Posts Tagged Exergames
To systematically evaluate the efficacy of exergames in individuals with major neurocognitive disorder.
Materials and methods
PubMed, EMBASE and PEDro were systematically searched from inception until October 2019 for randomised and clinical controlled trials. Methodological quality of the trials was assessed with the PEDro rating scale or Risk of Bias in Nonrandomised Studies of Interventions-I (ROBINS-I), when appropriate. Grading of Recommendations Assessments, Development and Evaluation (GRADE) was used to assess the overall quality of the evidence.
Eight trials, all of moderate to high methodological quality (i.e., PEDro score of 6 or higher or a Robins-I moderate quality score) were included. The overall quality of evidence was moderate to high according to the GRADE criteria. Improvements in gait, mobility and balance and beneficial effects on activities of daily living performance, cognitive function, fear of falls, quality of life and mood following exergaming were reported. Heterogeneity in outcome measures, intervention characteristics and included participants precluded a meta-analysis.
The current literature is of moderate to high quality and demonstrates that exergames have a wide range of physical and mental benefits in people with major neurocognitive disorder. More controlled trials are however needed to confirm the existing evidence before exergames can be recommended in treatment guidelines for people with major neurocognitive disorder.
Implications for rehabilitation
Exergames have many physical and mental benefits in people with major neurocognitive disorder
Exergaming can enhance gait, mobility and balance in people with major neurocognitive disorder
Evidence for beneficial cognitive effects of exergaming is emerging
A PhD thesis by Michele Pirovano (Politecnico di Milano, Italy), studying the feasibility of at-home rehabilitation using exergames for stroke patients. It includes the results of a 3-months pilot test using an original exergaming system developed by the author.
Download the thesis for free at http://www.michelepirovano.com/pdf/MichelePirovano_Thesis_Final_2015_01_09.pdf
[ARTICLE] Does a novel exergame challenge balance and activate muscles more than existing off-the-shelf exergames? – Full Text
Novel balance-targeting exergames controlled with off-the-shelf hardware, were developed based on current recommendations for balance training in healthy older adults and documented shortcomings of existing games. The aim of this study was to explore the feasibility of these novel exergames as training tool for elderly and, more specifically whether these games can elicit more challenging weight shifts and higher levels of muscle activity compared to existing off-the-shelf exergames. Furthermore, the motivational pull in these new games was studied.
Sixteen healthy older adults were recruited to play the novel games and two reference games that were found to be the most challenging ones in terms of weight shifts or muscle activity in previous studies. Weight shifts were expressed relative to participants’ Functional Limits of Stability (FLOS). Muscular challenge of the games was quantified by dividing the signal into 200 ms blocks and determining the average muscle activity within these blocks. The muscle activity was normalized to maximal voluntary contractions (MVC) to categorize the blocks in zones of < 40, 40–60, 60–80 and > 80% MVC. Subsequently, the number of blocks per intensity level and the number of consecutive blocks above 40% were determined. Motivation to play the games was assessed using the Intrinsic Motivation Inventory (IMI) and scores between the games were analyzed using Generalized Estimated Equations (GEE).
The novel exergames successfully elicited center of mass (COM) displacements with medians of around 80% of FLOS or higher for all directions. Furthermore, the COM displacements in the novel games were larger for each direction than in the reference games, although for one game the sideward left direction reached significance only at the third trial. Compared to the existing games, longer blocks of muscle activation above 40% MVC were found, but overall intensity remained low. IMI scores were high on all subscales, indicating that older adults experienced the games as motivating.
We conclude that affordable hardware can be used to create challenging and enjoyable balance training programs using exergames. The exergames that were successful in eliciting challenging weight shifts and muscle activity should now be further studied in longitudinal randomized controlled interventions, to assess effects on balance, muscle strength and eventually fall risk in healthy older adults.
Studies report that 30–40% of people older than 65 will fall at least once per year and about 10–20% of these falls will result in hospitalization [1, 2]. The number of people aged 65 and older will increase due to the demographic developments worldwide, which will further increase the total number of falls . Major risk factors for falling are an age-related decrease in functional capabilities, especially in balance control and muscle strength [4, 5]. Multidimensional training programs have been shown to ameliorate these risk factors and reduce fall risk in older adults. This is especially the case when strength training and sufficiently challenging balance exercises are provided for at least 3 h per week [1, 2, 6, 7]. However, ongoing participation in a training program is needed to prevent fading of the benefits due to the progressive strength and balance decline caused by aging [2, 6]. As long-term, structural supervised training is costly, home-based training appears most promising for long-term effects. Sadly, adherence to traditional home-based training programs is low due to the repetitive nature of the exercises, lack of perceived usefulness and therefore motivation [8, 9].
