Virtual Reality Games as an Adjunct in Improving Upper Limb Function and General Health among Stroke Survivors

Mohd Azzuan Ahmad, Devinder Kaur Ajit Singh, Nor Azlin Mohd Nordin, Khor Hooi Nee, Norliza Ibrahim, Mohd Azzuan Ahmad, Devinder Kaur Ajit Singh, Nor Azlin Mohd Nordin, Khor Hooi Nee, Norliza Ibrahim

Abstract

Virtual reality (VR) games has the potential to improve patient outcomes in stroke rehabilitation. However, there is limited information on VR games as an adjunct to standard physiotherapy in improving upper limb function. This study involved 36 participants in both experimental (n = 18) and control (n = 18) groups with a mean age (SD) of 57 (8.20) and 63 (10.54) years, respectively. Outcome measures were the Fugl-Meyer assessment for upper extremities (FMA-UE), Wolf motor function test (WMFT), intrinsic motivation inventory (IMI), Lawton of instrumental activities of daily living (IADL), and stroke impact scale (SIS) assessed at pre-post intervention. The experimental group had 0.5 h of upper limb (UL) VR games with 1.5 h of standard physiotherapy, and the control group received 2 h of standard physiotherapy. The intervention for both groups was performed once a week for eight consecutive weeks. The results showed a significant time-group interaction effect for IMI (p = 0.001), Lawton IADL (p = 0.01) and SIS domain of communication (p = 0.03). A significant time effect was found in FMA-UE (p = 0.001), WMFT (p = 0.001), Lawton IADL (p = 0.01), and SIS domains; strength, ADL and stroke recovery (p < 0.05). These results indicated an improvement in UL motor ability, sensory function, instrumental ADL, and quality of life in both groups after eight weeks of intervention. However, no significant (p > 0.05) group effect on all the outcome measures was demonstrated. Thus, replacing a portion of standard physiotherapy time with VR games was equally effective in improving UL function and general health compared to receiving only standard physiotherapy among stroke survivors.

Keywords: function; physiotherapy; stroke; upper limb; virtual reality games.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study with number of participants. FMA-UE, Fugl-Meyer assessment for upper extremities; WMFT, Wolf motor function test; IMI, intrinsic motivation inventory; IADL, instrumental activities of daily living; SIS, stroke impact scale; VR, virtual reality; SPSS, statistic product for statistical solutions.
Figure 2
Figure 2
Percentage of improvement for the outcome measures after eight weeks of intervention. FMA-UE, Fugl-Meyer assessment for upper extremities; WMFT, Wolf motor function test; IMI, intrinsic motivation inventory; IADL, instrumental activities of daily living; SIS, stroke impact scale.

