The Effects of Exergame on Postural Control in Individuals with Ataxia: a Rater-Blinded, Randomized Controlled, Cross-over Study

Ender Ayvat, Özge Onursal Kılınç, Fatma Ayvat, Cevher Savcun Demirci, Sibel Aksu Yıldırım, Oğuzhan Kurşun, Muhammed Kılınç, Ender Ayvat, Özge Onursal Kılınç, Fatma Ayvat, Cevher Savcun Demirci, Sibel Aksu Yıldırım, Oğuzhan Kurşun, Muhammed Kılınç

Abstract

Exergame trainings might have therapeutic value in ataxic patients. The aim of this study was to investigate the effect of exergame training with an exercise program on postural control by comparing it with traditional balance and coordination exercise program. Nineteen patients were randomly allocated to two groups. In the first group, exergame training and an exercise program (EEP) were applied together for the first 8 weeks; after 10 weeks washout, a conventional exercise program (CEP) was applied for the second 8 weeks. In the second group, the CEP was applied first followed by the EEP. Outcome measures were Limits of Stability test (LoS), International Classification Ataxia Ratio Scale (ICARS), Berg Balance Scale (BBS), and Timed-Up and Go test with a cognitive task (TUG-C), Reactive postural control and sensory orientation subscales of the Mini-BESTest. Seventeen patients (mean age ± SD, 32.53 ± 11.07 years) completed the study. ICARS, BBS scores improved only after EEP (p < 0.05). While there was no change in the RT and MVL parameters of the LoS test after EEP, the MXE, EPE, and DCL parameters improved significantly (p < 0.05). The MXE and MVL parameters of LoS improved after CEP (p < 0.05). There were no significant improvements in the Mini-BESTest's reactive postural control and sensory orientation subscale scores after both EEP and CEP (p > 0.05). The results of the present study demonstrated that exergame training can be used as a complementary training option in physiotherapy to improve postural control in patients with ataxia. ClinicalTrial.gov Identifier: NCT03607058.

Keywords: Ataxia; Exercise therapy; Exergames; Postural control; Rehabilitation; Virtual reality.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Fig. 1
Fig. 1
Flow chart of the study