The use of computer games to aid in balance training for older adults, also called exergames balance training, receives increasing attention [10,11,12]. In this study, exergames are defined as computer games using commercial consoles as the Wii and the Kinect console and that are controlled with body movements. Different commercial games are already available that might have a balance training potential [10,11,12]. Potential benefits of exergames over conventional training are: an increase in motivation and thereby adherence , the option to offer dual task training , the option to provide different forms of feedback  and to adapt the training intensity to the skill level of the player so that individualized progression is possible. However, the latter is not always possible in commercial games. Despite these promising features, systematic reviews report varying results on balance [10,11,12], possibly due to the wide variability in games that have been studied and the fact that these games were not specifically developed with the aim to improve balance in older adults. In conventional balance training, strength and specific balance training were shown to be key elements in preventing falls [2, 6, 16, 17]. It is recommended that balance training is sufficiently challenging by requiring weight-shifts to the limits of stability, by reducingthe base of support (BOS) , or by adding a cognitive task. For strength training, it is recommended in literature that the muscles are sufficiently challenged by increasing the intensity of the exercises or the number of repetitions, so that the muscles will fatigue . The American College of Sports Medicine defined the threshold for hypertrophy and strength gains to be 60% of the one-repetition maximum . However, exercises with external weights are unpractical in VR training, which is often performed at home. Recent research showed that strength exercises at low loads, but with high velocities, can induce muscle activations comparable to training with high loads . Furthermore, these low-load exercises also seem to induce benefits for strength and balance in older adults . Finally, ongoing participation in the training program is recommended to prevent fading of the gained benefits . A study that analysed the challenge of balance provided by off-the-shelf games showed that balance is challenged to a varying extent, but that ample room for improvements is left. Moreover, it was found that adaptation to or learning the game, as trials advanced, resulted in a decreasing challenge in some games [22, 23]. From the analysis of muscle activity in seven off-the shelf games, it was concluded that overall muscle activation was low and that longer periods of muscle activation were scarce . Only the games that required faster movements elicited some muscle activity that seemed challenging enough to be considered as a training impulse .
The motivational pull of exergame balance training with off-the-shelf games, was assessed in older adults and results showed that playing exergames can lead to strong intrinsic motivation . Especially games that provide positive feedback resulted in high intrinsic motivation. Furthermore, physically active games containing variation seemed to be the preferred game mechanics .
Based on the above summarized recommendations for balance training (e.g. sufficiently challenging balance tasks and strength exercises that lead to muscle fatigue), an exergame package for balance training for older adults was developed [2, 4, 6]. The aim of the current study was to evaluate whether the novel set of exergames (called Virbal), which are controlled with off-the-toy-shelf technologies, are feasible and well-suited from a content perspective for balance training in elderly. The novel games were evaluated to see whether they were more challenging in terms of balance movements and muscle activity than existing off-the shelf games. Furthermore, the novel exergames were evaluated on how motivating they are for older adults. Games were compared regarding the challenge imposed to balance in terms of magnitude of center of mass (COM) displacements and regarding the muscle activation elicited in terms of intensity and duration of muscle activation. Motivation was evaluated using questionnaires on motivation.
[ARTICLE] Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle – Full Text
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[ARTICLE] EXERGAMES AS A TOOL FOR THE ACQUISITION AND DEVELOPMENT OF MOTOR SKILLS AND ABILITIES: A SYSTEMATIC REVIEW – Full Text
To analyze the literature on the effectiveness of exergames in physical education classes and in the acquisition and development of motor skills and abilities.
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.
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. 2 Some 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 7due 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 ,8 , 9 , 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.[…]
[Abstract] Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis.
[EDITORIAL] ADVANCING GAMING TECHNOLOGY IN NEUROLOGICAL REHABILITATION – Pakistan Journal of Neurological Sciences (PJNS)
Samreen Sadiq, Lahore College of Physical therapy, email@example.com
Iqra khan, University Institute of Physical Therapy, University of Lahore
The consumption of gaming technology has recently gain unexpected signiﬁcance in medical health care for neurological rehabilitation. With increasing interest in exergames study, numerous deﬁnitions and terminology have been introduced to describe this term. Researchers from health-related background acknowledged the fact that engaging in video gaming was not always sedentary and might act as a means to ensure more physical work. Simplifying the terminology exergames are those types of gaming technology or multimedia communications that necessitate the player to perform physical activity during play.