References

    1. Feigin V.L., Norrving B., Mensah G.A. Global burden of stroke. Circ. Res. 2017;3:439–448. doi: 10.1161/CIRCRESAHA.116.308413.
    1. Ostwald S.K., Davis S., Hersch G., Kelley C., Godwin K.M. Evidence-based educational guidelines for stroke survivors after discharge home. J. Neurosci. Nurs. 2008;40:173–183. doi: 10.1097/01376517-200806000-00008.
    1. Nordin N.A.M., Aziz N.A., Aziz A.F.A., Singh D.K.A., Othman N.A.O., Sulong S., Aljinid S.M. Exploring views on long term rehabilitation for people with stroke in a developing country: Findings from focus group discussions. BMC Health Serv. Res. 2014;14:118. doi: 10.1186/1472-6963-14-118.
    1. Ward N.S., Kelly K., Brander F. The future of stroke rehabilitation: Upper limb recovery. Adv. Clin. Neurosci. Rehabil. 2015;15:6–9.
    1. Akinladejo F.O. Virtual environments in physical therapy. In: Cecilia S.L., editor. Virtual Reality and Environments. 1st ed. Volume 1. InTechOpen; London, UK: 2012. [(accessed on 12 March 2019)]. pp. 1–20. Available online: .
    1. Sveistrup H. Motor rehabilitation using virtual reality. J. Neuroeng. Rehabil. 2004;1:10–17. doi: 10.1186/1743-0003-1-10.
    1. International Society on Virtual Rehabilitation (ISVR) Virtual Reality Rehabilitation Newsletter 2014. [(accessed on 15 July 2018)]; Available online:
    1. Cheiloudaki E., Alexopoulos E.C. Adherence to Treatment in Stroke Patients. Int. J. Environ. Res. Public Health. 2019;16:196. doi: 10.3390/ijerph16020196.
    1. Singh D.K.A., Nordin N.A., Abd-Aziz N.A., Lim B.K., Soh L.C. Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. BMC Neurol. 2013;13:199–206. doi: 10.1186/1471-2377-13-199.
    1. Singh D.K.A., Rajaratnam B.S., Palaniswamy V., Raman V.P., Bong P.S., Pearson H. Effects of balance-focused interactive games compared to therapeutic balance classes for older women. Climacteric. 2013;16:141–147. doi: 10.3109/13697137.2012.664832.
    1. Singh D.K.A., Rajaratnam B.S., Palaniswamy V., Raman V.P., Bong P.S., Pearson H. Participating in a virtual reality balance exercise program can reduce risk and fear of falls. Maturitas. 2012;73:239–244. doi: 10.1016/j.maturitas.2012.07.011.
    1. Singh D.K.A., Ab-Rahman N.N.A., Rajiman S., Chang S.Y., Karim Z.A., Ruslan A.S., Rajwinder K.H.S. Impact of virtual reality games on psychological well-being and upper limb performance in adults with physical disabilities: A pilot study. Med. J. Malays. 2017;72:119–122.
    1. Hale L.A., Satherley J.A., McMillan N.J., Milosavljevic S., Hijmans J.M., King M.J. Participant perceptions of use of adapted CyWee Z as adjunct to rehabilitation of upper-limb function following stroke. J. Rehabil. Res. Dev. 2012;49:623–635. doi: 10.1682/JRRD.2001.04.0070.
    1. Hijmans J.M., Leigh A.H., Jessica A.S., Nicole J.M., Marcus J.K. Bilateral upper limb rehabilitation after stroke using a movement-based game controller. J. Rehabil. Res. Dev. 2011;48:1005–1015. doi: 10.1682/JRRD.2010.06.0109.
    1. Faul F., Erdfelder E., Lang A.G., Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods. 2007;39:175–191. doi: 10.3758/BF03193146.
    1. Fugl-Meyer A.R., Jaasko L., Leyman I., Olsson S., Steglind S. The post-stroke hemiplegic patient. A method for evaluation of physical performance. Scand. J. Rehabil. Med. 1975;7:13–22.
    1. Lin J.H., Hsueh I.P. Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients. Clin. Rehabil. 2004;18:391–398. doi: 10.1191/0269215504cr737oa.
    1. Sullivan K.J., Tilson J.K., Steven Y.C., Rose D.K., Hershberg J., Correa A., Gallichio J., McLeod M., Moore C., Wu S.S., et al. Fugl-Meyer Assessment of sensor motor function after stroke: Standardized training procedure for clinical practice and clinical trials. J. Am. Heart Assoc. 2011;42:427–433.
    1. Wolf S.L., Catlin P.A., Ellis M., Archer A.L., Morgan B., Piacentino A. Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke. J. Am. Heart Assoc. 2001;32:1632–1639. doi: 10.1161/01.STR.32.7.1635.
    1. Nijland R., Van-Wegen E., Verbunt J., Van-Wijk R., Van-Kordelaar J., Kwakkel G. A comparison of two validated tests for upper limb function after stroke: The Wolf Motor Function Test and the Action Research Arm Test. J. Rehabil. Med. 2010;42:694–697.
    1. Monteiro V., Mata L., Peixoto F. Intrinsic Motivation Inventory: Psychometric properties in the context of first language and mathematics learning. Psicol. Reflex. Crit. 2015;28:434–444. doi: 10.1590/1678-7153.201528302.
    1. Eow Y.L., Wan-Zah W.A., Roselan B., Rosnaini M. Stability of the Intrinsic Motivation Inventory (IMI) for the use of Malaysian form one students in ICT literacy class. Eurasia J. Math. Sci. Technol.Educ. 2010;6:215–227.
    1. Graf C. The Lawton Instrumental Activities Daily Living scale. Am. J. Nurs. 2008;108:52–63. doi: 10.1097/01.NAJ.0000314810.46029.74.
    1. Muldera M., Nijland R. Stroke Impact Scale. J. Physiother. 2016;62:117. doi: 10.1016/j.jphys.2016.02.002.
    1. Saposnik G., Teasell R., Muhammad M., Hall J., McLlroy W., Cheung D., Thorpe K.E., Cohen L.G., Bayley M. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: A pilot randomized clinical trial and proof of principle. J. Am. Heart Assoc. 2010;41:1477–1485. doi: 10.1161/STROKEAHA.110.584979.
    1. Levin M.F., Osnat S., Dario G.L., Harold W., Patrice L.W. Virtual reality versus conventional treatment of reaching ability in chronic stroke: Clinical feasibility study. Neurol. Ther. 2012;1:1. doi: 10.1007/s40120-012-0003-9.
    1. Rand D., Weiss P.L., Katz N. Training multitasking in a virtual supermarket: A novel intervention after stroke. Am. J. Occup. Ther. 2009;63:535–543. doi: 10.5014/ajot.63.5.535.
    1. Schuck S.O., Whetstone A., Hill V., Levine P., Page S.J. Game-based, portable, upper extremity rehabilitation in chronic stroke. Top. Stroke Rehabil. 2011;18:720–728. doi: 10.1310/tsr1806-720.
    1. Cameirao M.S., Bermudez I.B.S., Duartec E., Verschure P.F.M.J. Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: A randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system. Restor. Neurol. Neurosci. 2011;29:287–299.

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