Balance Training in Virtual Reality Promotes Performance Improvement but Not Transfer to Postural Control in People with Chronic Stroke

Serious Game-Based Balance Training with Augmented Kinesthetic Feedback Enhances Aspects of Postural Control in Poststroke Patients: A Randomized Clinical Trial

Background: Poststroke hemiparesis presents with motor asymmetry and decreased postural control leading to functional limitations. Serious games (SG) for balance rehabilitation of people with stroke may improve motor recovery, and the visual and auditory feedback provided by the SGs helps to explain the therapeutic benefits. However, the contribution of SG combined with kinesthetic and verbal cues during balance training has not been investigated. The aim of this study is to compare the effects of two feedback conditions for an SG balance intervention, with or without the addition of kinesthetic and verbal cues, on balance performance of people with stroke. Methods: Thirty people with chronic poststroke hemiparesis and balance impairment participated in this randomized controlled trial and performed 14 individual SG training sessions combined with kinesthetic and verbal cues provided by the physical therapist or with SG's feedback only. Outcomes were assessed before training (pre), 1 week after the end of training (post), and 8 weeks after the end of training, which were adopted as the follow-up period, using the Balance Evaluation Systems Test, Lower Limb Subscale of Fugl-Meyer, six-minute walk test, and Stroke-Specific Quality of Life Scale. Results: The results showed that SG combined with kinesthetic and verbal cues improved outcomes relating to lower limb function and some balance domains (biomechanical constraints and limits of stability outcomes) better than with SG's feedback only. Both groups had similar significant improvement in quality of life and long-distance walking performance. Conclusion: This study is the first to directly compare two feedback conditions for SG-based balance intervention. The addition of kinesthetic and verbal cues during the SG balance improved aspects of postural control better than without this form of feedback.

The Technology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review

Virtual reality (VR) technology has experienced a steady rise and has been widely applied in the field of rehabilitation. The integration of VR technology in rehabilitation has shown promising results in enhancing their motivation for treatment, thereby enabling patients to actively engage in rehab training. Despite the advancement, there is a dearth of comprehensive summary and analysis on the use of VR technology to enhance patient motivation in rehabilitation. Thus, this narrative review aims to evaluate the potential of VR technology in enhancing patient motivation during motor rehabilitation training. This review commences with an explanation of how enhancing motivation through the VR rehabilitation system could improve the efficiency and effectiveness of rehabilitation training. Then, the technology was analyzed to improve patient motivation in the present VR rehabilitation system in detail. Furthermore, these technologies are classified and summarized to provide a comprehensive overview of the state-of-the-art approaches for enhancing patient motivation in VR rehabilitation. Findings showed VR rehabilitation training utilizes game-like exercises to enhance the engagement and enjoyment of rehabilitation training. By immersing patients in a simulated environment with multisensory feedback, VR systems offer a unique approach to rehabilitation that can lead to improved patient motivation. Both ultimately lead to improved patient outcomes, which is not typically achievable with traditional rehabilitation methods. The review concludes that VR rehabilitation presents an opportunity to improve patient motivation and adherence to long-term rehabilitation training. However, to further enhance patient self-efficacy, VR rehabilitation should integrate psychology and incorporate methods. Moreover, it is necessary to build a game design theory for rehabilitation games, and the latest VR feedback technology should also be introduced.

The effect of mobile application-based technology on post-stroke aphasia: a systematic review

Background

Enhancing speech-language therapy remains the most effective strategy for improving post-stroke aphasia, However, conventional face-to-face interventions often lack the necessary therapeutic intensity. In recent years, mobile application-based speech-language therapy has emerged progressively, offering new opportunities for independent rehabilitation among aphasic patients. This review aims to evaluate the impact of mobile application-based interventions on post-stroke aphasic.

Methods

By conducting a systematic search across five databases (PubMed, Web of Science, EMBASE, CINAHL, and Scopus), we identified and included studies that investigated the utilization of mobile application-based technologies (such as computers, iPads, etc.) for treating post-stroke aphasia.

