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Berglund A, Orädd H. Exploring the Psychological Effects and Physical Exertion of Using Different Movement Interactions in Casual Exergames That Promote Active Microbreaks: Quasi-Experimental Study. JMIR Serious Games 2024; 12:e55905. [PMID: 39186776 PMCID: PMC11384167 DOI: 10.2196/55905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/19/2024] [Accepted: 07/15/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Prolonged sedentary behavior, such as sitting or reclining, has consistently been identified as a stand-alone risk factor for heightened cardiometabolic risk and overall mortality. Conversely, interrupting sedentary periods by incorporating short, active microbreaks has been shown to mitigate the negative effects of sedentary behavior. Casual exergames, which mix elements of casual gaming with physical activity, are one prospective intervention to reduce sedentary behavior because they require physical exertion. Casual exergames have shown promise in fostering emotional and physical advantages when played in specific circumstances. However, little research exists on how different types of movement interactions impact the psychological effects as well as the physical exertion of playing casual exergames. OBJECTIVE The primary aim of this work was to explore the psychological effects and physical exertion of playing casual exergames lasting 2 minutes. More precisely, the investigation focused on comparing upper body and full body movement interactions. In addition, the work examined variations in body positions, considering both standing and seated positions during upper body movement interactions. METHODS Two casual exergames were developed and investigated through 2 quasi-experimental studies. In study 1, we investigated how players' perceptions of control, exertion, and immersion were affected by using upper body as opposed to full body exergame controllers when playing casual exergames. In study 2, we investigated differences in positive affect, performance, enjoyment, and exertion when playing casual exergames with upper body movement interactions in seated and standing positions. RESULTS Study 1 showed that perceived control was significantly higher for upper body movement interactions than for full body movement interactions (P=.04), but there were no significant differences regarding perceived exertion (P=.15) or immersion (P=.66). Study 2 showed that positive affect increased significantly for both standing (P=.003) and seated (P=.001) gameplay. The participants in the standing gameplay group showed slightly higher actual exertion; however, there were no differences between the groups in terms of positive affect, perceived exertion, enjoyment, or performance. CONCLUSIONS Casual exergames controlled by upper body movement interactions in seated gameplay can produce similar psychological effects and physical exertion as upper body movement interactions in standing gameplay and full body movement interactions. Therefore, upper body and seated casual exergames should not be overlooked as a suitable microbreak activity.
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Affiliation(s)
- Aseel Berglund
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Helena Orädd
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
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Jaramillo JP, Johanson ME, Kiratli BJ. Adherence and perceptions of a home sports video gaming program in persons with spinal cord injuries: A pilot study. J Spinal Cord Med 2023:1-11. [PMID: 37975789 DOI: 10.1080/10790268.2023.2268328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Sports video-gaming can facilitate increased activity levels in persons with limited exercise options. Understanding how persons with spinal cord injuries (SCI) participate in home-based video-gaming and its potential impact on maintaining or enhancing physical function remains largely unexplored. The purpose of this study was to evaluate adherence, perceptions, and potential physical effects of a home sports video-game program for persons with chronic SCI. PARTICIPANTS Fourteen individuals with chronic SCI (9 tetraplegia, 5 paraplegia). DESIGN This was a prospective study. Wii video-gaming systems that included four sports games were provided to participants for home use. Participants were instructed to play for 8 weeks 3-4 days/week. The video consoles recorded the time and number of sessions played. OUTCOME MEASURES At baseline and at the conclusion of the program, measurements were made of upper extremity strength, perceived exertion, active heart rate, pain, balance, and a functional upper extremity (UE) test. The total time and number of sessions were compared to the prescribed game play as a measure of adherence. Scores from a self-reported survey were used to gauge participants' satisfaction and perceptions of their gaming experience. RESULTS Overall mean gaming adherence was 85% during the first 4 weeks and 69% for the second 4 weeks. There were no significant changes in upper extremity strength, active heart rate, balance, pain, or functional UE test for either group. All of the participants rated video gaming as enjoyable and 85.7% perceived that it could be used as a form of exercise. CONCLUSION The Wii sports home video-gaming intervention elicited overall high adherence rates and was well received by study participants indicating that it may have value as an adjunctive tool for increasing physical activity for individuals with SCI.
