance rehabilitation programmes in stroke patients. Cho et al. (8) investigated the effects of VR balance training using Wii in chronic stroke patients. They reported that Wii-based VR exercises resulted in a significant improvement in dynamic balance (8). In another study, chronic stroke patients were randomly assigned to 2 groups. In the first group patients played console games for 5 weeks, and in the control group patients maintained their usual daily activities. A slight improvement was measured in the first group (9).

There are conflicting results in the literature about the efficacy of Wii-based balance exercises compared with other balance rehabilitation programmes, such as progressive balance training and task-specific programmes.

A number of studies have investigated whether the addition of Wii exercises or other exercise options to balance rehabilitation programmes makes a difference in stroke patients. The results are controversial. Lee et al. (10) reported better results in the Wii group. In contrast, Yatar et al. (11) indicated that there were no differences between Wii Fit balance training and progressive balance exercises.

Adequate postural control and good balance performance are prerequisites for independence in daily activities; therefore, these should be important goals of stroke rehabilitation (8). The aim of this study was to investigate the efficacy of Wii Fit-based balance rehabilitation as an adjunctive therapy to conventional rehabilitation in stroke patients.[…]


Continue —>  Journal of Rehabilitation Medicine – Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study – HTML

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[Abstract] Towards an Immersive Virtual Reality Game for Smarter Post-Stroke Rehabilitation


Traditional forms of physical therapy and rehabilitation are often based on therapist observation and judgment, coincidentally this process oftentimes can be inaccurate, expensive, and non-timely. Modern immersive Virtual Reality systems provide a unique opportunity to make the therapy process smarter. In this paper, we present an immersive virtual reality stroke rehabilitation game based on a widely accepted therapy method, Constraint-Induced Therapy, that was evaluated by nine post-stroke participants. We implement our game as a dynamically adapting system that can account for the user’s motor abilities while recording real-time motion capture and behavioral data. The game also can be used for tele-rehabilitation, effectively allowing therapists to connect with the participant remotely while also having access to +90Hz real-time biofeedback data. Our quantitative and qualitative results suggest that our system is useful in increasing affordability, accuracy, and accessibility of post-stroke motor treatment.

via Towards an Immersive Virtual Reality Game for Smarter Post-Stroke Rehabilitation – IEEE Conference Publication

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[Abstract + References] Towards a framework for rehabilitation and assessment of upper limb motor function based on Serious Games – IEEE Conference Publication


 Serious Games and Virtual Reality (VR) are being considered at present as an alternative to traditional rehabilitation therapies. In this paper, the ongoing development of a framework focused on rehabilitation and assessment of the upper limb motor function based on serious games as a source of entertainment for physiotherapy patients is described. A set of OpenSource Serious Games for rehabilitation has been developed, using the last version of Microsoft1® Kinect™ as low cost monitoring sensor and the software Unity. These Serious Games captures 3D human body data and it stored them in the patient database to facilitate a later clinical analysis to the therapist. Also, a VR-based system for the automated assessment of motor function based on Fugl-Meyer Assessment Test (FMA) is addressed. The proposed system attempts to be an useful therapeutic tool for tele-rehabilitation in order to reduce the number of patients, time spent and cost to

I. Introduction

Biomechanical analysis is an important feature during the evaluation and clinical diagnosis of motor deficits caused by traumas or neurological diseases. For that reason Motion capture (MoCap) systems are widely used in biomechanical studies, in order to collect position data from anatomical landmarks with high accuracy. Their results are used to estimate joint movements, positions, and muscle forces. These quantitative results improve the tracking of changes in motor functions over time, being more accurately than clinical ratings [1]. For clinical applications, these results are usually transformed into clinically meaningful and interpretable parameters, such as gait speed, motion range of joints and body balance.


