Posts Tagged Wii

[BLOG POST] Incorporating the Wii into Occupational Therapy Treatment

This is guest post written by Grant Mitchell, author of TheOTpreneur.com. Grant currently works in Acute Rehab and completed his Master’s thesis on using the Wii as a rehab intervention. We are happy to have him on the My OT Spot blog!

Considering the rising cost of healthcare, consumer technology can often be an effective treatment modality that can double as a home exercise program. An example of consumer technology could include a Nintendo Wii + Sports which can be usually be purchased for less than $50. Given the lack of budget most every practitioner has to deal with, it’s a great opportunity to take advantage of low cost and high tech consumer products for rehabilitation.

Effective implementation of virtual reality (VR) as a treatment modality needs to be practical, accessible, and affordable to the client. The Nintendo Wii and Xbox Kinect are two examples of systems that demonstrate those traits comparatively to the high-end VR products that can cost upwards of $75,000.

Virtual reality can be used in variety of ways across settings. The Xbox Kinect and Nintendo Wii systems have different ways of engaging participants. While the Xbox Kinect doesn’t involve use of a controller, it is played by body motions alone. The Xbox Kinect is easier with a higher functioning population.

Conversely, the Wii system involves the use of a controller and includes games that can be modified to fit a variety of lower functioning populations both cognitively and physically. This article will address Wii use for the general physical disability population. Cognition is a component in the function of clients in the physical disability setting and so will be addressed.

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Benefits of Using the Wii in Treatment

One valuable aspect of incorporating this type of technology in therapy is that it is often a familiar technology to the general public. Its accessibility extends outside that of the clinical setting. The common household, including those in the low socioeconomic bracket, might have access to a Nintendo Wii.

Even adults that have not used a Wii before, can often recall family or friends who might have one or use one. Let’s not forget, video games can be fun! Adding fun can be an effective way to make activity purposeful and meaningful.

One benefit of engaging in a therapeutic activity such as the games found on Wii Sports, is the objective based movements so that patients are focused on moving the virtual character rather than thinking about left, right, up, and down. In this way, the client receives instant visual feedback of their performance as they guide the virtual character (Sparkes-Griffin, 2013).

Wii Sports Games to Incorporate into Treatment

Wii Sports is the most common game as it comes with most Wii consoles. Wii Sports comes with five games: boxing, bowling, tennis, golf, and baseball. The following is short description of the Wii Sports games and how you can incorporate them in treatment.

 

Boxing: This activity is a great strenuous upper extremity activity. Boxing is a go-to game with the Wii due to the level of endurance it facilitates. This game can be completed with either one upper extremity or can incorporate bilateral upper extremities for a greater coordination demand. This activity is one of the least cognitively demanding, involving a repetitive back and forth (punching) motion with no button pushing.

Bowling: The arm motion of this game is similar to that of the real life sport, however this activity can be done from almost any position. The motion does not stray far from the midline but does involve a two-button press and release component increasing the motor planning demand. This can be hard if hand function is minimal, but good if you want to incorporate fine motor and gross motor planning.

Tennis: This game involves no button pressing during game play, only to start and resume. However, tennis involves the most complex upper extremity arm movements of the 5 Wii sports games. Additionally, with either a computer or an opponent (dual play involves a split-screen and can involve family or friends if available), this game is a higher functioning game requiring the player to motor plan and swing the controller according to the direction of the virtual tennis ball.

Golf & Baseball: These two games are similar in that a minimal swinging motion is the primary physical demand to play. The movement can be accomplished with a good wrist flick, and generally requires a purposeful exaggerated real life swing to get therapeutic benefits. To get significant therapeutic benefit, these activities will often have to be modified to increase the challenge.

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Modifying the Games

Core Related: The Wii player is moved by the controller; therefore, the actual position of the client can vary. For impaired balance, the therapist can stand behind the client or have a chair available for when the client is fatigued. All games can be completed either standing or sitting. The common high-low mats in rehabilitation gyms provide a great platform for treatment while engaging in the Wii activity. Additionally, clients can participate while sitting on a balance board for a greater challenge.