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Affiliation(s)
- Jeffrey P Jaramillo
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - M Elise Johanson
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- University of California San Francisco, San Francisco State University Graduate Program in Physical Therapy, San Francisco, California, USA
| | - B Jenny Kiratli
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
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Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Malone LA, Mendonca CJ, Kim Y. Active Videogaming Interventions in Adults with Neuromuscular Conditions: A Scoping Review. Games Health J 2022; 11:141-156. [PMID: 35482057 DOI: 10.1089/g4h.2021.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Laurie A Malone
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
| | - Christen J Mendonca
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
| | - Yumi Kim
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
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Daniel CR, Yazbek P, Santos ACA, Battistella LR. Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center. Top Stroke Rehabil 2022; 30:402-409. [PMID: 35383539 DOI: 10.1080/10749357.2022.2058292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital. METHODS This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement. RESULTS An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer. CONCLUSION Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise.
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Affiliation(s)
- Christiane Riedi Daniel
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.,Departamento de Fisioterapia, Universidade Estadual do Centro Oeste, Gruarapuava, Brazil
| | - Paulo Yazbek
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Artur Cesar Aquino Santos
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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Malone LA, Davlyatov GK, Padalabalanarayanan S, Thirumalai M. Active Video Gaming Using an Adapted Gaming Mat in Youth and Adults With Physical Disabilities: Observational Study. JMIR Serious Games 2021; 9:e30672. [PMID: 34435962 PMCID: PMC8430845 DOI: 10.2196/30672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background A common leisure-time activity amongst youth and adults in the United States is video gameplay. Playing video games is typically a sedentary endeavor; however, to encourage an increased level of physical activity in an engaging and enjoyable way, active video gaming has become popular. Unfortunately, the accessibility of gaming controllers is often an issue for persons with disabilities. A commercial off-the-shelf (OTS) gaming mat was adapted to facilitate use by individuals with mobility impairments to address this issue. Objective Our study aimed to examine energy expenditure, enjoyment, and gameplay experience in youth and adults with mobility impairment during active video gaming using an OTS and adapted versions of a gaming mat. Methods The study used an observational design. During visit 1, physical function was assessed, and participants were given a familiarization period with the gaming system. For visit 2, based on observation during the physical function tests and discussion with the participant, it was decided whether the participant would play in a standing or seated position. For standing gameplay, the mat was placed on the floor, and for seated play, the mat was placed on a height-adjustable and tilt-adjustable tabletop. Metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus gameplay, with 2 bouts on each of the mats (adapted and OTS). During gameplay, the research staff observed and rated participants’ ability to use the game controller (mat) and the quality of gameplay. At the end of each game set, participants reported their rating of perceived exertion on a scale from 0 to 10. During rest, participants completed the physical activity enjoyment scale. Participants also answered additional questions regarding the system's usability with each controller (adapted mat and OTS mat). Statistical analyses were computed using Stata 16 (version 16.1; StataCorp). Linear mixed-effects maximum likelihood regression was performed separately for individuals who could play standing and for those who played seated. Results A convenience sample of 78 individuals with mobility impairments between the ages of 12 and 60 years (mean 39.6, SD 15.8) participated in the study. Of the sample, 48 participants played the video games in a seated position, while 30 played the games standing. Energy expenditure and heart rate tended to be higher in the OTS mat condition for seated players, while values were similar for both conditions among standing players. However, seated participants reported greater gameplay experience, and both groups exhibited a higher quality of gameplay during the adapted mat condition. Conclusions Active video gaming using an adapted gaming mat provided an enjoyable exercise activity for individuals with mobility impairments. The use of the adapted controller provides a means by which this population can engage in light to moderate intensity active video gaming, thereby reducing sedentary leisure time. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199
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Affiliation(s)
- Laurie A Malone
- University of Alabama at Birmingham/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ganisher K Davlyatov
- Department of Health Administration and Policy, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sangeetha Padalabalanarayanan
- University of Alabama at Birmingham/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
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Sawa R, Saitoh M, Morisawa T, Takahashi T, Morimoto Y, Kagiyama N, Kasai T, Dinesen B, Daida H. Potential of Commercially Available Active Video Game for Application to Cardiac Rehabilitation: A Scoping Review (Preprint). JMIR Serious Games 2021; 10:e31974. [PMID: 35302503 PMCID: PMC8976248 DOI: 10.2196/31974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. Objective The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. Methods Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. Results Among 120 nonduplicate articles reviewed, 5 (4.2%) were eligible for inclusion, of which 3 (2.5%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. Conclusions AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited.