D. A. Heldman, A. J. Espay, P. A. LeWitt, J. P. Giuffrida, “Clinician versus machine: reliability and responsiveness of motor endpoints in parkinson’s disease”, Parkinsonism & related disorders, vol. 20, no. 6, pp. 590-595, 2014.
K. Otte, B. Kayser, S. Mansow-Model, J. Verrel, F. Paul, A. U. Brandt, T. Schmitz- Hubsch, “Accuracy and reliability of the kinect version 2 for clinical measurement of motor function”, PloS one, vol. 11, no. 11, pp. e0166532, 2016.
O. O’Neil, C. Gatzidis, I. Swain, “A state of the art survey in the use of video games for upper limb stroke rehabilitation” in Virtual Augmented Reality and Serious Games for Healthcare 1, Springer, pp. 345-370, 2014.
H. Mousavi Hondori, M. Khademi, “A review on technical and clinical impact of microsoft kinect on physical therapy and rehabilitation”, Journal of medical engineering, vol. 2014, no. 846514, 2014.
J. A. Gil-Gomez, R. Lloréns, M. Alcafiiz, C. Colomer, “Effectiveness of a wii balance board-based system (ebavir) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury”, Journal of neuroengineering and rehabilitation, vol. 8, no. 1, pp. 30, 2011.
E. D. Ofia, C. Balaguer, R. Cano de la Cuerda, S. Collado Vázquez, A. Jardon, “Effectiveness of serious games for leap motion on the functionality of the upper limb in parkinsons disease: A feasibility study”, Computational Intelligence and Neuroscience, vol. 2018, 2018.
K. Salter, N. Campbell, M. Richardson et al., “Outcome measures in stroke rehabilitation”, Evidence-Based Review of Stroke Rehabilitation. Heart and Stroke Foundation. Canadian Partnership for Stroke Recovery, 2014.
E. D. Ofia, R. Cano de la Cuerda, P. Sanchez-Herrera, C. Balaguer, A. Jardon, “A review of robotics in neurorehabilitation: Towards an automated process for upper limb”, Journal of Healthcare Engineering, vol. 2018, 2018.
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K. Tanaka, J. Parker, G. Baradoy, D. Sheehan, J. R. Holash, L. Katz, “A comparison of exergaming interfaces for use in rehabilitation programs and research”, Loading…, vol. 6, no. 9, 2012.
J. E. Deutsch, M. Borbely, J. Filler, K. Huhn, P. Guarrera-Bowlby, “Use of a low-cost commercially available gaming console (wii) for rehabilitation of an adolescent with cerebral palsy”, Physical therapy, vol. 88, no. 10, pp. 1196-1207, 2008.
H. Sin, G. Lee, “Additional virtual reality training using xbox kinect in stroke survivors with hemiplegia”, American Journal of Physical Medicine & Rehabilitation, vol. 92, no. 10, pp. 871-880, 2013.
J. Wiemeyer, A. Kliem, “Serious games in prevention and rehabil-itationa new panacea for elderly people?”, European Review of Aging and Physical Activity, vol. 9, no. 1, pp. 41, 2011.
A. Pfister, A. M. West, S. Bronner, J. A. Noah, “Comparative abilities of microsoft kinect and vicon 3d motion capture for gait analysis”, Journal of medical engineering & technology, vol. 38, no. 5, pp. 274-280, 2014.
S. K. Jun, X. Zhou, D. K. Ramsey, V. N. Krovi, “A comparative study of human motion capture and computational analysis tools”, The 2nd International Digital Human Modeling Symposium, 2003.
A. M. d. C. Souza, M. A. Gadelha, E. A. Coutinho, S. R. d. Santos, A. Pantoja, A. Pereira, “A video-tracking based serious game for motor rehabilitation of post-stroke hand impairment”, SBC Journal on 3D Interactive Systems, vol. 3, no. 2, pp. 37-46, 2012.
Z. Luo, C. K. Lim, I. M. Chen, S. H. Yeo, “A virtual reality system for arm and hand rehabilitation”, Frontiers of Mechanical Engineering, vol. 6, no. 1, pp. 23-32, 2011.
O. Wasenmuller, D. Stricker, “Comparison of kinect v l and v2 depth images in terms of accuracy and precision”, Asian Conference on Computer Vision Workshop (ACCV workshop), 2016.
