An estimated 80% of individuals with stroke experience upper limb dysfunction and 60% of stroke survivors will not regain full use of the affected arm. Improvement in motor function is possible even in the chronic phase of stroke through motor rehabilitation. Rehabilitation is a lengthy process and has little chance of success if a patient is not dedicated to his or her regime. Highly motivated patients are more likely to adhere to a rehabilitation program and motivation has been linked to better therapeutic outcomes in many studies.
This study evaluated how motivating participants of experimental stroke rehabilitation interventions found their upper extremity (UE) rehabilitation regime and compared those scores to the data gathered in the Human Performance Laboratory (HPL).
A literature review was conducted. Interventions were sorted into the categories gaming, gaming with assistance, robotic training, mixed reality, and conventional therapy. Six studies from the HPL were used. Mean interest/enjoyment (I/E) subscale scores of the Intrinsic Motivation Inventory (IMI) were gathered for each category and the level of intrinsic motivation was determined.
All categories produced a highly positive I/E scores. All of the categories except conventional therapy produced a higher mean score for reported I/E than the HPL.
Personality traits of the participants can likely account for these higher-than-average levels of intrinsic motivation. Though the HPL did not outperform the other categories, it is comparable to other gaming interventions and has the unique advantages of affordability and accessibility these lack. Future work in personalized virtual reality (PVR) therapy that seeks to make interventions more intrinsically motivating may consider the potential benefits that lie within these other approaches to UE rehabilitation including using specialized games for persons with stroke and providing external support to the players.
Source: “Comparisons of Intrinsic Motivation for Novel Stroke Rehabilitation In” by Dorothy Kalmbach
Background and Purpose
A direct comparison between the effects of constraint-induced movement therapy (CIMT) applied early after stroke and that of CIMT applied in the chronic phase has not been conducted. This study aimed to compare the long-term effects of CIMT applied 6 months after stroke with the results of CIMT applied within 28 days post-stroke.
This study was a single-blinded, multicentre, randomized controlled trial with a crossover design. Forty-seven patients received CIMT either early (within 28 days) or 6 months after stroke. Both groups received standard rehabilitation and were tested at 5 time points. The primary outcome measure was Wolf Motor Function Test (WMFT); the secondary measures were Nine-Hole Peg Test (NHPT), the Fugl-Meyer Assessment (FMA) of the upper extremity, Stroke Impact Scale, and Modified Rankin Scale (MRS).
Compared with baseline data, both groups showed significant improvements in the primary and secondary outcome measures after 12 months. No significant differences between the 2 treatment groups were found before and after the delayed intervention group received CIMT at 6 months and during the 12-month follow-up. Both groups recovered considerably and showed only minor impairment (median FMA score of 64) after 6 months. The early intervention group showed an initially faster recovery curve of WMFT, NHPT, and MRS scores.
In contrast to most CIMT studies, our study could not find an effect of CIMT applied 6 months after stroke. Our results indicate that commencing CIMT early is as good as delayed intervention in the long term, specifically in this group of patients who might have reached a ceiling effect during the first 6 months after stroke. Nevertheless, the early CIMT intervention group showed a faster recovery curve than the delayed intervention group, which can be a clinically important finding for patients in the acute phase.
Source: Early versus late-applied constraint-induced movement therapy: A multisite, randomized controlled trial with a 12-month follow-up – Stock – 2017 – Physiotherapy Research International – Wiley Online Library
Background: Current motor rehabilitation strategies for people who suffered a stroke focus on occupational therapy and physiotherapy and rely on repetitive, intensive and task-oriented training of the body parts that are affected by functional impairments. Though these training methods are generally effective, rehabilitation therapy is often perceived as monotonous and mundane, which could result in an incomplete recovery as patients lack in motivation to do the training exercises as recommended. Motionbased gaming consoles as the Nintendo Wii offer several ways for deployment that can help to facilitate the recovery of motor functionality and increase patient motivation. A great number of health practitioners affirm that the Wii is a feasible tool for stroke rehabilitation purposes. Still, relevant research that focuses on an assessment of the feasibility of the system is limited and there is a need for more comprehensive work in this field.
Objective: This systematic review aims at summarizing the scientific work that is done in the field of integrating the Nintendo Wii into rehabilitation interventions for stroke patients.
Methods: The review is based on a systematic literature search that was focused on interventions that make use of games and game elements in health contexts. The initial search yielded 4556 publications that were subsequently screened with regard to their relevance for this review, by using several established eligibility criteria. The use of these criteria ensured that the studies, that were featured in this review included a discrete intervention that was aimed at stroke rehabilitation and incorporated the Nintendo Wii. The data that were extracted from these studies were categorized into 5 different fields, namely study characteristics, intervention characteristics, evaluation of outcome measures, major advantages and limitations.
Results: The final outcome of the screening phases yielded a number of 9 publications that met all of the established criteria for the inclusion in this systematic review. The major results that were derived from these interventions showed that Wii-based stroke therapy leads to significant improvements in motor functionality and increases patient motivation and engagement. Major advantages of the Wii system include the absence of adverse effects and the possibility that the Wii can be used for patients in the chronic phase post-stroke. Major limitations were identified as the Wii-gaming exercises required constant supervision and additional input from therapists and the integrated game feedback was not sensitive to measure a patient´s performance and progress in a compatible way.
Conclusions: The findings of this research suggest that the Nintendo Wii is a feasible tool for stroke rehabilitation purposes that can keep up with traditional therapy approaches with regard to the functional outcomes and succeeds in enhancing active participation in the therapy sessions. The use of the system holds limitations in the field of home deployment as it requires constant attendance by healthcare professionals. Still, the results of this study suggest that the system is feasible for a wide-scaled integration into stroke therapy
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