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Affiliation(s)
- Ryuichi Sawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Yuh Morimoto
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Telehealth & Telerehabilitation, Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hiroyuki Daida
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Digital Health and Telemedicine Research and Development, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Effect of the Wii Sports Resort on Mobility and Health-Related Quality of Life in Moderate Stroke. Behav Neurol 2021; 2021:6635298. [PMID: 34257740 PMCID: PMC8261187 DOI: 10.1155/2021/6635298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a common cerebral circulatory disorder that has several sequelae that affect the daily life of patients as well as their quality of life and the lives of people close to them. Video games are being used in the rehabilitation process to address these sequelae and their benefits are shown on physical activity and in the cognition area. However, their effects on daily life activities and quality of life are not known. This study was aimed to test the effect of the Nintendo Wii Sports Resort on mobility and health-related quality of life among patients who have suffered a moderate stroke. Methods A prepost design study was conducted with 30 moderately impaired stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and the others belong to the control group. They were assessed in mobility (Timed Get Up and Go Test—TUG) and health-related quality of life (SF-36 Health Questionnaire). Parametric test and effect sizes were used to analyze the change in outcomes and to compare groups. Results There were no differences at baseline between the groups. After the intervention, the intervention group had experienced a greater change according to the size of the effect on the variables concerning TUG (d = 1.32), physical function (d = 1.32), social function (d = 0.71), and Physical Component Summary (d = 0.75). On the other hand, the control group had a significant change in mental health according to effect size; however, this effect is not statistically relevant (d = 0.88; CI 95% = −3.74 to 5.50). Conclusions The results on mobility and health-related quality of life indicate an improvement in both groups. However, according to the effect sizes and its confidence of interval, the intervention group achieved better results than the control group. Although more studies are needed in this area, the results are encouraging for improving mobility and health-related quality of life after stroke.
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Biomechanical measures of balance after balance-based exergaming training dedicated for patients with Parkinson's disease. Gait Posture 2021; 87:170-176. [PMID: 33940308 DOI: 10.1016/j.gaitpost.2021.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/01/2021] [Accepted: 04/21/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although previous studies have contributed to our understanding of the effects of implementing the virtual reality as a rehabilitation tool in patients with Parkinson's disease (PD), additional research is needed to examine the effects of applying balance-based exergaming training on quantitative biomechanical measures of balance. RESEARCH QUESTION To investigate the effects of balance-based conventional and exergaming training on posture parameters. METHODS The study involved 24 patients with PD (Hoehn and Yahr stages II-III).Participants underwent twelve training sessions during the 4-week training period. The experimental group (n=12) was trained with a custom-made exergaming balance based training system, the control group (n=12) underwent a conventional balance training. All objective outcomes were measured before intervention and the day after completion of training program. Postural stability was assessed using the quiet standing test, dynamic balance was assessed using limits of stability (LOS) and functional balance (FBT) tests. RESULTS After training, participants in both groups showed significantly better results in static balance performance. However, only exergaming training significantly improved LOS performance (higher values of Range of forward lean (p = 0.039, dz = 0.67) and leaning rate (p=0.007, dz=0.96). Also FBT test improved significantly only in experimental group (decrease in time to target hit (p=0.02, dz=0.76) and significant increase of average COP velocity (p=0.008, dz=0.93). CONCLUSION This study found that exergaming training created for patients with PD enhanced static and dynamic balance whereas conventional balance training improved static balance. Posturography is sensitive enough to reveal differential effects of training for both groups. These findings support the inclusion of our exergaming training in the exercise program for participants with PD.