J. Van der Putten, J. Hobart, J. Freeman, A. Thompson, “Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the barthel index and the functional independencemeasure”, Journal of Neurology Neurosurgery & Psychiatry, vol. 66, no. 4, pp. 480-484, 1999.
E. D. Ofia, A. Jardon, C. Balaguer, Y. Gao, S. Fallah, Y. Jin, C. Lekakou, “The automated box and blocks test an autonomous assessment method of gross manual dexterity in stroke rehabilitation” in Towards Autonomous Robotic Systems TAROS 2017, Cham: Springer, vol. 10454, pp. 101-114, 2017.
C. Rodriguez-de Pablo, J. C. Perry, F. I. Cavallaro, H. Zabaleta, T. Keller, “Development of computer games for assessment and training in post-stroke arm telerehabilitation”, Engineering in Medicine and Biology Society (EMBC) 2012 Annual International Conference of the IEEE, pp. 4571-4574, 2012.
V. Vallejo, P. Wyss, A. Chesham, A. V. Mitache, R. M. Muri, U. P. Mosimann, T. Nef, “Evaluation of a new serious game based multitasking assessment tool for cognition and activities of daily living: Comparison with a real cooking task”, Computers in human behavior, vol. 70, pp. 500-506, 2017.
B. Bonnechere, V. Sholukha, L. Omelina, M. Van Vooren, B. Jansen, S. V. S. Jan, “Suitability of functional evaluation embedded in serious game rehabilitation exercises to assess motor development across lifespan”, Gait & posture, vol. 57, pp. 35-39, 2017.
E. van der Meulen, M. A. Cidota, S. G. Lukosch, P. J. Bank, A. J. van der Helm, V. T. Visch, “A haptic serious augmented reality game for motor assessment of parkinson’s disease patients”, Mixed and Augmented Reality (ISMAR-Adjunct) 2016 IEEE International Symposium on, pp. 102-104, 2016.
C. Bosecker, L. Dipietro, B. Volpe, H. Igo Krebs, “Kinematic robot-based evaluation scales and clinical counterparts to measure upper limb motor performance in patients with chronic stroke”, Neu-rorehabilitation and neural repair, vol. 24, no. 1, pp. 62-69, 2010.
L. Santisteban, M. Teremetz, J. P. Bleton, J. C. Baron, M. A. Maier, P. G. Lindberg, “Upper limb outcome measures used in stroke rehabilitation studies: a systematic literature review”, PloS one, vol. 11, no. 5, pp. e0154792, 2016.
J. W. Burke, M. McNeill, D. K. Charles, P. J. Morrow, J. H. Crosbie, S. M. McDonough, “Optimising engagement for stroke rehabilitation using serious games”, The Visual Computer, vol. 25, no. 12, pp. 1085-1099, 2009.
K. Sathian, L. J. Buxbaum, L. G. Cohen, J. W. Krakauer, C. E. Lang, M. Corbetta, S. M. Fitzpatrick, “Neurological principles and rehabilitation of action disorders common clinical deficits”, Neu-rorehabilitation and neural repair, vol. 25, no. 5 suppl, pp. 21S-32S, 2011.
P. W. Duncan, M. Propst, S. G. Nelson, “Reliability of the fugl-meyer assessment of sensorimotor recovery following cerebrovascular accident”, Physical therapy, vol. 63, no. 10, pp. 1606-1610, 1983.
J. Sanford, J. Moreland, L. R. Swanson, P. W. Stratford, C. Gow-land, “Reliability of the fugl-meyer assessment for testing motor performance in patients following stroke”, Physical therapy, vol. 73, no. 7, pp. 447-454, 1993.
A. Deakin, H. Hill, V. M. Pomeroy, “Rough guide to the fugl-meyer assessment: Upper limb section”, Physiotherapy, vol. 89, no. 12, pp. 751-763, 2003.
D. J. Gladstone, C. J. Danells, S. E. Black, “The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties”, Neurorehabilitation and neural repair, vol. 16, no. 3, pp. 232-240, 2002.
W. S. Kim, S. Cho, D. Baek, H. Bang, N. J. Paik, “Upper extremity functional evaluation by fugl-meyer assessment scoring using depth-sensing camera in hemiplegic stroke patients”, PloS one, vol. 11, no. 7, pp. e0158640, 2016.

