Clinical feasibility of interactive motion-controlled games for stroke rehabilitation

Kelly J Bower, Julie Louie, Yoseph Landesrocha, Paul Seedy, Alexandra Gorelik, Julie Bernhardt, Kelly J Bower, Julie Louie, Yoseph Landesrocha, Paul Seedy, Alexandra Gorelik, Julie Bernhardt

Abstract

Background: Active gaming technologies, including the Nintendo Wii and Xbox Kinect, have become increasingly popular for use in stroke rehabilitation. However, these systems are not specifically designed for this purpose and have limitations. The aim of this study was to investigate the feasibility of using a suite of motion-controlled games in individuals with stroke undergoing rehabilitation.

Methods: Four games, which utilised a depth-sensing camera (PrimeSense), were developed and tested. The games could be played in a seated or standing position. Three games were controlled by movement of the torso and one by upper limb movement. Phase 1 involved consecutive recruitment of 40 individuals with stroke who were able to sit unsupported. Participants were randomly assigned to trial one game during a single session. Sixteen individuals from Phase 1 were recruited to Phase 2. These participants were randomly assigned to an intervention or control group. Intervention participants performed an additional eight sessions over four weeks using all four game activities. Feasibility was assessed by examining recruitment, adherence, acceptability and safety in both phases of the study.

Results: Forty individuals (mean age 63 years) completed Phase 1, with an average session time of 34 min. The majority of Phase 1 participants reported the session to be enjoyable (93 %), helpful (80 %) and something they would like to include in their therapy (88 %). Sixteen individuals (mean age 61 years) took part in Phase 2, with an average of seven 26-min sessions over four weeks. Reported acceptability was high for the intervention group and improvements over time were seen in several functional outcome measures. There were no serious adverse safety events reported in either phase of the study; however, a number of participants reported minor increases in pain.

Conclusions: A post-stroke intervention using interactive motion-controlled games shows promise as a feasible and potentially effective treatment approach. This paper presents important recommendations for future game development and research to further explore long-term adherence, acceptability, safety and efficacy.

Trial registration: Australian and New Zealand Clinical Trials Registry ( ACTRN12613000220763 ).

Figures

Fig. 1
Fig. 1
Screen shots of the four game activities. Legend:a. Ball Maze b. Fridge Frenzy c. Tentacle Dash d. Bubble Fish
Fig. 2
Fig. 2
Study flow diagram