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Deutsch JE, James-Palmer A, Damodaran H, Puh U. Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke. J Neuroeng Rehabil 2021; 18:63. [PMID: 33853608 PMCID: PMC8045246 DOI: 10.1186/s12984-021-00850-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Active video games have been embraced for the rehabilitation of mobility and promotion of physical activity for persons post-stroke. This study seeks to compare carefully matched standard of care stepping activities, off-the-shelf (non-custom) active video games and custom active video games that are either self-paced or game-paced for promoting neuromuscular intensity and accuracy, cardiovascular intensity, enjoyment and perceived effort. Methods Fifteen persons (ages 38–72) with mild to moderate severity in the chronic phase post-stroke (average 8 years) participated in a single group counter balanced repeated measures study. Participants were included if they were greater than 6 months post-stroke, who could walk 100 feet without assistance and stand unsupported for three continuous minutes. They were excluded if they had cardiac, musculoskeletal or neurologic conditions that could interfere with repeated stepping and follow instructions. In a single session located in a laboratory setting, participants executed for 8.5 min each: repeated stepping, the Kinect-light race game, two custom stepping games for the Kinect, one was repeated and self-paced and the other was random and game paced. Custom video games were adjusted to the participants stepping volume. Ten-minute rest periods followed the exercise during which time participants rested and completed the PACES an enjoyment questionnaire. Participants were instrumented with a metabolic cart and heart rate sensor for collection of cardiovascular intensity (METs and % of max HR) data. Stepping frequency, accuracy and pattern were acquired via video. Data were analyzed using a RMANOVA and post-hoc comparison with a Holm's/Sidak correction. Results Neuromuscular intensity (repetitions) was significantly greater for the off-the-shelf and self-paced custom game, however accuracy was greater for the custom games. Cardiovascular intensity for all activities took place in the moderate intensity exercise band. Enjoyment (measured with a questionnaire and rankings) was greater for the custom active video games and rate of perceived exertion was lower for the custom active video games. Conclusions Custom active video games provided comparable intensity but better accuracy, greater enjoyment and less perceived exertion than standard of care stepping activities and a carefully matched off-the-shelf (non-custom) video game. There were no differences between the game-paced and self-paced custom active video games. Trial registration: NCT04538326.
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Affiliation(s)
- Judith E Deutsch
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA.
| | - Aurora James-Palmer
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA.,Motor Behavior Lab, Department of Rehab and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA
| | - Harish Damodaran
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07101, USA
| | - Urska Puh
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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The Effects of Exergaming Training on Balance in Healthy Elderly Women-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041412. [PMID: 33546350 PMCID: PMC7913576 DOI: 10.3390/ijerph18041412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/10/2023]
Abstract
Our aim was to observe, through objective testing using an assessment module incorporated in a new exergaming system, whether elderly people's static and functional balance is improved by a balance exergaming training program based on movements performed in everyday life. Thirteen healthy elderly women participated in 12 sessions of balance-based exergaming training (three times a week, 30 min per session). All objective outcomes, the quiet standing test, functional balance test (FBT), and limit of stability (LOS) test, were measured on three occasions: before intervention, after six training sessions, and after the completion of the four-week program. The results showed a significant improvement in LOS performance after the intervention. In FBT, participants exhibited a significant decrease (p < 0.01; Kendall's W = 0.5) in the average time to target hit after six trainings. The average center of pressure velocity increased after six and 12 sessions, however did not reach significance (p = 0.053); nevertheless the size of the effect was large (ηp2 = 0.22). The parameters of the quiet standing test were not significantly affected by the training. The results support the need for more definite and objective studies assessing exergaming for balance in elderly.