Results

This study included 15 research investigations, including 10 randomized controlled trials (RCTs), four self-controlled studies and one cross-over experimental design study. Among these, eight studies demonstrated the efficacy of mobile application-based therapy in enhancing overall language functionality for post-stroke aphasia patients, three studies highlighted its potential for improving communication skills, three studies observed its positive impact on spontaneous speech expression. Moreover, four studies indicated its effectiveness in enhancing naming abilities, two studies underscored the positive influence of mobile application-based interventions on the quality of life for individuals with aphasia. Six studies noted that speech improvement effects were maintained during the follow-up period.

Conclusion

The results of this review demonstrate the potential of mobile application-based interventions for improving speech-language function in individuals with aphasia. However, further high-quality research is needed to establish their effects across different domains and to delve into the comparative advantages of various treatment approaches.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=405248.

Biopsychosocial Effects of a Conventional Exercise Program and Culturally Relevant Activities in Older Women From Mozambique

AIM

This randomized controlled trial compared the effects of a Conventional Exercise Program (CEP) and Culturally Relevant Activities (CRA) on body mass, cardiovascular risk, functional fitness (strength, flexibility, cardiorespiratory fitness, and agility), self-efficacy, and self-esteem in older women dwelling in Mozambique.

METHODS

Fifty-seven women (67 [7] y) underwent 60-minute sessions of CEP (n = 28) or CRA (n = 29) performed 3 days per week for 12 weeks. CRA included Mozambican traditional dances and games (intensity corresponding to scores 3-4 of BORG-CR10 scale), and CEP included 20-minute stationary cycling (65%-75% heart rate reserve) and a resistance training circuit (8 exercises, 15-repetition maximum).

RESULTS

CEP and CRA (P < .05) showed increased percent fat (3.4% and 5.3%), waist circumference (3.3% and 5.8%), and cardiorespiratory fitness (14.4% and 9.4%), and decreased triglycerides (-20.0% and -77.8%). In CEP (P < .05), body mass (2.9%), body mass index (3.2%), and high-density lipoprotein (10.0%) increased, while glycemia (-4.8%) and total cholesterol (-9.8%) decreased. Blood pressure slightly increased in CEP (6.2%, P > .05) and CRA (4.3%, P < .05). Self-efficacy and self-esteem increased to similar levels in both groups (15%, P < .05).

CONCLUSIONS

CEP and CRA were capable to improve biopsychosocial health-related variables in Mozambican older women. Culturally referenced PA interventions should be considered as an alternative in African countries.

Active Videogaming Interventions in Adults with Neuromuscular Conditions: A Scoping Review

This review synthesized active videogaming (AVG) intervention literature over a 10-year period (2010-2020) for people with neuromuscular conditions (18-64 years of age), examining interventions that aimed to improve health and secondary conditions, physical activity, and outcomes quality of life (QOL). Systematic searches yielded 40 eligible studies. The major groups were multiple sclerosis (40%) and stroke (33%), and the study participants had mostly mild-to-moderate disability who were able to play games in a standing position. Research designs primarily involved randomized controlled trials (65%) and pre/post-trial design without a control group (28%). The majority of interventions used commercial off-the-shelf gaming systems, such as Nintendo Wii and Microsoft Kinect. Studies reported significant improvements in health outcomes, specifically in balance (n = 30/36), mobility (n = 24/27), and cardiorespiratory fitness (n = 6/8). Positive changes were also seen in secondary conditions (n = 8/12), physical activity (n = 3/4), and QOL outcomes (n = 8/16). AVG research for people with neuromuscular conditions has grown in both quantity and quality but several gaps remain. Study findings provide a roadmap for future AVG trials on understudied populations, and highlight technology and targeted outcomes as drivers of future intervention research.

The Effects of Virtual Reality Nonphysical Mental Training on Coordination and Skill Transfer in Healthy Adults

CONTEXT

Mental training is a promising method to improve motor skills. However, transfer of these improvements to different skills or functional activities is still unclear. The purpose of this study was to investigate the effects of mental balance training programs on motor coordination and skill transfer.

DESIGN

Randomized controlled trial.

