[THESIS] Game Based Rehabilitation – Full Text PDF

ABSTRACT

Impaired standing balance and stroke incidences occur 800,000 times every year and are expected to rise as the population ages. The neurological impairments that can result from a stroke incident include hemiparesis (paralysis of one side of the body), coordination difficulties, apraxia (inability to perform particular purposive actions), and impairments in postural control that have a detrimental effect on a person’s functional ability and increase their risk of falling. The use of exercise and conventional physical therapy is one way and is considered the standard way of improving the standing balance.

Although the conventional physical therapy has often been shown to improve balance and mobility, poor adherence and inadequate exercise techniques often result in poor outcome for the patient and delay their balance recovery. There is growing evidence that the game based rehabilitation for balance control improves the body balance. The primary measure to balance stability is the center of pressure of the body. Currently the physical therapist has no validated system to precisely quantify center of pressure, an important component for standing balance. However Nintendo Wii Balance Board (WBB) is able to measure this center of pressure and it can be used to monitor sensitive change in the balance. Hence coupling the game based rehabilitation with the WBB results in a useful rehabilitation tool for recovering standing balance. Given that the WBB is portable, widely available, and a low cost, it can provide the average clinician with a standing balance game based rehabilitation tool suitable for the clinical setting once software is provided.

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[WEB SITE] Severely impaired stroke survivors regain arm function after intensive physical therapy

Time may heal all wounds, but in the case of stroke survivors, the key to better recovery is to spend more time in an intensive physical therapy program, according to a University of Florida Health study.

After a stroke, the brain and body can start recovering immediately and can show improvement up to six months afterward, said UF Health researcher Janis Daly, Ph.D. But this study focused on people who had persistent disability even a year or more after completing standard care. The study found that extensive physical therapy helped them recover motor function, even though they began the study treatment a year or more after stroke.

“The recovery was meaningful to patients in terms of physical function. Each person’s recovery was somewhat unique,” said Daly, the paper’s lead author and a professor in the UF College of Medicine’s department of neurology. “Some had dramatic recovery, some had less. Some were able to perform functional tasks that they weren’t able to do before; some recovered the ability to move their arm so they could actually place the arm for functional tasks, for example into the sleeve of a sweater.”

Daly said the average change in function for patients who had been severely affected by their stroke was clinically significant for arm movements and for performing complex tasks. For instance, a man who had been unable to lift a spoon to his mouth can now feed himself.

Inability to combine regular motions – for example, flexing the shoulder and simultaneously extending the elbow while reaching for an object – can be one result of a stroke. The patient may concentrate on the reaching movement of the arm, but the normal neural pathways are interrupted, and the patient’s arm may flex inward toward the body instead of extending to reach for a glass of water or a fork, said Daly, also the director of the National Veterans Affairs Brain Rehabilitation Research Center of Excellence in Gainesville.

To help patients regain movements of the shoulders, arms and hands, which are crucial in many daily activities, researchers administered an intensive physical therapy program that included five hours of rehabilitation per day, five days per week, for 12 weeks to 39 study participants.

The researchers tested three different modes of rehabilitation. The first was motor learning rehabilitation. Daly compared motor learning rehabilitation after stroke to learning a new sport move, such as a beginner learning a tennis serve. In this type of rehabilitation, patients must concentrate on performing a movement as deliberately as possible, with as much normal movement as possible, and must practice the task repetitively.

“Think about a child learning to walk or to ride a bicycle,” Daly said. “They must practice over and over until they come close to perfection.”

The second and third modes of rehabilitation were electrical stimulation rehabilitation and robotics-assisted rehabilitation. In electrical stimulation rehabilitation, electrodes comfortably stimulated the muscles on a person’s forearm and caused the hand to lift. Participants in the robotics-assisted rehabilitation group practiced the reach movement using robot software. The software guided them to attempt to reach targets displayed on a computer monitor. Their forearm and hand were cradled in a support so participants could concentrate on moving the shoulder and elbow.

One group received five hours per day of motor learning alone, while the other two groups received motor learning for 3 1/2 hours and electrical stimulation or robotics-assisted rehabilitation for the remaining 1 1/2 hours per day. All three groups received some motor learning rehabilitation. Each of the groups improved significantly, on average doubling or nearly doubling their scores on a scale that assesses coordination.

Daly says the recovery for all three groups was equal, with no statistically significant difference between the groups. The researchers named a small sample size as a potential limitation of the study, pointing out that there might have been statistical differences in the results between groups if the group sizes had been larger. Because of the intensity of the program, one physical therapist worked with three patients; this ratio of therapist to patients was successful. Factoring in the salaries of the therapists and the cost of equipment used in rehabilitation, the researchers calculated that treatment for each patient cost between $4,500 and $5,600.

“Often after stroke, people can recover normal function without intensive treatment, in response to normal protective physiological processes. Some people recover quite well and can function normally. For this study, however, we enrolled people who had a stroke a year or more prior to their study participation, and who were still severely impaired,” Daly said. “The magnitude of recovery we observed in our study is higher than any other studies that have been published so far, which supports the promise of longer treatment and more intensive treatment after stroke, even for those who are more severely impaired.”

Grants B2801R, B9024-S and B5080S from the Department of Veterans Affairs funded the study.

Adapted by MNT from original media release

via Severely impaired stroke survivors regain arm function after intensive physical therapy – Medical News Today.

[ARTICLE] Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients

Abstract

Background: The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed.

Objective: To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients.

Methods: The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl–Meyer scales were used to evaluate the patients.

Results: After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl–Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients’ performance in a similar manner.

Conclusion: Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

via Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients: Topics in Stroke Rehabilitation: Vol 0, No 0.