Computer games as a means of movement rehabilitation

The test was performed in a standardized manner with a dedicated set-up of the test equipment. For example in the category grip the subject is asked to pour the water from one cup to another cup and have to manage that within 5 seconds without spilling and without compensating movements like later flexion in the trunk.

Recent studies from other researchers have demonstrated satisfactory reliability, validity and responsiveness [ 33 , 34 ]. ABILHAND is an inventory of manual activities that the patient is asked to judge on a three-level scale: 0 impossible , 1 difficult and 2 easy.

The test explores both unimanual and bimanual activities done without human or technical help. According to the manual, activities not attempted in the last three months were encoded as missing responses. The place where the subject intended to place the game console for playing was reviewed for ergonomics and suggestions were given.

The subjects went through the game console once more and were given a short manual in order to be able to handle the game console on their own. They were told to play as much as they liked during this five week period; no specific recommendations were made as to how much they should play. During this five week period, the subjects went once a week four times to the clinic to see the therapist for testing and the therapist for coaching.

On these occasions, which also included a game session, the coaching therapist checked that movements were performed in an optimal manner without risk of injury, that the subjects could manage the system and that they understood how to play the games. All subjects gave their written informed consent. Statistical analyses were performed using PASW v. Means of measurements during intervention, post-test and follow-up respectively were compared to measurements of data from baseline.

The deviations from baseline were tested by t-tests. In order to get more symmetric distribution log transformed data were used in the calculations. Ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models.

Deviations from baseline as above were tested. The eleven subjects in the study six females and five males , had an average age of 58 years range 26— Five subjects had an ischemic and six had a haemorrhagic stroke. Six subjects were impaired in the dominant hand Table 2. All subjects lived in the community in their own homes, three were single, and two had minor children in the home.

Eight subjects were retired or on disability pension, two subjects worked part-time and one subject worked full-time. The mean time at the game-based computer was min range — The mean time of days of play out of a maximum of 35 was One subject completed the protocol but did not return for the follow-up due to a medical problem.

One person n 8 was away for one week during the intervention. An improvement in motor function was noted in the affected upper limb. Fugl-Meyer motor function changes during all tests, shown for all participants.

The number below indicates the test-occasion. As can be seen, due to administrative reasons, some participants were only tested once prior to intervention.

The box-plots are showing the median thick line , the inter-quartiles and whiskers smallest and largest value of the Action Research Arm Test ARAT and illustrate the improvement with time. Median of measurements post-test and follow-up respectively were compared to measurements of data from baseline, and showed significant improvement 0. This was not the case for the un-affected side. The objective of the present study was to assess whether computer game-based training in the late phase after stroke could improve upper extremity motor function.

The intervention improved upper extremity motor function and also improved activity capacity, and this improvement was maintained at follow-up.

In the present study, 7 points between pre-intervention and post-intervention and 5 points between pre-intervention and follow-up. Having a statistically significant improvement in FMA-UE and at the same time no clinical difference has been seen also in other studies [ 37 , 38 ]. There was a statistically significant improvement on the ARAT.

According to the literature, there must be a difference of at least six points to define a minimal clinical important difference [ 39 ]. In this study, the median difference was 11 points between baseline and post-test and 21 points between baseline and follow-up, which shows a clinical definable difference. This is not surprising since the actual performance is not necessarily reflected in perceived functions. Michielsen et al. The participants in this study were interested in the games.

The game factors, such as challenges and scores, had an important impact. The results reveal a positive attitude towards the games as well as a substantial time spent on playing the games.

Results regarding the attitudes were analyzed in detail in the pilot study and have been presented in detail in Alklind Taylor et al. The participants seemed to develop a taste for certain games as their favorites.

Interestingly, remakes of classic games such as Breakout and Puzzle bubble were the most popular. Feedback through the games repeatedly encouraged the users to improve their performance. Not only arm movements but also concentrating on the games was important. The player was required to attend, comprehend, recall and plan and execute appropriate responses to the visual and auditory cues provided.