via Towards a framework for rehabilitation and assessment of upper limb motor function based on Serious Games – IEEE Conference Publication

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[Abstract + Related Articles] Adaptive gameplay and difficulty adjustment in a gamified upper-limb rehabilitation – IEEE Conference Publication



Lack of motivation during physical rehabilitation is a very common problem that worsens the efficacy of rehabilitation, decreasing the recovery rates of the patient. We suggest a gamified upper-limb rehabilitation that incorporates adaptive gameplay and difficulty so as to overcome that issue, emerging as a support tool for physical therapy professionals. The presence of difficulty adjustment in the game allows a higher motivation level for the patients by preserving the trade off between keeping the difficulty low enough to avoid frustration, but high enough to promote motivation and engagement. This rehabilitation game is a home-based system that allows the patient to exercise at home, due to its Kinect-based portable setup. The game aims to increase the motivation of the patients and thus the speed of their recovery. To accomplish that goal, it is key to potentiate a full immersion into the therapeutic activity. Thus gamification elements, gameplay design and adaptive difficulty are explored and incorporated into the concept.

Related Articles

via Adaptive gameplay and difficulty adjustment in a gamified upper-limb rehabilitation – IEEE Conference Publication

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[ARTICLE] Virtual Reality for Stroke Rehabilitation – Full Text

The use of virtual reality programs specifically designed for stroke rehabilitation is increasing as is the use of commercial video game devices in clinical settings. This review is an update of our review published first in 2011 and then in 2015.1


The primary objective of this review was to examine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Our secondary objective was to examine the efficacy on gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events.


We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and 7 additional databases as well as trials registries. We included randomized and quasi-randomized trials of virtual reality in adults after stroke. The primary outcome of interest was upper limb function and activity. Two review authors independently selected trials, extracted data, and assessed risk of bias with input from a third author to moderate disagreements when required.

Main Results

A total of 72 trials (with 2470 participants) were included in the review. This review includes 35 new studies in addition to the studies included in the previous version of this review (published in 2015). Most studies involved small sample sizes and interventions varied in terms of both the goals of treatment and the virtual reality program or device used. Although there are a relatively large number of randomized controlled trials, the evidence remains mostly low quality when rated using the GRADE system because of the risk of bias in the studies and inconsistent findings between studies. Control groups in the included studies usually received either no therapy or conventional therapy which was provided by an occupational therapist or physiotherapist. Primary outcome: when virtual reality was compared with the same dose of conventional therapy the results were not statistically significant for upper limb function (standardized mean difference, 0.07; 95% confidence interval, −0.05–0.20; 22 studies, 1038 participants, low-quality evidence). However, when virtual reality was used to supplement usual care (thereby providing participants in the intervention group with a higher dose of therapy), there was a statistically significant difference between groups (standardized mean difference, 0.49; 95% confidence interval, 0.21–0.77, 10 studies, 210 participants, low-quality evidence). Secondary outcomes: when compared with conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living outcome (standardized mean difference, 0.25; 95% confidence interval, 0.06–0.43; 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. There were few adverse events experienced in the 23 studies which reported on this and adverse events were relatively mild. There was a trend suggesting that customized virtual reality programs were preferable to commercial game products, however, these findings were not statistically significant (Figure).


Figure. Virtual reality versus conventional therapy: upper limb function: subgroup analyses, specialized, or gaming program. CI indicates confidence interval.

Implications for Practice

We found that virtual reality therapy may not be more effective than conventional therapy for upper limb outcomes, but there is low-quality evidence that virtual reality may be used to improve outcomes in the absence of other therapy interventions after stroke. Clinicians who currently have access to virtual reality programs should be reassured that their use as part of a comprehensive rehabilitation program seems reasonable, taking into account the patient’s goals, abilities, and preferences.

Sources of Funding

Dr Laver is supported by a National Health and Medical Research Council-Australian Research Council fellowship. Dr Saposnik is supported by the 2017 to 2021 Heart and Stroke Foundation of Canada Career Award following an open and peer-reviewed competition. He also served as the Topic Editor for the Emerging Therapies Section (Stroke Journal).




  • This paper is based on a Cochrane Review published in The Cochrane Library 2017, Issue 11 (see for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.

  • Received December 13, 2017.
  • Revision received December 13, 2017.
  • Accepted December 21, 2017.


  1. 1.

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via Virtual Reality for Stroke Rehabilitation | Stroke

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[ARTICLE] A multisession evaluation of an adaptive competitive arm rehabilitation game – Full Text


People with neurological injuries such as stroke should exercise frequently and intensely to regain their motor abilities, but are generally hindered by lack of motivation. One way to increase motivation in rehabilitation is through competitive exercises, but such exercises have only been tested in single brief sessions and usually did not adapt difficulty to the patient’s abilities.