References

    1. Kandel ER, Schwartz JH, Jessell TM, Siegelbaum S, Hudspeth AJ, Mack S. Principles of neural science (4th Edition): McGraw-hill New York; 2000.
    1. Mariotti C, Fancellu R, Di Donato S. An overview of the patient with ataxia. J Neurol. 2005;252(5):511–518. doi: 10.1007/s00415-005-0814-z.
    1. Soong B-W, Paulson HL. Spinocerebellar ataxias: an update. Curr Opin Neurol. 2007;20(4):438–46. doi: 10.1097/WCO.0b013e3281fbd3dd.
    1. Zesiewicz TA, Wilmot G, Kuo S-H, Perlman S, Greenstein PE, Ying SH, et al. Comprehensive systematic review summary: treatment of cerebellar motor dysfunction and ataxia: report of the Guideline development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(10):464–471. doi: 10.1212/WNL.0000000000005055.
    1. Marquer A, Barbieri G, Pérennou D. The assessment and treatment of postural disorders in cerebellar ataxia: a systematic review. Ann Phys Rehabil Med. 2014;57(2):67–78. doi: 10.1016/j.rehab.2014.01.002.
    1. Ilg W, Synofzik M, Brötz D, Burkard S, Giese M, Schöls L. Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology. 2009;73(22):1823–1830. doi: 10.1212/WNL.0b013e3181c33adf.
    1. Omiyale O, Crowell CR, Madhavan S. Effect of Wii-based balance training on corticomotor excitability post stroke. J Mot Behav. 2015;47(3):190–200. doi: 10.1080/00222895.2014.971699.
    1. Chang Y-J, Chen S-F, Huang J-D. A Kinect-based system for physical rehabilitation: a pilot study for young adults with motor disabilities. Res Dev Disabil. 2011;32(6):2566–2570. doi: 10.1016/j.ridd.2011.07.002.
    1. Cho KH, Lee KJ, Song CH. Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. Tohoku J Exp Medi. 2012;228(1):69–74. doi: 10.1620/tjem.228.69.
    1. Baram Y, Miller A. Virtual reality cues for improvement of gait in patients with multiple sclerosis. Neurology. 2006;66(2):178–181. doi: 10.1212/01.wnl.0000194255.82542.6b.
    1. Bonnechère B, Jansen B, Omelina L, Van Sint JS. The use of commercial video games in rehabilitation: a systematic review. Int J Rehabil Res. 2016;39(4):277–290. doi: 10.1097/MRR.0000000000000190.
    1. Synofzik M, Ilg W. Motor training in degenerative spinocerebellar disease: ataxia-specific improvements by intensive physiotherapy and exergames. BioMed Res Int. 2014;2014:583507. doi: 10.1155/2014/583507.
    1. He M, Zhang H-n, Tang Z-c, Gao S-g. Balance and coordination training for patients with genetic degenerative ataxia: a systematic review. J Neurol. 2020:1–16. [published online ahead of print, 2020 Jun 24].
    1. Ilg W, Schatton C, Schicks J, Giese MA, Schöls L, Synofzik M. Video game–based coordinative training improves ataxia in children with degenerative ataxia. Neurology. 2012;79(20):2056–2060. doi: 10.1212/WNL.0b013e3182749e67.
    1. Santos G, Zeigelboim DBS, Severiano M, Teive H, Liberalesso P, Marques J, et al. Feasibility of virtual reality-based balance rehabilitation in adults with spinocerebellar ataxia: a prospective observational study. Hear Balance Commun. 2017;15(4):244–251. doi: 10.1080/21695717.2017.1381490.
    1. Schatton C, Synofzik M, Fleszar Z, Giese MA, Schöls L, Ilg W. Individualized exergame training improves postural control in advanced degenerative spinocerebellar ataxia: a rater-blinded, intra-individually controlled trial. Parkinsonism Relat D. 2017;39:80–84. doi: 10.1016/j.parkreldis.2017.03.016.
    1. Molloy DW, Standish TI. A guide to the standardized Mini-Mental State Examination. Int Psychogeriatr. 1997;9(S1):87–94. doi: 10.1017/S1041610297004754.
    1. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurology. 1983;33(11):1444–1452. doi: 10.1212/WNL.33.11.1444.
    1. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006;35(suppl_2):ii7–ii11. doi: 10.1093/ageing/afl077.
    1. Trouillas P, Takayanagi T, Hallett M, Currier R, Subramony S, Wessel K, et al. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. J Neurol Sci. 1997;145(2):205–211. doi: 10.1016/S0022-510X(96)00231-6.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehab. 1992;73(11):1073–1080.
    1. Clark S, Rose DJ, Fujimoto K. Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults. Arch Phys Med Rehab. 1997;78(10):1078–1084. doi: 10.1016/S0003-9993(97)90131-3.
    1. Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med. 2010;42(4):323–331. doi: 10.2340/16501977-0537.
    1. Wang R-Y, Huang F-Y, Soong B-W, Huang S-F, Yang Y-R. A randomized controlled pilot trial of game-based training in individuals with spinocerebellar ataxia type 3. Sci Rep. 2018;8(1):1–7.
    1. Brooks V. The neuronal basis of motor control. New York Oxford. 1986;11:88–95.
    1. Missaoui B, Thoumie P. How far do patients with sensory ataxia benefit from so-called “proprioceptive rehabilitation”? Clin Neurophysiol. 2009;39(4–5):229–233. doi: 10.1016/j.neucli.2009.07.002.
    1. Camicioli R, Howieson D, Lehman S, Kaye J. Talking while walking: the effect of a dual task in aging and Alzheimer’s disease. Neurology. 1997;48(4):955–958. doi: 10.1212/WNL.48.4.955.
    1. Fritz NE, Cheek FM, Nichols-Larsen DS. Motor-cognitive dual-task training in neurologic disorders: a systematic review. J Neurol Phys Ther. 2015;39(3):142. doi: 10.1097/NPT.0000000000000090.
    1. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Movement Disord. 2008;23(3):329–342. doi: 10.1002/mds.21720.
    1. Lacorte E, Bellomo G, Nuovo S, Corbo M, Vanacore N, Piscopo P. The use of new mobile and gaming technologies for the assessment and rehabilitation of people with ataxia: a systematic review and meta-analysis. Cerebellum. 2020:1–13. [published online ahead of print, 2020 Nov 14].

Source: PubMed

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