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Mohd Jai NA, Mat Rosly M, Abd Razak NA. Physiological Responses of Exergaming Boxing in Adults: A Systematic Review and Meta-Analysis. Games Health J 2020; 10:73-82. [PMID: 33297818 DOI: 10.1089/g4h.2020.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: Studies investigating the effects of exergaming in available platforms are still limited. This review aims to systematically identify available studies on physiological intensities of exergaming boxing in able-bodied adults and recategorize them based on different platforms or environments. The meta-analysis further analyzes the physiological responses during exergaming boxing into a set of pooled data for any evidence of outliers, heterogeneity, or publication bias. Materials and Methods: A systematic search was conducted by using databases from Google Scholar, PubMed, and Web of Science. Population, intervention, comparison, and outcomes (PICO) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used in the study selection process for the review. Results: From the 1534 articles examined, 16 articles were included for further analyses. Results indicated that exergaming boxing exhibits a wide range of metabolic equivalent of task (MET) values and intensity, from very light to vigorous, with elements of heterogeneity and bias detected. The Xbox® Kinect boxing platform produced higher MET (mean = 5.3) compared with the Nintendo® Wii™ boxing (mean = 3.8). Conclusion: The results of this review suggest that boxing exergames can produce intensity-adequate physical activity among younger adults that are beneficial for cardiometabolic improvements, regardless of platforms used. Exergaming boxing may be employed as an effective exercise tool to increase energy expenditure and physical activity level in young adults.
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Affiliation(s)
- Nor Aina Mohd Jai
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Maziah Mat Rosly
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nasrul Anuar Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Gomes TT, Schujmann DS, Fu C. Rehabilitation through virtual reality: physical activity of patients admitted to the intensive care unit. Rev Bras Ter Intensiva 2020; 31:456-463. [PMID: 31967219 PMCID: PMC7008986 DOI: 10.5935/0103-507x.20190078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/09/2019] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the level of activity that Nintendo WiiTM can elicit in intensive care unit patients and its associated safety and patient satisfaction. Methods Experimental, single-center study performed at a tertiary care hospital. Patients ≥ 18 years old who were admitted to the intensive care unit, participated in videogames as part of their physical therapy sessions and did not have mobility restrictions were included. Th exclusion criteria were the inability to comprehend instructions and the inability to follow simple commands. We included n = 60 patients and performed 100 sessions. We used the Nintendo WiiTM gaming system in the sessions. An accelerometer measured the level of physical activity of patients while they played videogames. We evaluated the level of activity, the modified Borg scale scores, the adverse events and the responses to a questionnaire on satisfaction with the activity. Results One hundred physical therapy sessions were analyzed. When the patients played the videogame, they reached a light level of activity for 59% of the session duration and a moderate level of activity for 38% of the session duration. No adverse events occurred. A total of 86% of the patients reported that they would like to play the videogame in their future physical therapy sessions. Conclusion Virtual rehabilitation elicited light to moderate levels of activity in intensive care unit patients. This therapy is a safe tool and is likely to be chosen by the patient during physical therapy.