References

    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2013;383:245–55.
    1. Michael KM, Allen JK, MacKo RF. Reduced ambulatory activity after stroke: The role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil. 2005;86:1552–1556. doi: 10.1016/j.apmr.2004.12.026.
    1. Tyson SF, Hanley M, Chillala J, Selley A, Tallis RC. Balance disability after stroke. Phys Ther. 2006;86:30–38.
    1. Kwakkel G, Kollen BJ, Van der Grond JV, Prevo AJH. Probability of regaining dexterity in the flaccid upper limb: Impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34:2181–2186. doi: 10.1161/.
    1. Sturm JW, Dewey HM, Donnan GA, Macdonell RAL, McNeil JJ, Thrift AG. Handicap after stroke: How does it relate to disability, perception of recovery, and stroke subtype? The North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2002;33:762–8.
    1. Batchelor FA, Mackintosh SF, Said CM, Hill KD. Falls after stroke. Int J Stroke. 2012;7:482–490.
    1. Veerbeek JM, Van Wegen E, Van Peppen R, Van Der Wees PJ, Hendriks E, Rietberg M, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One. 2014;9(2):e87987.
    1. Van Peppen RPS, Kwakkel G, Wood-Dauphinee S, Hendriks HJM, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: What’s the evidence? Clin Rehabil. 2004;18:833–62.
    1. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693–1702. doi: 10.1016/S0140-6736(11)60325-5.
    1. West T, Bernhardt J. Physical activity in hospitalised stroke patients. Stroke Res Treat. 2012;2012:813765.
    1. Thomson K, Pollock A, Bugge C, Brady M. Commercial gaming devices for stroke upper limb rehabilitation: A systematic review. Int J Stroke. 2014;9:479–488. doi: 10.1111/ijs.12263.
    1. Sin H, Lee G. Additional virtual reality training using Xbox Kinect in stroke survivors with hemiplegia. Am J Phys Med Rehabil. 2013;92:871–880. doi: 10.1097/PHM.0b013e3182a38e40.
    1. Peters DM, McPherson AK, Fletcher B, McClenaghan BA, Fritz SL. Counting repetitions: An observational study of video game play in people with chronic poststroke hemiparesis. J Neurol Phys Ther. 2013;37:105–111. doi: 10.1097/NPT.0b013e31829ee9bc.
    1. Celinder D, Peoples H. Stroke patients’ experiences with Wii Sports® during inpatient rehabilitation. Scand J Occup Ther. 2012;19:457–463. doi: 10.3109/11038128.2012.655307.
    1. van Vliet P, Wulf G. Extrinsic feedback for motor learning after stroke: What is the evidence? Disabil Rehabil. 2006;28:831–840. doi: 10.1080/09638280500534937.
    1. Saposnik G, Teasell R, Mamdani M, Hall J, McIlroy W, Cheung D, et al. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: A pilot randomized clinical trial and proof of principle. Stroke. 2010;41:1477–84.
    1. Joo LY, Yin TS, Xu D, Thia E, Chia PF, Kuah CWK, et al. A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. J Rehabil Med. 2010;42:437–41.
    1. Bower KJ, Clark RA, McGinley JL, Martin CL, Miller KJ. Clinical feasibility of the Nintendo Wii for balance training post-stroke: A phase II randomized controlled trial in an inpatient setting. Clin Rehabil. 2014;28:912–923. doi: 10.1177/0269215514527597.
    1. Morone G, Tramontano M, Iosa M, Shofany J, Iemma A, Musicco M, et al. The efficacy of balance training with video game-based therapy in subacute stroke patients: A randomized controlled trial. Biomed Res Int. 2014;2014:580861.
    1. Pompeu JE, Arduini LA, Botelho AR, Fonseca MBF, Pompeu SMAA, Torriani-Pasin C, et al. Feasibility, safety and outcomes of playing Kinect Adventures!™ for people with Parkinson’s disease: A pilot study. Physiotherapy. 2014;100:162–8.
    1. Gutiérrez RO, Galán Del Río F, De La Cuerda RC, Alguacil Diego IM, González RA, Page JCM. A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients. NeuroRehabilitation. 2013;33:545–54.
    1. Lange B, Flynn S, Rizzo A. Initial usability assessment of off-the-shelf video game consoles for clinical game-based motor rehabilitation. Phys Ther Rev. 2009;14:355–363. doi: 10.1179/108331909X12488667117258.
    1. Barry G, Galna B, Rochester L. The role of exergaming in Parkinson’s disease rehabilitation: A systematic review of the evidence. J Neuroeng Rehabil. 2014;11:33. doi: 10.1186/1743-0003-11-33.
    1. Putnam C, Cheng J, Seymour G. Therapist perspectives: Wii active videogames use in inpatient settings with people who have had a brain injury. Games Health J. 2014;3:366–370. doi: 10.1089/g4h.2013.0099.