Upper Extremity Related: Boxing is the only game in Wii sports that can involve both arms with two controllers. However, boxing does allow the option of playing with only one controller. For an added challenge, weights, such as Velcro wrist weights can be utilized to increase the resistance. It is important to note that due to the design of the game system, clients can “cheat” in terms of movement, meaning using little ROM and compensating arm movements with wrist movements. If you as the therapist want good movement, you may have to cue it as little feedback is provided by the Wii.

More on the Research Behind this Post

As a thesis project to complete the requirements of graduating with a Master’s in Occupational Therapy, my classmate Kyle Nelson and I (Grant Mitchell) collected literature surrounding the Wii and Xbox use in rehabilitation.

Our poster has been accepted for display at this coming year’s 2017 AOTA conference. This information is in the process of being made available as a free resource on an independent website. Until then, the Prezi presentation of the initial poster can be viewed describing this thesis project.

For additional questions, please don’t hesitate to email me at TheOTpreneur@gmail.com.

Resources

Emerging Niche: New Technology for Rehab

http://www.aota.org/Practice/Rehabilitation-Disability/Emerging-Niche/NewTech.aspx

Prezi Presentation: Use of VR in Rehab

https://prezi.com/botxz1nkctid/virtual-reality-an-evidence-based-guide-for-occupational-therapy/

Sparkes-Griffin, C. (2013, February 25). Wii-habilitation: Using the Wii as an Effective Intervention Tool for Seniors. OT Practice, p. 18.

via Incorporating the Wii into Occupational Therapy Treatment | myotspot.com

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[Abstract] A Longitudinal EMG Study of Complex Upper-limb Movements in Post-stroke Therapy: 2 Changes in Co-ordinated Muscle Activation

Fine motor control is achieved through the co-ordinated activation of groups of muscles, or ‘muscle synergies’. Muscle synergies change after stroke as a consequence of the motor deficit. We investigated the pattern and longitudinal changes in upper-limb muscle synergies during therapy in a largely unconstrained movement in patients with a broad spectrum of post-stroke residual voluntary motor capacity.Electromyography (EMG) was recorded using wireless telemetry from 6 muscles acting on the more-affected upper body in 24 stroke patients at early- and late-therapy during formal Wii-based Movement Therapy sessions, and in a subset of 13 patients at 6-month follow-up. Patients were classified with low, moderate or high motor-function. The Wii-baseball swing was analysed using a non-negative matrix factorisation (NMF) algorithm to extract muscle synergies from EMG recordings based on the temporal activation of each synergy and the contribution of each muscle to a synergy. Motor-function was clinically assessed immediately pre- and post-therapy and at 6-month follow-up using the Wolf Motor Function Test, upper-limb motor Fugl-Meyer Assessment and Motor Activity Log Quality of Movement scale.Clinical assessments and game performance demonstrated improved motor-function for all patients at post-therapy (p0.05). NMF analysis revealed fewer muscle synergies (mean±SE) for patients with low motor-function (3.38±0.2) than those with high motor-function (4.00±0.3) at early-therapy (p=0…

Source: A Longitudinal EMG Study of Complex Upper-limb Movements in Post-stroke Therapy: 2 Changes in Co-ordinated Muscle Activation

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[ARTICLE] Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline

Abstract

Purpose:

In this study, we investigated the effectiveness of a 12-week virtual reality exercise program using the Nintendo Wii console (Wii) in improving balance, emotion, and quality of life among patients with cognitive decline.

Methods:

The study included 30 patients with cognitive decline (12 female, 18 male) who were randomly assigned to an experimental (n=15) and control groups (n=15). All subjects performed a traditional cognitive rehabilitation program and the experimental group performed additional three 40-minute virtual reality based video game (Wii) sessions per week for 12 weeks. The berg balance scale (BBS) was used to assess balance abilities. The short form geriatric depression scale-Korean (GDS-K) and the Korean version of quality of life-Alzheimer’s disease (KQOL-AD) scale were both used to assess life quality in patients. Statistical significance was tested within and between groups before and after treatment, using Wilcoxon signed rank and Mann-Whitney u-tests.

Results:

After 36 training sessions, there were significant beneficial effects of the virtual reality game exercise on balance (BBS), GDS-K, and KQOL-AD in the experimental group when compared to the control group. No significant difference was observed within the control group.

