[Abstract + References] Virtual reality and serious game therapy for post-stroke individuals: A preliminary study with humanized rehabilitation approach protocol

Abstract

Objective

The current study proposed the development and preliminary validation of a humanized training approach for upper limb rehabilitation of chronic post-stroke individuals, using serious game (SG) and virtual reality (VR) technologies.

Materials and methods

Ten individuals with chronic stroke participated in the study. Accompanied by a health professional, 15 sessions of the SG were performed in a laboratory, in a humanized way, lasting between 30 and 45 min each. The assessments were made pre- and post-intervention with the SG, and the following parameters were evaluated (considering the elbow joint): Modified Ashworth Scale (MAS), range of movement (ROM) and tonic stretch reflex threshold (TSRT). Global measures such as quality of life (QOL) were also assessed by the Stroke-Specific Quality of Life Scale (SSQL), Brunnstrom Recovery Scale (BRS) and General Health Questionnaire (GHQ-28). The following tests were applied to verify statistically significant differences: Shapiro-Wilk test, t-test, and Wilcoxon-Mann-Whitney test.

Results

The parameters ROM, TSRT, BRS, and SSQL showed statistically significant differences between pre- and post-intervention (p < 0.01). The ROM increase was about 8%. The objective evaluation of spasticity (provided by the TRST) showed an increase of 28% over the average pre- and post-intervention values. Three participants showed decreased resistance to passive stretching according to the results of the MAS, and seven participants moved to the next stage of the BRS. For QOL, the scores indicated around 20% of post-intervention improvement.

Conclusion

The intervention had no adverse effects, showed a high degree of compliance, provided increased ROM, improved QOL, reduced spasticity and allowed these individuals the opportunity to test a promising technology for upper limb rehabilitation with emphasis in humanized aspects of therapy.

References (37)

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• There are more references available in the full text version of this article.

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[Abstract] Hand and Fingertip Detection for Game-Based Hand Rehabilitation

Abstract

Hand rehabilitation is the process of recovering hand movements to return to normal. For rehabilitation to be effective, it is necessary for patients to practice repetitive movements. During the process, the patients usually feel bored, lack motivation and enjoyable time. There is a growing interest in building games for rehabilitation to make it more interesting and motivating for patients. However, the major obstacle is that the devices are expensive, and the patients must go to use them in hospitals. This paper focuses on designing and implementing hand rehabilitation software by using hand and fingertip detection. The purpose of the project is to make the rehabilitation process more accessible, enjoyable, affordable, and can be made portable for patients to use at home. Deep learning techniques were utilized to perform hand and fingertip detection. The SuperFox game is developed; the game is controlled by commands associated with hand and fingertip movements. The system was tested with 10 participants to evaluate effectiveness of the game controls. The results showed that the system is feasible in controlling the game and able to be used to create motivation and enjoyable time for patients.

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[Abstract] The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study.

Abstract

PURPOSE:

To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.

METHOD:

Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14-25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl-Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.

RESULTS:

Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p < 0.05 for all measures).

CONCLUSIONS:

Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability. Implications for rehabilitation To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation. Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment. Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

 

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[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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[ARTICLE] Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review – Full Text HTML

Abstract

Rehabilitation interventions involving virtual reality (VR) technology have been developed for the promotion of functional independence post stroke. A scoping review was performed to examine the efficacy of VR-based interventions on balance and mobility disorders post stroke.

Twenty-four articles in the English language examining VR game-based interventions and outcomes directed at balance and mobility disorders were included. Various VR systems (customized and commercially available) were used as rehabilitation tools. Outcome measures included laboratory and clinical measures of balance and gait. Outcome measures of dynamic balance showed significant improvements following VR-based interventions as compared to other interventions. Further, it was observed that VR-based intervention may have favorable effects in improving walking speed and the ability to deal with environmental challenges, which may also facilitate independent community ambulation.

VR-based therapy thus has the potential to be a useful tool for balance and gait training for stroke rehabilitation. Utilization of motor learning principles related to task-related training may have been an important factor leading to positive results. Other principles such as repetition, feedback etc. were used in studies but were not explored explicitly and may need to be investigated to further improve the strength of results.

Lastly, robust study designs with appropriate attention towards the intensity and dose-response aspects of VR training, clear study objectives and suitable outcomes would further aid in determining evidence-based efficacy for VR game-based interventions in the future.

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