We designed a competitive arm rehabilitation game for two players that dynamically adapts its difficulty to both players’ abilities. This game was evaluated by two participant groups: 15 participants with chronic arm impairment who exercised at home with an unimpaired friend or relative, and 20 participants in the acute or subacute phase of stroke who exercised in pairs (10 pairs) at a rehabilitation clinic. All participants first played the game against their human opponent for 3 sessions, then played alone (against a computer opponent) in the final, fourth session. In all sessions, participants’ subjective experiences were assessed with the Intrinsic Motivation Inventory questionnaire while exercise intensity was measured using inertial sensors built into the rehabilitation device. After the fourth session, a final brief questionnaire was used to compare competition and exercising alone.


Participants who played against an unimpaired friend or relative at home tended to prefer competition (only 1 preferred exercising alone), and exhibited higher enjoyment and exercise intensity when competing (first three sessions) than when exercising alone (last session).

Participants who played against each other in the clinic, however, did not exhibit significant differences between competition and exercising alone. For both groups, there was no difference in enjoyment or exercise intensity between the first three sessions, indicating no negative effects of habituation or novelty.


Competitive exercises have high potential for unsupervised home rehabilitation, as they improve enjoyment and exercise intensity compared to exercising alone. Such exercises could thus improve rehabilitation outcome, but this needs to be tested in long-term clinical trials. It is not clear why participants who competed against each other at the clinic did not exhibit any advantages of competition, and further studies are needed to determine how different factors (environment, nature of opponent etc.) influence patients’ experiences with competitive exercises.

Trial registration

The study is not a clinical trial. While human subjects are involved, they do not participate in a full rehabilitation intervention, and no health outcomes are examined.

Electronic supplementary material

The online version of this article (10.1186/s12984-017-0336-9) contains supplementary material, which is available to authorized users.


Rehabilitation games

Stroke is a leading cause of disability, with 795,000 new or recurrent strokes per year in the United States alone [1]. 88% of survivors experience motor function impairment and thus require rehabilitation to regain their movement abilities [2]. However, even top hospitals devote only an hour per day to motor rehabilitation [3], and exercise intensity is usually too low for optimal rehabilitation outcome [4]. Patients are thus expected to exercise independently at home after leaving the clinic to fully regain their abilities, but frequently do not exercise frequently or intensely enough. For example, one study found that only 30% of unsupervised patients comply with prescribed home rehabilitation regimens [5]. Another home rehabilitation study found that patients average around 1.5 h of exercise per week [6], while clinical studies involve at least 3 h of exercise per week [78]. To improve home rehabilitation, it is therefore critical to increase the frequency and intensity of exercise.

One key reason for poor compliance in home rehabilitation is lack of motivation, which is an important predictor of rehabilitation outcome [910]. While the definition of motivation in rehabilitation is blurry, it is generally agreed to involve a willingness to actively engage in exercise [1112]. To improve engagement, researchers have thus developed numerous rehabilitation games that try to both ensure high enjoyment (using, e.g., meaningful goals, in-game rewards and entertaining graphics [1215]) and provide an appropriate exercise intensity via automated difficulty adaptation [121416]. The games are controlled using motion tracking hardware such as the Microsoft Kinect or even with rehabilitation robots that provide limb support in addition to motion tracking. However, recent reviews have emphasized that such games are not yet sufficiently engaging for all patients [1718]. Therefore, additional rehabilitation game development and validation is necessary to improve patient engagement.[…]


Continue —> A multisession evaluation of an adaptive competitive arm rehabilitation game

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Fig. 1
The Bimeo arm rehabilitation system in the wrist and forearm training configuration. Inertial sensors are attached to the upper arm, attached to the forearm, and integrated in the sphere that supports the hand

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[WEB SITE] Who Needs Fingers? Disabled Gamers Finally Get an Adaptive Controller – Rehab Managment

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The strength of adaptive technology has rippled out into the video gaming realm. On May 16 Microsoft reported the coming release of the Microsoft Xbox Adaptive Controller, which allows individuals who have extremely limited function in their upper extremities to take the controls of their favorite video game. For people affected by spinal cord injury, cerebral palsy, traumatic brain injury, or other challenging physical circumstances, the Microsoft Xbox Adaptive Controller brings individuals into the game who previously watched from the sidelines.