Conclusion:

These findings demonstrate that a virtual reality-training program could improve the outcomes in terms of balance, depression, and quality of life in patients with cognitive decline. Long-term follow-ups and further studies of more efficient virtual reality training programs are needed.

INTRODUCTION

Dementia is a degenerative disease of the nervous system, which is prevalent in the elderly population. It involves deterioration in cognitive function and ability to perform everyday activities. As the early diagnosis and treatment of dementia is delayed, its economic costs and burden on families and society are gradually increasing and becoming a social problem.1 Older people with dementia have an increased risk of falls and lower levels of everyday activities being performed due to cognitive decline and decreased muscle mass. This is a result of reduced physical activity, which further deteriorates their quality of life.2 Therapeutic interventions to improve cognitive function and to increase activities of daily living (ADL) in patients with dementia are divided into pharmacological and non-pharmacological treatments. For pharmacological treatment, acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists are the most widely used in clinical practice.3 However, because pharmacological treatment alone cannot prevent the progression of cognitive decline and ADL deterioration in patients with dementia, various non-pharmacological treatments including cognitive therapy or physical exercise are used as additional treatments.4
Recent reports have stated that regular exercise was effective in delaying cognitive impairment in people with dementia.5 In a three-year follow-up study of healthy older people, a combination of cognitive activity and physical activity was found to be effective in reducing the risk for mild cognitive impairment.6 However, physical activity was found to be more important than cognitive activity in order to further reduce the risk for cognitive decline.6 When older people with dementia performed regular physical exercise, there was an improvement in the mini-mental state examination (MMSE) score.7 Physical exercise prevented the deterioration of ADL.8 The mechanism of the benefit of physical exercise on patients with dementia is thought to be that it can facilitate neuroplasticity, promote injury recovery mechanisms at a molecular level and facilitate self-healing of the brain through its neuroprotective effect.9
However, unless individuals perform exercise in the long run, such beneficial effects of exercise may wear off, leading to impaired brain function and worsened disease.10 Therefore, patients with dementia should continue exercise under the supervision of professional physical therapists in order to stop the progression of cognitive impairment for a long time. In order to achieve this, it is required to keep patients interested in the exercise therapy allowing them to maintain adherence. However, it is difficult to execute exercise treatment continuously in patients with dementia because of space, time, and cost issues in Korea. Patients get easily bored and tired of passive and simply repetitive forms of exercise treatment. In general, 20-50% of older people who start an exercise program will stop within six months.11 Patients with dementia are expected to be more likely to discontinue exercise program due to lowered levels of patience and self-regulation abilities. Therefore, exercise programs utilizing media, including games, attempt to keep patients interested in exercise programs and to improve therapeutic effects. With recent advances in scientific technologies and computer programs, exercise and rehabilitation interventions using virtual reality are being introduced in the medical field.12 Virtual reality refers to a computer-generated environment that allows users to have experiences similar to those in the real world. It is an interactive simulation characterized by technology that provides reality through various feedbacks.13 While performing predetermined tasks such as playing a game in virtual reality, users manipulate objects as if they were real and can control their movements by giving and receiving various feedbacks via numerous senses such as sight and hearing.14
The virtual reality-enhanced exercise consisting of exercise with computer-simulated environments and interactive videogame features allows patients to enjoy performing tasks, encourages competition, and creates motivation and interest in their treatment.15 Participation in a virtual reality-enhanced exercise was reported to lead to higher exercise frequency and intensity and enhanced health outcomes when compared with traditional exercise.16
However, despite these advantages, conventional virtual reality systems could not be widely available for patients in clinical settings due to several limitations including high costs and a large size.17 Therefore, it is necessary to develop virtual reality exercise programs that are easy to follow in hospitals and at home. As an alternative, the use of computer-based individual training programmes is becoming increasingly popular due to the low cost, independence and ease of use in the home. One such system that is increasing in popularity for use in exercise training is the Nintendo Wii (Wii; Nintendo Inc., Kyoto, Japan) personal game, which became commercially available. Wii is a video gaming console with a simple method, as its virtual reality system is implemented via a television monitor. It combine physical exercise with computer-simulated environments and interactive videogame features. Because the Wii console is inexpensive and small in size, it is easy to install or move it in hospitals or at home. This gaming console is designed to be controlled using a wireless controller, allowing user to interact with his/her own avatar, which is displayed on the screen through a movement sensing system. The controller is provided with an acceleration sensor that responds to acceleration changes recognizing direction and velocity changes.18 Wii-balance board is being used when playing a Wii Fit game. It is a force plate collecting movement information in the center of pressure of the standing user, enabling reflection of movements in a virtual environment on the monitor and thus constantly resending visual feedback to the user. Through this process, the user can adjust his/her postural responses. Studies have shown that the Wii balance board can be helpful in postural control training.19 Because Wii is a typical example of virtual reality applications and is simple, inexpensive, and easily accessible, Wii is expected to create interest among patients encouraging them to put more efforts in exercise via games and thus augmenting effects of the treatment.
Domestic studies on the use of Wii have reported its effects on the upper extremity function, visual perception and sense of balance in chronic stroke patients,20 spinal cord injury patients,21 Parkinson’s disease patients,22 and multiple sclerosis patients.23 However, there have been only a few controlled research studies about the effects of Wii on patients with cognitive decline. The present study aimed to analyze effects of virtual reality exercise program on balance function, emotions, and quality of life (QOL) in patients with cognitive decline.