The challenging component of the games could be at the expense of carrying out tasks correctly but is required to retain motivation. It is reasonable to suggest that the ultimate aim is to promote restoration of function to the point at which the stroke patient can use the arm in everyday tasks.

The games in this computer-based training were not specifically designed to increase the use of the arm in everyday tasks, and changes in activities are thus not to be taken for granted.

As always in single subject design, the subject serves as their own control. The single subject design only makes it possible to assess whether there is a change achieved by an intervention. The results are similar to another small study where similar outcome measures were used [ 43 ].

A strength in this study is that assessments were made that cover different domains of the ICF. The selections of assessments are seen by others as good [ 44 , 45 ].

The results indicate that computer game-based training appears to be a promising approach to improving upper extremity function in the late phase after stroke. Written informed consent was obtained from the patients for the publication of this report and any accompanying images. In the latter case, please turn on Javascript support in your web browser and reload this page.

Read article at publisher's site DOI : Psychotherapy J Neurol Neurosurg Psychiatry, 7 Sci Rep , 9 1 , 17 Sep J Healthc Eng , , 09 Jul Dev Neurorehabil , 21 6 , 09 Mar Cited by: 5 articles PMID: J Med Syst , 41 1 , 18 Nov Cited by: 1 article PMID: Front Hum Neurosci , , 13 Sep To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. J Manipulative Physiol Ther , 16 6 , 01 Jul J Hand Surg Br , 23 2 , 01 Apr Cited by: 18 articles PMID: Disabil Rehabil Assist Technol , 9 3 , 18 Apr Cited by: 3 articles PMID: Harefuah , 41 8 , 01 Oct Am J Obstet Gynecol , 3 , 01 Mar Cited by: 60 articles PMID: Leffert RD.

Neurol Clin , 5 4 , 01 Nov If your center is interested in trialling this version, please contact us. Currently available as a prototype, this version works on Android tablets. Home-based patients receive a hardware kit that connects their TV screen directly to the clinic for automatic data exchange. Once therapy is completed, the same kit can be used with other patients.

Del Pino, R. Mov Disord. Jonsdottir, J. Multiple Sclerosis and Related Disorders. Shirani, A. Handedness and potential implications for neurorehabilitation in multiple sclerosis. Unilateral arm rehabilitation for persons with multiple sclerosis using serious games in a virtual reality approach: Bilateral treatment effect? Multiple Sclerosis and Related Disorders, Volume 35, 76 - Zarbo, M. Evaluation of usability and pleasantness of a technological device for the upper limb rehabilitation in quadriplegic patients.

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A User Centred Design Approach. In: Lawo, M. Scase, M. Performing more randomized controlled studies as the gold standard for evidence-based interventions e. In rehabilitation, numerous applications have been reported [ 5 , 74 ]. Compared to the realm of prevention, many of the publications are just technical reports, case reports or qualitative studies based on small samples of patients.

The following application fields of therapy and rehabilitation are covered:. Asthma [ 38 ]. Diabetes [ 6 , 38 ]. Cancer [ 32 , 49 ]. Respiratory diseases [ 67 ]. Cardiac rehabilitation [ 14 ]. Neurological therapy after stroke and other brain injuries [ 9 , 16 , 25 , 35 , 48 , 55 , 79 ]. Leukaemia [ 58 ]. Cystic fibrosis [ 15 ]. Burns [ 1 ]. Wheelchair patients [ 47 ]. Therapeutic robots [ 26 ].

Intellectual and development disability [ 41 ]. Subsyndromal depression [ 50 ]. The first published applications date back to the s, where specific interfaces were developed [ 1 ] and the motivational impact of games was exploited [ 49 ]. In modern medical therapy, analogous to prevention, the effect models comprise numerous relevant aspects of human action and perception, ranging from knowledge to actual behaviour. One important result of these studies is that therapy has to employ meaningful movements, i.

