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"Kinect-ing" with clinicians: a knowledge translation resource to support decision making about video game use in rehabilitation. Phys Ther 2015; 95:426-40. [PMID: 25256741 PMCID: PMC4348717 DOI: 10.2522/ptj.20130618] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Microsoft's Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection and implementation that address individual therapeutic goals. This article describes the development and preliminary evaluation of a knowledge translation (KT) resource to support clinical decision making about selection and use of Kinect games in physical therapy. The knowledge-to-action framework guided the development of the Kinecting With Clinicians (KWiC) resource. Five physical therapists with VR and video game expertise analyzed the Kinect Adventure games. A consensus-building method was used to arrive at categories to organize clinically relevant attributes guiding game selection and game play. The process and results of an exploratory usability evaluation of the KWiC resource by clinicians through interviews and focus groups at 4 clinical sites is described. Subsequent steps in the evaluation and KT process are proposed, including making the KWiC resource Web-based and evaluating the utility of the online resource in clinical practice.
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Liao YY, Yang YR, Cheng SJ, Wu YR, Fuh JL, Wang RY. Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease. Neurorehabil Neural Repair 2014; 29:658-67. [PMID: 25539782 DOI: 10.1177/1545968314562111] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson's disease (PD). However, programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established. OBJECTIVE To examine the effects of virtual reality-based exercise on obstacle crossing performance and dynamic balance in participants with PD. METHODS Thirty-six participants with a diagnosis of PD (Hoehn and Yahr score ranging 1 to 3) were randomly assigned to one of three groups. In the exercise groups, participants received virtual reality-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks. Participants in the control group received no structured exercise program. Primary outcomes included obstacle crossing performance (crossing velocity, stride length, and vertical toe obstacle clearance) and dynamic balance (maximal excursion, movement velocity, and directional control measured by the limits-of-stability test). Secondary outcomes included sensory organization test (SOT), Parkinson's Disease Questionnaire (PDQ39), fall efficacy scale (FES-I), and timed up and go test (TUG). All outcomes were assessed at baseline, after training, and at 1-month follow-up. RESULTS The VRWii group showed greater improvement in obstacle crossing velocity, crossing stride length, dynamic balance, SOT, TUG, FES-I, and PDQ39 than the control group. VRWii training also resulted in greater improvement in movement velocity of limits-of-stability test than TE training. CONCLUSIONS VRWii training significantly improved obstacle crossing performance and dynamic balance, supporting implementation of VRWii training in participants with PD.
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Affiliation(s)
- Ying-Yi Liao
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan National Yang-Ming University, Taipei, Taiwan
| | - Yea-Ru Yang
- National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yih-Ru Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Linkou, Taiwan Chang-Gung University College of Medicine, Linkou, Taiwan
| | - Jong-Ling Fuh
- National Yang-Ming University, Taipei, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
OBJECTIVE To identify all reported cases of injury and other problems caused by using a Nintendo video gaming system. DESIGN Review. DATA SOURCES AND REVIEW METHODS Search of PubMed and Embase in June 2014 for reports on injuries and other problems caused by using a Nintendo gaming system. RESULTS Most of the 38 articles identified were case reports or case series. Injuries and problems ranged from neurological and psychological to surgical. Traditional controllers with buttons were associated with tendinitis of the extensor of the thumb. The joystick on the Nintendo 64 controller was linked to palmar ulceration. The motion sensitive Wii remote was associated with musculoskeletal problems and various traumas. CONCLUSIONS Most problems are mild and prevalence is low. The described injuries were related to the way the games are controlled, which varies according to the video game console.