Continue —> Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline – ScienceCentral

 

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Figure 1 The level of satisfaction about Wii game for dementia patients (Number=%).

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[Abstract] Gaming-based virtual reality therapy for the rehabilitation of upper extremity function after stroke.

Abstract

Objective To investigate the effects of playing virtual reality games on the recovery of hemiplegic upper extremities after stroke.

Methods Thirty stroke patients with hemiplegic upper extremities were randomly assigned to a treatment group (n=15) or a control group (n=15).Both groups received routine medication and conventional physical therapy,while the treatment group was additionally given (Nintendo) gaming-based virtual reality therapy.Before and after 2 weeks of treatment,the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities (FMA-UE),Brunnstrom staging and co-contraction ratios (CRs).Surface electromyogram signals from the biceps brachii and triceps brachii were also recorded during maximum isometric voluntary flexion and extension of the affected elbow.

Results No significant differences in any of the measurements were observed between the 2 groups before or after the intervention.Both groups demonstrated significant increases in their average FMA-UE score,Brunnstrom staging and CRs.

Conclusions Virtual reality gaming using a Wii controller is as effective as conventional therapy in enhancing upper extremity motor function and elbow flexion and extension after stroke.

Source: Gaming-based virtual reality therapy for the rehabilitation of upper extremity function after stroke | BVS Violência e Saúde

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[Abstract] Exergaming for individuals with neurological disability: a systematic review – Disability and Rehabilitation –

Abstract

Introduction: Exergames have the potential to enable persons with disabilities to take part in physical activities that are of appropriate “dose-potency” and enjoyable within a relatively safe home environment. It overcomes some of the challenges regarding transportation difficulties in getting to commercial gymnasium facilities, reducing physical activities perceived as “boring” or getting access into the built environment that may be “wheelchair unfriendly”. Objective: This systematic review assessed available evidence whether “exergaming” could be a feasible modality for contributing to a recommended exercise prescription according to current ACSM™ or WHO guidelines for physical activity.Methods: Strategies used to search for published articles were conducted using separate search engines (Google Scholar™, PubMed™ and Web of Science™) on cardiometabolic responses and perceived exertion during exergaming among neurologically-disabled populations possessing similar physical disabilities. Each study was categorized using the SCIRE-Pedro evidence scale. Results: Ten of the 144 articles assessed were identified and met specific inclusion criteria. Key outcome measures included responses, such as energy expenditure, heart rate and perceived exertion. Twelve out of the 17 types of exergaming interventions met the ACSM™ or WHO recommendations of “moderate intensity” physical activity. Exergames such as Wii Jogging, Bicycling, Boxing, DDR and GameCycle reported moderate physical activity intensities. While Wii Snowboarding, Skiing and Bowling only produced light intensities. Conclusion: Preliminary cross-sectional evidence in this review suggested that exergames have the potential to provide moderate intensity physical activity as recommended by ACSM™ or WHO in populations with neurological disabilities. However, more research is needed to document exergaming’s efficacy from longitudinal observations before definitive conclusions can be drawn.