METHODS

Fifty-seven healthy adults (28 females and 29 males) aged between 18 and 25 years participated in this study. Participants were randomly assigned to 3 groups: virtual reality (VR) mental training group, conventional mental training group, and control group. The training program included action observation and motor imagery practice with balance exercise videos. The VR mental training group trained with a VR head-mounted display and the conventional mental training group trained with a nonimmersive computer monitor for 30 minutes, 3 days per week, for 4 weeks. Coordination skills were tested with 2 separate custom-made obstacle course tests (OCT-1 and OCT-2). OCT tests included crouching, turning, leaning, stepping over, changing direction, walking on various surfaces, or using repeated hand and arm movement tasks. OCT-1 was used to investigate the effects of mental exercises on coordination skills, and OCT-2 to investigate transfer effects for novel tasks. Test time (total and corrected) and error types (minor, major, and total) were recorded. Touching an obstacle without changing its position was classified as a minor error, and changing its position was a major error.

RESULTS

OCT-1 test time and number of errors significantly decreased in the VR mental training and conventional mental training groups, but not in the control group. The number of minor errors was only decreased in the VR mental training group. For OCT-2, total and corrected time were not significantly different between the groups. However, both training groups were significantly superior to the control group for all types of errors.

CONCLUSIONS

Our findings suggest that both training interventions can significantly improve coordination and skill transfer test results. In addition, VR mental training may have some advantages over conventional mental training. These findings are promising for the use of mental training for prevention and rehabilitation in special populations.

Effects of exergaming on functional outcomes in people with chronic stroke: A systematic review and meta-analysis

AIMS

The aim of this review is to synthesize and evaluate effectiveness of exergaming on balance, lower limb functional mobility and functional independence in individuals with chronic stroke.

DESIGN

The present review is a systematic review and meta-analysis. The review is written in accordance with the guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) DATA SOURCE: Searches were conducted across seven databases (PubMed, EMBASE, Web of Science, CINAHL, CENTRAL, Scopus and PEDro) and in grey literature from inception until January 2021.

REVIEW METHODS

Only randomized controlled trials (RCTs) written in English were included. All eligible studies were assessed for risk of bias by two reviewers independently. Meta-analyses were performed using RevMan 5.4.1 software. Narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall quality of evidence from included studies was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

RESULTS

4511 records were retrieved, with 32 RCTs eligible for inclusion and 27 RCTs included in meta-analysis. Meta-analyses reported statistically significant small effect sizes favouring exergaming on balance (pooled standardized mean difference [SMD] = 0.25, 95% confidence interval [CI, 0.08-0.41], p = .004), lower limb functional mobility (pooled SMD = 0.29, 95% CI [0.08-0.50], p = .007) and functional independence (pooled SMD = 0.41, 95% CI [0.09-0.73], p = .01). Most of the included studies failed to provide adequate description of the measures taken to prevent bias.

CONCLUSION

Exergaming has favourable effects on improving balance, lower limb functional mobility and functional independence among individuals with chronic stroke, making it a suitable adjunct to conventional physiotherapy.

IMPACT

People with chronic stroke have difficulty achieving the required rehab intensity. Exergaming can help individuals with chronic stroke to undertake further rehabilitation exercises at home. It can be a suitable adjunct to conventional physiotherapy.

Applying Game-Based Approaches for Physical Rehabilitation of Poststroke Patients: A Systematic Review

Objective

A large number of patients need critical physical rehabilitation after the stroke. This study aimed to review and report the result of published studies, in which newly emerged games were employed for physical rehabilitating in poststroke patients.

Materials and Methods

This systematic review study was performed based on the PRISMA method. A comprehensive search of PubMed, Scopus, IEEE Xplore Digital Library, and ISI Web of Science was conducted from January 1, 2014, to November 9, 2020, to identify related articles. Studies have been entered in this review based on inclusion and exclusion criteria, in which new games have been used for physical rehabilitation.

Results

Of the 1326 retrieved studies, 60 of them met our inclusion criteria. Virtual reality-oriented games were the most popular type of physical rehabilitation approach for poststroke patients. “The Nintendo Wii Fit” game was used more than other games. The reviewed games were mostly operated to balance training and limb mobilization. Based on the evaluation results of the utilized games, only in three studies, applied games were not effective. In other studies, games had effective outcomes for target body members.

Conclusions

The results indicate that modern games are efficient in poststroke patients' physical rehabilitation and can be used alongside conventional methods.