However, health related researchers were hesitant to use the terminology of exergaming, their descriptions shared a mutual purpose of enhancing physical activity level. Two similar terms were deﬁned to explain that concept known as activity promotion and active video gaming. For instance, videogames that promote physical activity were described as those video games that have capability to enhance physical movements during screen period whereas active video gaming may give new opportunities to transform the conventional sedentary attitude into physical active behavior. The chief impression of using such terminology is to discriminate engaging in video gaming that encourage active attitude from those resulting in inactive behavior.’
The growing utilization of exergaming and the expansion of diverse software’s by ground breaking minds in gaming industry have inadvertently opened new ways to address goals of neurological rehabilitation. The common aims of rehabilitation include improvement in balance, enhancing functional movements as well as to promote ﬂexibility. The chief reason for integrating video gaming in neurological rehabilitation is to enhance patient motivation, strict adherence to treatment procedure and to ignore boring training.
An important question which rises in mind is could those clients who are involved in neurological rehabilitation through gaming technology capitalize on its entertainment value? Motivating a person’s interest is probably a key to strict exercise adherence. The utilization of gaming technology is limitless. A research was done to evaluate efﬁcacy of Wii Ninetedo in Parkinson’s disease patients and the impact of integrating exergaming for the management of childhood obesity. Case reports utilizing exergaming have been described for improving balance and gait parameters in patients suffering from neurological condition known as stroke. The practice of exergames were found to be effective in improving exercise tolerance and adherence in Multiple Sclerosis patients. A study on efﬁcacy of Wii Fit was also conducted to evaluate the balance problems among Cerebral palsy children and the results suggested that Nintendo Wii provides entertaining, safe and effective means in conjunction with traditional management to improve balance of cerebral palsy children.
The safety of these emergent devices as medical equipment is questionable and whether there is need to give approval to these devices by governing authorities before using them. The concerned issue should be emphasized keeping in consideration the risks, dangers and adverse effects associated with the use of this exergames technology. Several case reports of injuries have been identiﬁed with utilization of this gaming technology for example shoulder joint dislocation, pulmonary disorder, tendon and ligamentous tear. Another case was reported about primary spontaneous pneumothorax in an old man with initial presentation following prolonged period of playing Nintendo Wii. Commonly reported injuries include overuse strain injuries, joint injuries and has been named as Wiiitis by authors. Terminology mostly used to describe such injuries associated to to Wii-habilitation include Wii Shoulder, Wii Knee and Nintendinitis.
Worldwide utilization of this novel technology has been implemented and various international scholars showed strong interest in integrating the use of exergaming for neurological rehabilitation. Global attention has been focused to this technology and paper based work has been presented in World Confederation for Physical Therapy. A lot of document based work displayed in Amsterdam was also put together on this speciﬁc topic, some were initial researches but they depict a worldwide interest in this emergent technology. Previous literature have focused the remarkable and extraordinary effects of exergaming on upper extremity function, daily living activities and posture control. This novel technology can efﬁciently provide opportunity to neuro patients to accomplish maximal repetition of movement and tasks and provide a better possibility in comparison to traditional techniques. In Pakistan, a similar paper highlighted the application of exergaming as an effective and innovative tool for stroke rehabilitation. It was suggested that this tool offers a collaborative activity and the cost of video games is less as well as ensure easier implementation. So, it is the chief responsibility of concerned professionals to deliver a complete rehabilitation protocol so that optimal functioning level can be achieved. It enables the person to perform activities of daily living independently. This novel technology lessens the full time help of physical therapist and home-based management can also be manageable in future. Therefore, it is correct time to use this technological advancement for assistance in neurological rehabilitation to attain best outcome in small period.
The debate on emergent technologies is relatively noteworthy in rehabilitation and physical therapy practice. This forward technology shift and use of other analogous devices offer countless choices for rehabilitation extending from heart rate measuring and respiratory rate monitoring tools, to diagnostic and education applications. It now seems possible to foresee the effect and impact of this emergent technology in rehabilitation ﬁelds. It is pretty clear that technology has substantially improved the delivery of rehabilitation services and exer-gaming is likely to positively inﬂuence neurological rehabilitation in the future.
[ARTICLE] The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials – Full Text
Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.