  • Implications for Rehabilitation

  • Exergaming can be deployed as physical activity or exercise using commercially available game consoles for neurologically disabled individuals in the convenience of their home environment and at a relatively inexpensive cost

  • Moderate-to-vigorous intensity exercises can be achieved during exergaming in this population of persons with neurological disabilities. Exergaming can also be engaging and enjoyable, yet achieve the recommended physical activity guidelines proposed by ACSM™ or WHO for health and fitness benefits.

  • Exergaming as physical activity in this population is feasible for individuals with profound disabilities, since it can be used even in sitting position for wheelchair-dependent users, thus providing variability in terms of exercise options.

  • In the context of comprehensive rehabilitation, exergaming should be viewed by the clinician as “at least as good as” (and likely more enjoyable) than traditional arm-exercise modalities, with equivalent aerobic dose-potency as “traditional” exercise in clinic or home environments.

Related articles

View all related articles

Source: Exergaming for individuals with neurological disability: a systematic review – Disability and Rehabilitation –

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[VIDEO] Wii-based Movement Therapy for stroke rehabilitation

Uploaded on Feb 2, 2012

Neuroscience Research Australia’s Dr Penelope McNulty is using Wii-based movement therapy to help those living with stroke related disabilities regain use of their affected limbs.

The focus of Neuroscience Research Australia, or NeuRA, has always been on neuroscience. We conduct clinical and laboratory research into neurological, psychiatric and psychological disorders.

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[ARTICLE] The effects of game-based virtual reality movement therapy plus mental practice on upper extremity function in chronic stroke patients with hemiparesis: a randomized controlled trial – Full Text PDF

[Purpose] The purpose of this study was to investigate the effects of game-based virtual reality movement therapy plus mental practice on upper extremity function in chronic stroke patients with hemiparesis.

[Subjects] The subjects were chronic stroke patients with hemiparesis.

[Methods] Thirty subjects were randomly assigned to either the control group or experimental group. All subjects received 20 sessions (5 days in a week) of virtual reality movement therapy using the Nintendo Wii. In addition to Wii-based virtual reality movement therapy, experimental group subjects performed mental practice consisting of 5 minutes of relaxation, Wii games imagination, and normalization phases before the beginning of Wii games. To compare the two groups, the upper extremity subtest of the Fugl-Meyer Assessment, Box and Block Test, and quality of movement subscale of the Motor Activity Log were performed.

[Results] Both groups showed statistically significant improvement in the Fugl-Meyer Assessment, Box and Block Test, and quality of the movement subscale of Motor Activity Log after the interventions. Also, there were significant differences in the Fugl-Meyer Assessment, Box and Block Test, and quality of movement subscale of the Motor Activity Log between the two groups.

[Conclusion] Game-based virtual reality movement therapy alone may be helpful to improve functional recovery of the upper extremity, but the addition of MP produces a lager improvement.

Download —> Full Text PDF [567K]

Source: The effects of game-based virtual reality movement therapy plus mental practice on upper extremity function in chronic stroke patients with hemiparesis: a randomized controlled trial

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[Abstract] Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy.

Introduction: Post-stroke cardiovascular fitness is typically half that of healthy age-matched people. Cardiovascular deconditioning is a risk factor for recurrent stroke that may be overlooked during routine rehabilitation. This study investigated the cardiovascular responses of two upper limb rehabilitation protocols.

Methods: Forty-six stroke patients completed a dose-matched program of Wii-based Movement Therapy (WMT) or modified Constraint-induced Movement Therapy (mCIMT). Heart rate and stepping were recorded during early (day 2)- and late (day 12–14)-therapy. Pre- and post-therapy motor assessments included the Wolf Motor Function Test and 6-min walk.

Results: Upper limb motor function improved for both groups after therapy (WMT p = 0.003, mCIMTp = 0.04). Relative peak heart rate increased from early- to late-therapy WMT by 33% (p < 0.001) and heart rate recovery (HRR) time was 40% faster (p = 0.04). Peak heart rate was higher and HRR faster during mCIMT than WMT, but neither measure changed during mCIMT. Stepping increased by 88% during Wii-tennis (p < 0.001) and 21% during Wii-boxing (p = 0.045) while mCIMT activities were predominantly sedentary. Six-min walk distances increased by 8% (p = 0.001) and 4% (p = 0.02) for WMT and mCIMT, respectively.