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Affiliation(s)
- Tamires Teixeira Gomes
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Debora Stripari Schujmann
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Carolina Fu
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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Dębska M, Polechoński J, Mynarski A, Polechoński P. Enjoyment and Intensity of Physical Activity in Immersive Virtual Reality Performed on Innovative Training Devices in Compliance with Recommendations for Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3673. [PMID: 31574911 PMCID: PMC6801661 DOI: 10.3390/ijerph16193673] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 12/15/2022]
Abstract
The aim of the study is to assess the enjoyment and intensity of physical exercise while practicing physical activity (PA) in immersive virtual reality (IVR) using innovative training devices (omni-directional Omni treadmill and Icaros Pro flight simulator). The study also contains the results of subjective research on the usefulness of such a form of PA in the opinion of users. In total, 61 adults (10 women and 51 men) took part in the study. To assess the enjoyment level (EL) Interest/Enjoyment subscale of Intrinsic Motivation Inventory (IMI) was used. Exercise intensity was assessed during 10-min sessions of active video games (AVGs) in IVR based on heart rate (HR). The average enjoyment level during physical exercise in IVR on the tested training devices was high (Omni 5.74 points, Icaros 5.60 points on a 1-7 Likert scale) and differed significantly in favor of PA on Omni. In the opinion of the majority of participants, AVGs in IVR on the tested devices constitute a sufficiently useful form of PA to meet the needs of leisure time activities, and they can even replace some forms of physical effort performed in a classic way. The intensity of PA during games on training devices was at the level recommended for health benefits for 80.55% (Omni) and 50.77% (Icaros Pro) of its duration. Based on the conducted research, it can be assumed that AVGs in IVR using a multi-directional treadmill and a flight simulator can be an effective tool for increasing participation in health-oriented PA.
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Affiliation(s)
- Małgorzata Dębska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, 43-512 Katowice, Poland.
| | - Jacek Polechoński
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, 43-512 Katowice, Poland.
| | - Arkadiusz Mynarski
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, 43-512 Katowice, Poland.
| | - Piotr Polechoński
- Faculty of Physiotherapy, The Jerzy Kukuczka Academy of Physical Education in Katowice, 43-512 Katowice, Poland.
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Physiological Gait versus Gait in VR on Multidirectional Treadmill-Comparative Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55090517. [PMID: 31443382 PMCID: PMC6780052 DOI: 10.3390/medicina55090517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/17/2019] [Accepted: 08/20/2019] [Indexed: 12/02/2022]
Abstract
Background and objectives: Virtual reality (VR) is increasingly often finding applications in physiotherapy and health promotion. Recent years have seen the use of advanced technologies in the promotion of physical activity (PA) in society. New simulators, e.g., treadmills, enable the performance of PA (e.g., locomotive movements) in VR (artificially created virtual world). The question of how such movements are similar to natural forms of human locomotion (march, run) inspired the comparative analysis of physiological gait and gait in VR on a multidirectional Omni treadmill. Materials and Methods: The tests involved the use of the BTS Smart system for the triplanar analysis of motion. The test involved 10 healthy females aged 20–24 (weight: 52 ± 3.1 kg, height 162 ± 5.4 cm). Measurements were performed at two stages. The first stage involved the standard assessment of physiological gait, whereas the second was focused on gait forced by the Omni treadmill. The following gait parameters were analyzed: Flexion-extension in the ankle, knee joint and hip joint, rotation in the hip joint and knee joint, foot progression, adduction-abduction in the knee joint and hip joint, pelvic obliquity, pelvic tilt, pelvic rotation as well as energy expenditure and the movement of the body center of mass. Results: The analysis of the test results revealed the existence of differences in the kinematics of physical gait and gait on the treadmill. The greatest differences were recorded in relation to the dorsal-plantar flexion in the ankle, the foot progression, the rotation of the knee joint, pelvic tilt and rotation. In addition, the gait on the treadmill is characterized by the longer duration of the stance phase and reduced ranges of the following movements: Flexion-extension in the ankle, knee joint and hip joint, adduction-abduction in the hip joint as well as rotation in the ankle and hip joint. The values of potential, kinetic and total energy recorded in relation to forced gait are significantly lower than those of physiological gait. Conclusions: Because of the fact that the parameters of gait on the Omni platform vary significantly from the parameters of physical gait, the application of the Omni treadmill in the re-education of gait during rehabilitation should be treated with considerable care. Nonetheless, the treadmill has adequate potential to become a safe simulator enabling active motion in VR using locomotive movements.