Using movements to control a game instead of rote movements had a significant positive effect on therapeutic results. Studies employing physical activities in therapy with older patients are predominantly found in the therapy of brain injuries. Sietsema et al. In a single-case study, Betker et al. Rand, Kizony and Weiss [ 48 ] study 3 found that seven chronic and five subacute stroke patients aged from 50 to 91 years enjoyed playing the video games very much because they improved gradually.

Whereas ten patients did not become frustrated despite comparatively low performance, two subacute patients showed obvious frustration because they were not able to use their weak upper extremity to control the game. All patients had problems restricting their movements to the frontal plane. Yavuzer et al. One experimental group played video games for 4 weeks five min sessions a week in addition to the normal rehabilitation programme, whereas the other group did not attend additional training.

The game group improved significantly more dependent measures: Brunnstrom stages, FIM self-care. There were, however, initial differences in favour of the control group. Therefore, the results of this study are to be considered with caution. O'Connor et al.

Chuang et al. In the VR condition, an outdoor running track and physiological responses were displayed. Overall, the participants of the VR group reached their target goal significantly earlier than the non-VR group, i. However, the study suffers from confounding of projection of a natural running environment and biofeedback in the VR group. It is not clear whether increased motivation, distraction, feedback or a mixture of the three conditions caused the results.

Lotan et al. Rosenberg et al. This study showed significant improvement in depression symptoms, mental health-related quality of living QoL , and cognitive functioning, and no major adverse events. There were no significant changes in physical health-related QoL or anxiety. Due to a missing control group, the results cannot be attributed to the exercise treatment.

Studies on the impact of SG and VR on different diseases show a great variety of both design and results and often suffer from poor study quality.

In principle, SG and VR have been proved to motivate patients to fulfil the therapeutic requirements, to improve physical fitness and to reduce symptoms of diseases. The additional benefit of SG is predominantly evident as an enhancement of compliance or therapeutic effects compared to traditional therapies, whereas components of game experience are rarely or incompletely addressed. Taken together, the existing studies show promising tendencies for additional benefits of SG and VR on the physiological, behavioural and psychological level.

Compared to prevention, social aspects only play a marginal role in the studies of SG and VR for rehabilitation. This may be due to the institutional constraints where therapy normally is performed in dyadic interactions of patient and therapist s. Selection of appropriate sport or sport-like movements or activities of daily living in order to offer meaningful and motivating exercise contexts for older subjects. Determining appropriate dose—response relationships for the different rehabilitation purposes depending on the stage of the disease.

Performing more randomized controlled trials in order to corroborate effects and to find out moderators of game effects. In this contribution, two promising application fields of serious games for older people have been discussed. Models and theoretical frameworks consider four levels of SG effects: physiological, psychological, sensory—motor behavioural and social level. Existing studies clearly show that SG have much to offer to the fields of prevention and rehabilitation.

The requirements of the field particularly the heterogeneity of the target group; [ 31 ] have to match the options of digital games including appropriate content, interface design and game demands. Successful applications show that this synthesis is possible and can produce substantial benefits of SG at least for a considerable portion of older people. However, studies of good quality including older people are rare, and some evidence shows that older people may have specific playing preferences including social gaming context and particular difficulties handling digital games and may not generally take advantage of higher motivation and enjoyment as much as younger people.

Therefore, game concepts as well as game interventions have to be developed and evaluated that are tailored to the individual prerequisites of older people. Another key problem to be solved is sustainability.

Serious games have been proved to produce transient effects. These effects may be due to initial increase of motivation. However, prevention and rehabilitation aim at enduring effects. Few studies investigating long-term effects are much less promising. In order to ensure sustainability, research has to evaluate which settings support long-term motivation and engagement of older people in SG. Therefore, to give a preliminary answer to the question posed in the subtitle of this contribution, SG are not a new panacea of older people but can be a valuable option for prevention and rehabilitation if certain constraints are considered.

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