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Affiliation(s)
- Maarten B Jalink
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, 9700 RB Groningen, Netherlands
| | - Erik Heineman
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, 9700 RB Groningen, Netherlands
| | - Jean-Pierre E N Pierie
- Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - Henk O ten Cate Hoedemaker
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, 9700 RB Groningen, Netherlands Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands
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Garrido Navarro JE, Ruiz Penichet VM, Lozano Pérez MD. Movement-Based Interaction Applied to Physical Rehabilitation Therapies. J Med Internet Res 2014. [DOI: 10.2196/jmir.3154 10.2196/jmir.3154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Garrido Navarro JE, Ruiz Penichet VM, Lozano Pérez MD. Movement-based interaction applied to physical rehabilitation therapies. J Med Internet Res 2014; 16:e281. [PMID: 25491148 PMCID: PMC4275476 DOI: 10.2196/jmir.3154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 04/07/2014] [Accepted: 10/17/2014] [Indexed: 11/13/2022] Open
Abstract
Background Health care environments are continuously improving conditions, especially regarding the use of current technology. In the field of rehabilitation, the use of video games and related technology has helped to develop new rehabilitation procedures. Patients are able to work on their disabilities through new processes that are more motivating and entertaining. However, these patients are required to leave their home environment to complete their rehabilitation programs. Objective The focus of our research interests is on finding a solution to eliminate the need for patients to interrupt their daily routines to attend rehabilitation therapy. We have developed an innovative system that allows patients with a balance disorder to perform a specific rehabilitation exercise at home. Additionally, the system features an assistive tool to complement the work of physiotherapists. Medical staff are thus provided with a system that avoids the need for them to be present during the exercise in specific cases in which patients are under suitable supervision. Methods A movement-based interaction device was used to achieve a reliable system for monitoring rehabilitation exercises performed at home. The system accurately utilizes parameters previously defined by the specialist for correct performance of the exercise. Accordingly, the system gives instructions and corrects the patient’s actions. The data generated during the session are collected for assessment by the specialist to adapt the difficulty of the exercise to the patient’s progress. Results The evaluation of the system was conducted by two experts in balance disorder rehabilitation. They were required to verify the effectiveness of the system, and they also facilitated the simulation of real patient behavior. They used the system freely for a period of time and provided interesting and optimistic feedback. First, they evaluated the system as a tool for real-life rehabilitation therapy. Second, their interaction with the system allowed us to obtain important feedback needed to improve the system. Conclusions The system improves the rehabilitation conditions of people with balance disorder. The main contribution comes from the fact that it allows patients to carry out the rehabilitation process at home under the supervision of physiotherapists. As a result, patients avoid having to attend medical centers. Additionally, medical staff have access to an assistant, which means their presence is not required in many exercises that involve constant repetition.
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Abbruzzese G, Trompetto C, Mori L, Pelosin E. Proprioceptive rehabilitation of upper limb dysfunction in movement disorders: a clinical perspective. Front Hum Neurosci 2014; 8:961. [PMID: 25505402 PMCID: PMC4243688 DOI: 10.3389/fnhum.2014.00961] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/12/2014] [Indexed: 11/15/2022] Open
Abstract
Movement disorders (MDs) are frequently associated with sensory abnormalities. In particular, proprioceptive deficits have been largely documented in both hypokinetic (Parkinson’s disease) and hyperkinetic conditions (dystonia), suggesting a possible role in their pathophysiology. Proprioceptive feedback is a fundamental component of sensorimotor integration allowing effective planning and execution of voluntary movements. Rehabilitation has become an essential element in the management of patients with MDs, and there is a strong rationale to include proprioceptive training in rehabilitation protocols focused on mobility problems of the upper limbs. Proprioceptive training is aimed at improving the integration of proprioceptive signals using “task-intrinsic” or “augmented feedback.” This perspective article reviews the available evidence on the effects of proprioceptive stimulation in improving upper limb mobility in patients with MDs and highlights the emerging innovative approaches targeted to maximizing the benefits of exercise by means of enhanced proprioception.
