Friday, February 26, 2010

Exergames rehab improved motor function for post-stroke patients (Study)

Effectiveness Of Virtual Reality Using Wii Gaming Technology In Stroke Rehabilitation (EVREST): Results From A Randomized Clinical Trial



**ExerGame Lab Note**
Both groups improved on their Wolf Motor Function Tests in fact there was a difference between groups at baseline:
Recreation therapy (RT):  103.9 seconds
Wii-Sports (VRWii): 28.2 seconds

Post-test        
Recreation therapy (RT):  28.0 seconds
Wii-Sports (VRWii): 19.8 seconds


In other words, relatively speaking the RT group who played Jenga improved their score by a factor of about 4 and the VRWii group improved by less than a factor of one.  Sure the VRWii group ended up scoring better on the post-test WMFT but the groups were not balanced to begin with.  The abstract should really mention that traditional forms of therapy like Jenga or any other clinically relevant therapeutic modality is also very effective at improving motor function.  To see if the differences were significant the researchers will probably have to run an ANCOVA to account for the differences in pre-test scores or other possible variable.


Gustavo Saposnik, Mark Bayley, Muhammad Mamdani, Donna Cheung, Kevin Thorpe, Univ of Toronto, Toronto, ON, Canada; Judith Hall, Applied Health Reearch Ctr, Toronto, ON, Canada; William McIlroy, Univ of Waterloo, Waterloo, ON, Canada; Jackeline Willems, Stroke Program, Toronto, ON, Canada; Robert Teasell, Univ of Western Ontario, London, ON, Canada; Leonardo G. Cohen, Human Cortical Physiology and Stroke Neurorehabilitation Section, Natl Inst of Health, Bethesda, WA; Stroke Outcome Research Canada (SORCan) Working Group

Background: Evidence suggests that increasing intensity of rehabilitation results in better motor recovery. Nintendo introduced a new style of virtual reality (VR) by using a wireless controller that interacts with the player through a motion detection system captured and reproduced on a TV screen. Limited evidence is available on the effectiveness of an interactive virtual reality gaming system for stroke rehabilitation. Objective: to evaluate feasibility, safety and efficacy of VR using Nintendo Wii gaming technology on motor function during stroke rehabilitation.

Design: Pilot randomised, two parallel group study comparing VR using Wii gaming system (VRWii) vs. recreational therapy (RT) in patients receiving standard rehabilitation within 2 months after a mild/moderate stroke (arm deficit of ≥4 on the Chedoke-McMaster Scale).

Intervention: Patients were randomized to VRWii or RT (playing cards, ‘Jenga’). All received an intensive program of 8 sessions, 60 minutes each, over a 2-week period. Patients were instructed to primarily use their affected arm. Outcome Measures: The primary feasibility outcome is the total time receiving the intervention. The primary safety outcome is the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy is a secondary outcome, measured using Wolf Motor Function Test (WMFT), Box and Block Test (BBT), and the Stroke Impact Scale (SIS) in the 4 week follow up visit.

Results: Among 111 screened patients, 22 were randomized. The mean age was 61 years. The mean time from stroke onset to randomization was 24 days (range 10-56). Groups were comparable in baseline characteristics. Mean grip strength was 19±15 kg in RT and 22±10 kg in VRWii. Primary and secondary end-points are summarized in the table. Conclusions: VR using Wii is a novel, safe, and feasible strategy to facilitate motor function after stroke that, if proven useful, could be easily implemented for home rehabilitation.


[Via American Heart Association and source]

Wii video games may help stroke patients improve motor function

Virtual reality game technology using Wii™ may help recovering stroke patients improve their motor function, according to research presented as a late breaking poster at the American Stroke Association's International Stroke Conference 2010.

The study found the virtual reality gaming system was safe and feasible strategy to improve motor function after stroke.

"This is the first randomized clinical study showing that virtual reality using Wii™ gaming technology is feasible and safe and is potentially effective in enhancing motor function following a stroke, but our study results need to be confirmed in a major clinical trial," said Gustavo Saposnik, M.D., M.Sc., director of the Stroke Outcomes Research Unit at the Li Ka Shing Institute, St. Michael's Hospital and lead investigator of the study carried out at theToronto Rehabilitation Institute at the University of Toronto, Canada.

The pilot study focused on movements with survivors' impaired arms to help both fine (small muscle) and gross (large muscle) motor function.

Twenty survivors (average age 61) of mild to moderate ischemic or hemorrhagic strokes were randomized to playing recreational games (cards or Jenga, a block stacking and balancing game) or Wii™ tennis and Wii™ Cooking Mama, which uses movements that simulate cutting a potato, peeling an onion, slicing meat and shredding cheese.

Both groups received an intensive program of eight sessions, about 60 minutes each over two weeks, initiated about two months following a stroke.

The study found no adverse effects in the Wii™ group, reflecting safety. There was only one reported side effect in the recreational therapy group: nausea or dizziness. The Wii™ group used the technology for about 364 minutes in total session time, reflecting its feasibility. The recreational therapy group's total time was 388 minutes.

"The beauty of virtual reality is that it applies the concept of repetitive tasks, high-intensity tasks and task-specific activities, that activates special neurons (called 'mirror neuron system') involved in mechanisms of cortical reorganization (brain plasticity)," Saposnik said. "Effective rehabilitation calls for applying these principles."

Researchers found significant motor improvement in speed and extent of recovery with the Wii™ technology.

"Basically, we found that patients in the Wii™ group achieved a better motor function, both fine and gross, manifested by improvement in speed and grip strength," Saposnik said. "But it is too early to recommend this approach generally. A larger, randomized study is needed and is underway."

Wii™ is a virtual reality video gaming system using wireless controllers that interact with the user. A motion detection system allows patients their actions on a television screen with nearly real time sensory feedback. 

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