While Microsoft has stocked the gaming market with a variety of controllers lauded for their customization ability, comfort, and responsiveness, those devices uniformly share one shortcoming: their designers assume the user will have two hands.

“The latest controller for Xbox totally changes this script,” tech industry reporter, Jessica Conditt, says in a report about the new device. “It’s built for players with one hand, no hands, or lack of fine motor control.”

Erin Muston-Firsch, MSOT, looks on as Corey uses features built into the new adaptive controller to play video games with his twin brother, Zachary.

Erin Muston-Firsch, MSOT, looks on as Corey uses features built into the new adaptive controller to play video games with his twin brother, Zachary.

In contrast to the popular butterfly shape of conventional Xbox controllers, the adaptive controller is an 11-inch by 6-inch rectangle, loaded with 19 inputs on the back that correspond with every button on a conventional Xbox controller. Microsoft reports that the device can be connected to external switches, buttons, mounts, and joysticks. Accessories include a sip-puff joystick, a one-handed joystick, and hardware that allows the game to be controlled with one leg placed between two buttons.

An online video depicts how individuals affected by varying disabilities are using the adaptive controller.

Therapeutic Dimensions

For occupational therapists and physical therapists, the new adaptive controller may represent a device that not only has therapeutic qualities to be harnessed, but a way to reconnect patients recovering from injury with their favorite pastimes, and maintain personal relationships.

“Our role as occupational therapists is to get people back to doing,” says Erin Muston-Firsch, MSOT, a clinician at Craig Hospital, Denver, in a video that demonstrates how the controller is used by patients who have spinal cord injuries. The device is made to integrate smoothly and provide a user experience that will be familiar to experienced gamers.

For those who want to get back to gaming rather than be faced with a litany of technical glitches, Muston-Firsch says of the new controller, “It just works.”

 Jonah, a young video gamer, says the larger joysticks and larger buttons engineered into the new adaptive controller make it easier for him to operate the gaming platform.

Jonah, a young video gamer, says the larger joysticks and larger buttons engineered into the new adaptive controller make it easier for him to operate the gaming platform. Mike Luckett, at right, is a retired U.S. Army captain, who helped test the controller.

The device can also positively affect socialization, according to Muston-Firsch. In the video she explains that prior to a spinal cord injury a favorite pastime of a young male patient at Craig was to play video games regularly with his twin brother. The interaction provided a way for them to relate to each other prior to the injury. Muston-Firsch points out that the new controller’s “co-pilot” feature enabled the brothers to once again play video games with each other.

Engineers and Disabled Gamers Collaborate

The inspiration for the controller took root in 2014 when a Microsoft employee reportedly stumbled onto a Twitter photo that depicted a video game controller developed for injured war veterans. To participate in video games some veterans had to overcome obstacles created by multiple amputations, quadriplegia, and traumatic brain injury.

A collaboration of purposeful hacking followed, which helped fuel teamwork inside Microsoft’s Inclusive Tech Lab between the company’s hardware developers and gamers affected by disabilities who were brought into the lab for consultation.

Solomon Romney, who was born without fingers on his left hand, says the new adaptive controller is simple to use, and can be customized to how the user wants to interface with the device at any time.

Solomon Romney, who was born without fingers on his left hand, says the new adaptive controller is simple to use, and can be customized to how the user wants to interface with the device at any time.

“As the game platforms have gotten more sophisticated, the controllers have gotten more sophisticated, and [playing the games] started to get frustrating,” says a gamer identified only as ‘John,’ who is affected by cerebral palsy on his entire right side. He explains in an online video the how the interface allows him to engage in play.

Microsoft chief accessibility officer, Jenny Lay-Flurrie, notes in her May 16 blog entry that the device is designed primarily for gamers who have limited mobility. Furthermore, she says, the device will allow individuals to create a custom controller experience that is affordable, and will be adaptive to a variety of disabilities.

Lay-Flurrie writes: “We gained feedback from people with disabilities and collaborated with gamers to build an accessible controller from the ground up, and I think this will make a huge difference for gamers of all abilities — connecting more gamers than ever before.”

Individuals can request an email notification from Microsoft when the controller becomes available.

Frank Long is editorial director of Rehab Management andPhysical Therapy Products. For more information, contact

via Who Needs Fingers? Disabled Gamers Finally Get an Adaptive Controller – Rehab Managment

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