    1. Forsberg A, Nilsagård Y, Boström K. Perceptions of using videogames in rehabilitation: A dual perspective of people with multiple sclerosis and physiotherapists. Disabil Rehabil. 2015;37:338–344. doi: 10.3109/09638288.2014.918196.
    1. Tatla SK, Shirzad N, Lohse KR, Virji-Babul N, Hoens AM, Holsti L, et al. Therapists’ perceptions of social media and video game technologies in upper limb rehabilitation. JMIR Serious Games. 2015;3(1):e2. doi:10.2196/games.3401
    1. Gil-Gómez JA, Lloréns R, Alcañiz M, Colomer C. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. J Neuroeng Rehabil. 2011;8:30. doi: 10.1186/1743-0003-8-30.
    1. Galna B, Jackson D, Schofield G, McNaney R, Webster M, Barry G, et al. Retraining function in people with Parkinson’s disease using the Microsoft kinect: Game design and pilot testing. J Neuroeng Rehabil. 2014;11:60.
    1. Lange B, Flynn S, Proffitt R, Chang CY, Rizzo A. Development of an interactive game-based rehabilitation tool for dynamic balance training. Top Stroke Rehabil. 2010;17:345–352. doi: 10.1310/tsr1705-345.
    1. Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Phys Ther. 1985;65:175–180.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Wallace D, Duncan PW, Lai SM. Comparison of the responsiveness of the Barthel Index and the Motor Component of the Functional Independence Measure in stroke: The impact of using different methods for measuring responsiveness. J Clin Epidemiol. 2002;55:922–928. doi: 10.1016/S0895-4356(02)00410-9.
    1. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: A new clinical measure of balance. J Gerontol. 1990;45:M192–M197. doi: 10.1093/geronj/45.6.M192.
    1. Likert R. Chapter 19: The Method of Constructing an Attitude Scale. In: Maranell GM, editor. Scaling: A Sourcebook for Behavioural Scientists. New Brunswick, NJ, USA: Transaction Publishers; 1974.
    1. Tseng BY, Gajewski BJ, Kluding PM. Reliability, responsiveness, and validity of the visual analog fatigue scale to measure exertion fatigue in people with chronic stroke: A preliminary study. Stroke Res Treat. 2010; doi:10.4061/2010/412964
    1. Benaim C, Froger J, Cazottes C, Gueben D, Porte M, Desnuelle C, et al. Use of the Faces Pain Scale by left and right hemispheric stroke patients. Pain. 2007;128:52–8.
    1. Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–381.
    1. Hill KD, Bernhardt J, McGann AM, Maltese D, Berkovits D. A new test of dynamic standing balance for stroke patients: Reliability, validity and comparison with healthy elderly. Physiother Can. 1996;48:257–262. doi: 10.3138/ptc.48.4.257.
    1. Kosak M, Smith T. Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. J Rehabil Res Dev. 2005;42:103–108.
    1. Mouawad MR, Doust CG, Max MD, McNulty PA. Wii-based movement therapy to promote improved upper extremity function post-stroke: A pilot study. J Rehabil Med. 2011;43:527–533. doi: 10.2340/16501977-0816.
    1. Lange B, Chang CY, Suma E, Newman B, Rizzo AS, Bolas M. Development and evaluation of low cost game-based balance rehabilitation tool using the Microsoft Kinect sensor. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:1831–4.
    1. Hansen AP, Marcussen NS, Klit H, Andersen G, Finnerup NB, Jensen TS. Pain following stroke: A prospective study. Eur J Pain. 2012;16:1128–36.
    1. Malloy KM, Milling LS. The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin Psychol Rev. 2010;30:1011–1018. doi: 10.1016/j.cpr.2010.07.001.
    1. Lohse KR, Sherwood DE. Defining the focus of attention: Effects of attention on perceived exertion and fatigue. Front Psychol. 2011;2:332. doi: 10.3389/fpsyg.2011.00332.
    1. Kwakkel G, Van Peppen R, Wagenaar RC, Dauphinee SW, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: A meta-analysis. Stroke. 2004;35:2529–36.
    1. Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The Trunk Impairment Scale: A new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18:326–34.
    1. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232–240. doi: 10.1177/154596802401105171.
    1. Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: The Postural Assessment Scale for Stroke patients (PASS) Stroke. 1999;30:1862–1868. doi: 10.1161/01.STR.30.9.1862.
    1. Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke. Stroke. 2001;32:1635–9.

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