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Polechoński J, Dębska M, Dębski PG. Exergaming Can Be a Health-Related Aerobic Physical Activity. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1890527. [PMID: 31275964 PMCID: PMC6582844 DOI: 10.1155/2019/1890527] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 12/26/2022]
Abstract
The purpose of the study was to assess the intensity of aerobic physical activity during exergame training sessions with a moderate (MLD) and high (HLD) level of difficulty of the interactive program "Your Shape Fitness Evolved 2012" for Xbox 360 Kinect in the context of health benefits. The study involved 30 healthy and physically fit students. During the game, the HR of the participants was monitored using the Polar M400 heart rate monitor. The average percentage of maximum heart rate (%HRmax) and heart rate reserve (%HRR) during the game was calculated and referred to the criterion of intensity of aerobic physical activity of American College of Sports Medicine and World Health Organization health recommendations. During the MLD training, the participants achieved on average 69.6 ± 8.7% HRmax and 57.0 ± 11.9% HRR (moderate intensity), while performing HLD exercises, they achieved 78.9 ± 8.1% HRmax and 70.2 ± 11.3% HRR (vigorous intensity). The time spent in recommended moderate-to-vigorous intensity during 15-min exergame session was 14.6 min (97,1%) for MLD and 14.8 min (99%) for HLD. The intensity of aerobic PA during exergame "Your Shape Fitness Evolved 2012" both medium and high level of difficulty almost all the training sessions was at the level recommended for health benefits. Active video games, especially exergames, containing an element of physical activity, can be used to increase the weekly dose of PA in the direction recommended for health benefits.
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Affiliation(s)
- Jacek Polechoński
- Department of Tourism and Health-Oriented Physical Activity, The Jerzy Kukuczka Academy of Physical Education, Katowice, 40-065, Poland
| | - Małgorzata Dębska
- Department of Tourism and Health-Oriented Physical Activity, The Jerzy Kukuczka Academy of Physical Education, Katowice, 40-065, Poland
| | - Paweł G. Dębski
- Chair and Clinical Department of Psychiatry, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
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Malone LA, Thirumalai M, Padalabalanarayanan S, Neal WN, Bowman S, Mehta T. Energy Expenditure and Enjoyment During Active Video Gaming Using an Adapted Wii Fit Balance Board in Adults with Physical Disabilities: Observational Study. JMIR Serious Games 2019; 7:e11326. [PMID: 30707098 PMCID: PMC6376329 DOI: 10.2196/11326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/10/2018] [Accepted: 12/30/2018] [Indexed: 01/18/2023] Open
Abstract
Background Individuals with physical disabilities have fewer opportunities to participate in enjoyable physical activity. One option for increasing physical activity is playing active video games (AVGs); however, many AVGs are inaccessible or offer limited play options. Objective This study aimed to examine energy expenditure and enjoyment in adults with mobility impairment during AVG play using off-the-shelf (OTS) and adapted versions of the Wii Fit balance board (Nintendo). Methods During visit 1, participants completed a functional assessment and the familiarization period. During visit 2, metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus game play, with two bouts on each of the boards. During the resting period, participants completed the Physical Activity Enjoyment Scale (PACES). Statistical analyses were computed using SPSS software. Data were analyzed separately for individuals who were able to play while standing on both boards (StdStd); those who could not play while standing on the OTS board, but were able to play while standing on the adapted board (aStd); and those who could only play while sitting on the adapted board (aSit). Results Data were collected for 58 participants (StdStd, n=17; aStd, n=10; aSit, n=31). The sample included 31 men and 27 women with a mean age of 41.21 (SD 12.70) years. Energy expenditure (metabolic equivalent [MET]) during game play was significantly greater than that during rest for all players. Only 17 participants (StdStd group) were able to play using the OTS board. During game play on the adapted board, the average MET values for the two game sets were 2.261 (SD 0.718) kcal/kg/hour and 2.233 (SD 0.751) kcal/kg/hour for the aSit group, 3.151 (SD 1.034) and 2.990 (SD 1.121) for the aStd group, and 2.732 (SD 0.655) and 2.777 (SD 0.803) for the StdStd group. For game play on the adapted board, self-reported ratings of perceived exertion on a 0-10 scale suggested greater exercise intensity levels, with median scores ranging from moderate (3) to very hard (7). The PACES scores indicated that all players enjoyed using the adapted board, with a median score of 4 on a 5-point scale. Conclusions The adapted Wii Fit balance board provided an opportunity for individuals with mobility impairments, including wheelchair users, to engage in AVG. All participants were able to utilize the adapted controller and enjoyed the AVG activity. Although the average MET values achieved during AVG represented light-intensity exercise (<3 METs), 16% of sitting participants and 41% of standing participants achieved moderate-intensity exercise (3-6 METs) in at least one of the games. Factors not accounted for, which may have influenced the intensity of exercise, include game selection, limited familiarization period, and discomfort wearing the COSMED portable metabolic system for measurement of oxygen consumption. Accessible AVG controllers offer an innovative approach to overcome various barriers to participation in physical activity. The next steps include assessment of an AVG intervention using an adapted board gaming controller on health and fitness outcomes. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by Webcite at http://www.webcitation.org/75fc0mN39).