Discussion: Cardiovascular benefits were evident after WMT as both a cardiovascular challenge and improved cardiovascular fitness. The peak heart rate gradient across WMT activities suggests this therapy can be further individualized to address cardiovascular needs. The mCIMT data suggest a cardiovascular stress response.

Conclusions: This is the first study to demonstrate a cardiovascular benefit during specifically targeted upper limb rehabilitation. Thus, WMT not only improves upper limb motor function but also improves cardiovascular fitness.

Source: Maney Online – Maney Publishing

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[Abstract] The efficacy of Wii-based Movement Therapy for upper limb rehabilitation in the chronic poststroke period: a randomized controlled trial

Background: More effective and efficient rehabilitation is urgently needed to address the prevalence of unmet rehabilitation needs after stroke. This study compared the efficacy of two poststroke upper limb therapy protocols.

Aims and/or hypothesis: We tested the hypothesis that Wii-based movement therapy would be as effective as modified constraint-induced movement therapy for post-stroke upper-limb motor rehabilitation.

Methods: Forty-one patients, 2–46 months poststroke, completed a 14-day program of Wii-based Movement Therapy or modified Constraint-induced Movement Therapy in a dose-matched, assessor-blinded randomized controlled trial, conducted in a research institute or patient’s homes. Primary outcome measures were the Wolf Motor Function Test timed-tasks and Motor Activity Log Quality of Movement scale. Patients were assessed at prebaseline (14 days pretherapy), baseline, post-therapy, and six-month follow-up. Data were analyzed using linear mixed models and repeated measures analysis of variance.

Results: There were no differences between groups for either primary outcome at any time point. Motor function was stable between prebaseline and baseline (P > 0·05), improved with therapy (P  0·05). Wolf Motor Function Test timed-tasks log times improved from 2·1 ± 0·22 to 1·7 ± 0·22 s after Wii-based Movement Therapy, and 2·6 ± 0·23 to 2·3 ± 0·24 s after modified Constraint-induced Movement Therapy. Motor Activity Log Quality of Movement scale scores improved from 67·7 ± 6·07 to 102·4 ± 6·48 after Wii-based Movement Therapy and 64·1 ± 7·30 to 93·0 ± 5·95 after modified Constraint-induced Movement Therapy (mean ± standard error of the mean). Patient preference, acceptance, and continued engagement were higher for Wii-based Movement Therapy than modified Constraint-induced Movement Therapy.

Conclusions: This study demonstrates that Wii-based Movement Therapy is an effective upper limb rehabilitation poststroke with high patient compliance. It is as effective as modified Constraint-induced Movement Therapy for improving more affected upper limb movement and increased independence in activities of daily living.

Source: The efficacy of Wii-based Movement Therapy for upper limb rehabilitation in the chronic poststroke period: a randomized controlled trial – McNulty – 2015 – International Journal of Stroke – Wiley Online Library

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[ARTICLE] Effectiveness of Virtual Reality Game on Functional Movement and Activities of Daily Living in Hemiparetic Stroke Patients.

Abstract:

Independent activities of daily living (ADLs) performance are recognized as a major goal of stroke rehabilitation. Recently, virtual reality training using a video game is considered as an effective approach to improve functional activity of stroke patients.

The purpose of this study is to investigate the effects of virtual reality game using a wii fit balance board on functional movement and ADLs of hemiparetic stroke patients.

20 subjects were randomly allocated into two groups: the virtual reality game training (n = 10) and control groups (n = 10). Both groups participated in standard rehabilitation program for 6 weeks. In addition, virtual reality game training group participated in virtual reality game training for 30 minutes per day, 3 times a week, for 6 weeks.

Virtual reality game training program consisted of balance bubble, ski slalom, ski jump, soccer heading, table tiling, and the penguin slide was conducted with the Wii-Fit balance board. After 6 weeks virtual reality game training, significant improvement observed in functional movement and ADL performance in the virtual reality game training group compared to the control group.

Findings of this study demonstrated that the virtual reality game training has an effective on functional movement and ADL performance in hemiparetic stroke patients when added to standard rehabilitation.

Source: Effectiveness of Virtual Reality Game on Functional Movement and …: ingentaconnect

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