Cognition can be broadly defined as the actions of the brain involved in understanding and functioning in our external environment (Hirschfeld and Gelman, 1994). As it is generally accepted that cognition requires multiple mental processes, this broader concept has been theoretically separated into multiple ‘cognitive domains’ (Hirschfeld and Gelman, 1994). Although definitions vary, and the boundaries between domains often overlap, examples of distinct areas of cognitive functioning include the processes for learning and remembering verbal and spatial information, attentional capacities, response speed, problem-solving and planning (Strauss et al., 2006).
Various neuropsychological tests have been developed as tools for assessing and quantifying an individual’s overall cognitive functioning (or ‘global cognition’) along with their performance within the separable domains of cognition (Strauss et al., 2006). Performance in these various cognitive tests has been found to be relatively stable over time in healthy adults, and moderately accurate predictors of real-world functioning and occupational performance (Chaytor and Schmitter-Edgecombe, 2003 ; Hunter, 1986). Furthermore, neuropsychological tests can detect the deficits in cognitive functioning which arise as a consequence of various psychiatric and neurological diseases (Mathuranath et al., 2000 ; Nuechterlein et al., 2004). For example, people with Parkinson’s disease show marked impairments in planning and memory tasks (Dubois and Pillon, 1996), whereas those with schizophrenia have cognitive pervasive deficits, 1–2 standard deviations below population norms, which also predict the severity of disability in this population (Green et al., 2000). Additionally, cognitive abilities decline naturally in almost all people during healthy ageing (Van Hooren et al., 2007). In an ageing population, the functional consequences of cognitive decline may ultimately have a severe social and economic impact. Thus, interventions which improve cognition hold promise for the treatment of psychiatric and neurological diseases, an have positive implications for population health.
Fortunately, interventions which stimulate the brain and/or body can improve cognition, or attenuate decline. For instance, physical exercise has been shown to significantly improve global cognition, along with working memory and attentional processes, in both clinical and healthy populations (Firth et al., 2016; Smith et al., 2010 ; Zheng et al., 2016). Interventions can also be designed to target cognition directly, as computerized training programs for memory and other functions have been found to provide significant cognitive benefits, at least in the short term (Hill et al., 2017 ; Melby-Lervåg and Hulme, 2013). Furthermore, ‘gamification’ of cognitive training programs can maximize their clinical effectiveness, as more complex and interesting programs are capable of better engaging patients in cognitively-demanding tasks while also training multiple cognitive processes simultaneously (Anguera et al., 2013).
Previous studies have found that providing both aerobic exercise and cognitive training together may have additive effects, preventing ageing-related cognitive decline more effectively (Shatil, 2013). This may be due to aerobic and cognitive activity stimulating neurogenesis through independent but complementary pathways; as animal studies show that while exercise stimulates cell proliferation, learning tasks support the survival of these new cells (Kempermann et al., 2010), such that combining these two types of training results in 30% more new neurons than either task alone (Fabel et al., 2009).
Rather than delivering aerobic and cognitive training in separate training sessions, recent advances in technology has presented an opportunity for combining physical activity with cognitively-challenging tasks in a single session through ‘exergames’. Exergames are considered as interactive video-games which require the player to produce physical body movements in order to complete set tasks or actions, in response to visual cues (Oh and Yang, 2010). Common examples include the ‘Nintendo Wii’ (along with ‘Wii Fit’ or ‘Wii Sports software’) or the ‘Microsoft Xbox Kinect’. Additionally, virtual reality systems which use exercise bikes and/or treadmills as a medium for players to interact with three-dimensional worlds have also been developed to provide immersive training experiences (Sinclair et al., 2007).
Along with their popular usage for leisure and entertainment, there is growing interest in the application of exergame systems to improve clinical outcomes. Recent systematic reviews and meta-analyses of this growing literature have provided preliminary evidence that exergames can improve various health-related outcomes, including reducing childhood obesity, improving balance and falls risk factors in elderly adults, facilitating functional rehabilitation in people with parkinson’s disease, and even reduce depression (Barry et al., 2014; Li et al., 2016 ; van’t Riet et al., 2014). However, the effects of exergames on cognitive functioning have not been systematically reviewed, despite many individual studies in this area.
Therefore, the aim of this study was to systematically review all existing trials of exergames for cognition, and apply meta-analytic techniques to establish the effects of exergames on global cognition along with individual cognitive domains. We also sought to (i) examine the effects of exergames on cognition in healthy and clinically-impaired populations, and (ii) investigate if the effects of exergames differed from those of aerobic exercise alone, by comparing exergames to traditional physical activity control conditions.