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Affiliation(s)
- Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
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Chung SJ, Koh SB, Ju YS, Kim JW. Nationwide Survey of Patient Knowledge and Attitudes towards Human Experimentation Using Stem Cells or Bee Venom Acupuncture for Parkinson's Disease. J Mov Disord 2014; 7:84-91. [PMID: 25360232 PMCID: PMC4213536 DOI: 10.14802/jmd.14012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 08/26/2014] [Accepted: 09/08/2014] [Indexed: 11/24/2022] Open
Abstract
Objective Stem cell treatment is a well-recognized experimental treatment among patients with Parkinson’s disease (PD), for which there are high expectations of a positive impact. Acupuncture with bee venom is one of the most popular complementary and alternative treatments for PD. Patient knowledge and attitudes towards these experimental treatments are unknown. Methods Using a 12-item questionnaire, a nationwide survey was conducted of 963 PD patients and 267 caregivers in 44 Korean Movement Disorders Society member hospitals from April 2013 to June 2013. The survey was performed by trained interviewers using conventional methods. Results Regarding questions on experimental treatments using stem cells or bee venom acupuncture, 5.1–17.7% of PD patients answered questions on safety, efficacy, and evidence-based practice incorrectly; however, more than half responded that they did not know the correct answer. Although safety and efficacy have not been established, 55.5% of PD patients responded that they were willing to receive stem cell treatment. With regard to participating in experimental treatments, there was a strong correlation between stem cell treatment and bee venom acupuncture (p < 0.0001, odds ratio = 5.226, 95% confidence interval 3.919–6.969). Younger age, higher education, and a longer duration of PD were all associated with a correct understanding of experimental treatments. Conclusions Our data suggest that relatively few PD patients correctly understand the safety and efficacy of experimental treatments and that PD patients are greatly interested in new treatments. We hope that our data will be used to educate or to plan educational programs for PD patients and caregivers.
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Affiliation(s)
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Beom Koh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Young-Su Ju
- Department of Occupational & Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University School of Medicine, Busan, Korea
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The role of exergaming in Parkinson's disease rehabilitation: a systematic review of the evidence. J Neuroeng Rehabil 2014; 11:33. [PMID: 24602325 PMCID: PMC3984732 DOI: 10.1186/1743-0003-11-33] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 02/20/2014] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Evidence for exercise based computer games (exergaming) as a rehabilitation tool for people with Parkinson's disease (PD) is only now emerging and is yet to be synthesised. To this end, we conducted a systematic review of the exergaming literature to establish what is known about the safety, feasibility and effectiveness of exergaming for rehabilitation of motor symptoms experienced by people with PD. Seven electronic databases were searched for key terms surrounding exergaming and PD. Data were extracted by two reviewers independently. From an initial yield of 1217 articles, seven were included in the review. Six studies used commercial games with the Nintendo Wii fit platform. The scientific quality of reporting was generally good, however the overall methodological design of studies was weak, with only one randomised controlled trial being reported. SAFETY Participant safety was not measured in any of the studies. Feasibility: People with PD were able to play exergames, improve their performance of gameplay and enjoyed playing. However, one study observed that people with PD had difficulty with fast and complex games. Effectiveness: Six studies showed that exergaming elicited improvements in a range of clinical balance measures or reduction in the severity of motor symptoms. Results from the only randomised controlled trial showed that exergaming was as effective as traditional balance training for people with PD to improve the UPDRS II, standing balance and cognition, with improvements in both groups retained 60 days after the training ended. In conclusion, exergaming is an emerging tool to help rehabilitate motor skills in people with PD. Although we were able to establish that exergaming is feasible in people with PD, more research is needed to establish its safety and clinical effectiveness, particularly in the home. The use of commercial games may be too difficult for some people with PD and exergames tailored specifically to the rehabilitation needs and capabilities of people with PD are required for optimal efficacy, adherence and safety.
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Abstract
BACKGROUND Over the past decade, the treatment of Parkinson disease (PD) has undergone tremendous changes. New drugs have been introduced to manage the cardinal motor symptoms of PD, and other agents have been borrowed to treat the nonmotor manifestations of the illness. For neurologists faced with the task of treating PD patients, the available array of medications may be confusing and intimidating. REVIEW SUMMARY In this review, I summarize the newest approved medications for the treatment of PD, including the new dopamine agonists and catechol-O-methyl-transferase inhibitors. I also describe agents that are used to treat common problems in PD patients, including hallucinations, orthostasis, nausea, erectile dysfunction, depression, and memory loss. Guidelines for handling common scenarios in PD patients will be illustrated by 10 case histories. Finally, the most promising PD drugs that are currently in development will be reviewed. CONCLUSIONS Neurologists have a vast armamentarium to treat both motor and nonmotor manifestations of PD. Understanding this array allows the astute clinician to improve the lives of their patients with PD.
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Affiliation(s)
- Steven J Frucht
- Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
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