[ARTICLE] New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments – Full Text
Figure 8. Different scenes while the volunteers were playing. (a) “The Paper-Bird”, (b) “The Ladder”, (c) “The Boat” and (d) “Whack-a-Mole”.
[ARTICLE] “FIND Technology”: investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial – Full Text HTML
Stroke results in significant disability, which can be reduced by physical rehabilitation. High levels of repetition and activity are required in rehabilitation, but patients are typically sedentary. Using clinically relevant and fun computer games may be one way to achieve increased activity in rehabilitation.
A single-blind randomized controlled trial will be conducted to evaluate the feasibility, efficacy and safety of novel stroke-specific rehabilitation software. This software uses controller-free client interaction and inertial motion sensors. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, enjoyment and ease of use of the games. Efficacy will be determined by measuring activity and using upper-limb tasks as well as measures of balance and mobility. The hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group will be tested.
Results from this study will provide a basis for discussion of feasibility of this interactive video technological solution in an inpatient situation. Differences in activity levels between groups will be the primary measure of efficacy. It will also provide data on measures of upper-limb function, balance and mobility.
In the US alone, one person per minute has a stroke, and although death rates have declined over the last decade, the burden of disease remains high . Physical rehabilitation has the potential to positively impact functional outcomes and improve this burden; however, this requires a high dose of therapy. A significant factor limiting rehabilitation outcomes is low levels of patient activity . Observational studies in different countries have found that patients after stroke in rehabilitation are surprisingly inactive for the vast majority of the waking day. For example, only 13 % of a stroke unit patient’s day is typically spent in activities related to functional outcome, such as active therapy or walking practice . Many rehabilitation activities, aimed at stimulating neuroplasticity, are by their very nature repetitive and tend to be tedious . One method by which engagement with rehabilitation programs and levels of activity could be improved involves the use of fun and engaging video games.
Commercial, off-the-shelf devices such as the Microsoft Xbox Kinect (Microsoft Corporation, Redmond, WA, USA) are relatively inexpensive and use motion capture and feedback technologies with potential for use in rehabilitation. Interactive video games increase adherence to and enjoyment of exercise in the general population  and have the potential to increase the dose of repetitive exercise completed by people with reduced mobility. Exercise-based video games could be used to increase exercise dose during therapy and to enable exercise outside of therapy hours. This is true both in inpatient and outpatient rehabilitation settings as well as at home after discharge from hospital.
In particular, the Kinect for Xbox 360, or simply Kinect, is a “controller-free gaming and entertainment experience” by Microsoft for the Xbox 360 video-game platform and is now also supported by PCs via Windows 8. It enables users to control and interact with the Xbox 360 without the need to touch a game controller, through a user interface using gestures and spoken commands. Kinect enables full-body depth-based three-dimensional motion-capture, facial recognition and voice recognition capabilities. This differentiates it from previous generations of interactive technologies that have been used in rehabilitation.
Despite the promise of such low-cost, consumer-based technologies, many, if not all, off-the-shelf video-game solutions are inappropriate for individuals with functional impairment . There is an opportunity for purpose-built, clinically relevant video game-based rehabilitation to add significant value to current rehabilitation practice. Jintronix, a Montreal-based company, has recently launched a Kinect-based rehabilitation system, Jintronix Rehabilitation System (JRS), which provides an easy-to-use software solution (JRS WAVE) for patients to use. The software solution has been designed in collaboration with physical and occupational therapists and draws upon the motor relearning recommendations by Carr and Shepard . As such, upper limb, sitting balance, standing balance and stepping rehabilitation tasks have been programmed in the JRS WAVE as fun and engaging video games that can be played at a number of different levels of complexity and speed. The system is also capable of automatically measuring changes in the range, speed and quality of motion to give patients instant feedback on their progress.
A second feature of the JRS WAVE is a cloud-based client management telehealth system for clinicians to recommend rehabilitation tasks and track and record performance of those tasks (JRS PORTAL). The PORTAL allows clinicians to provide patients regular updates and information on what has happened to them with daily, weekly or monthly progress reports on their rehabilitation, either face-to-face or remotely.
The proposed project will evaluate the feasibility, efficacy and safety of the JRS WAVE for use in an Australian stroke inpatient rehabilitation context. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, and enjoyment and ease of use of the games. Efficacy will be determined by measuring physical activity (using an accelerometer) and using upper-limb tasks as well as measuring changes in balance and mobility over time between the two groups. Adverse events will be monitored and changes in pain and fatigue with the interventions will be used to determine safety of the system. We will test the hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group.
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