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Affiliation(s)
- Laurie A Malone
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | | | - Whitney N Neal
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Sean Bowman
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Tapan Mehta
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
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Abstract
Whole-body movement is required to interact (play) with Microsoft Xbox with the 3D Kinect sensor (Xbox-Kinect) and, therefore, may be suitable for encouraging and practicing movements as part of stroke rehabilitation. We aimed to describe (i) game analysis, (ii) clinical use, and (iii) to characterize the Xbox-Kinect game experience with individuals with chronic stroke. Four therapists played the Xbox-Kinect games and then carried out a games analysis on the basis of the categories suggested by Deutsch. Eleven participants (age 29-69 years) with chronic stroke and varying motor deficits played Xbox-Kinect games for 4-22 sessions as part of a video-game group intervention and the clinical use was documented. The game experience of 'Bowling' (Kinect-Sport) and '20 000 leaks' (Kinect Adventures) was characterized by self-report questionnaires. Detailed tables of game analysis are provided. The clinical use of the console with the participants is presented. Participants reported high enjoyment and 'somewhat-high' perceived exertion after playing the two games and stated that overall the console suited their therapeutic goals. This information can assist clinicians with their clinical reasoning and decision-making for incorporating the Xbox-Kinect into stroke rehabilitation. Potentially, the Xbox-Kinect could be used as an on-going tool to facilitate whole-body movement and physical activity of individuals with chronic stroke.
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19
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Jaramillo JP, Johanson ME, Kiratli BJ. Upper limb muscle activation during sports video gaming of persons with spinal cord injury. J Spinal Cord Med 2019; 42:77-85. [PMID: 29616887 PMCID: PMC6340275 DOI: 10.1080/10790268.2018.1452391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Video gaming as a therapeutic tool has largely been studied within the stroke population with some benefits reported in upper limb motor performance, balance, coordination, and cardiovascular status. To date, muscle activation of upper limb muscles in persons with spinal cord injuries (SCI) has not been studied during video game play. In this paper, we provide descriptive and comparative data for muscle activation and strength during gaming for players with tetraplegia and paraplegia, as well as, compare these results with data from traditional arm exercises (ie, biceps curl and shoulder press) with light weights which are commonly prescribed for a home program. PARTICIPANTS Fourteen individuals with chronic SCI (9 tetraplegia, 5 paraplegia). DESIGN We measured upper limb muscle activation with surface electromyography (EMG) during Wii Sports video game play. Muscle activation was recorded from the playing arm during 4 selected games and normalized to a maximum voluntary contraction (MVC). OUTCOME MEASURES Heart rate and upper limb motion were recorded simultaneously with EMG. Wilcoxon signed rank tests were used to analyze differences in muscle activation between participants with paraplegia versus tetraplegia and compare gaming with traditional arm exercises with light weights. A Friedman 2-way analysis of variance identified key muscle groups active during game play. RESULTS Overall muscle activation across the games was not different between those with paraplegia and tetraplegia. Heart rate during video game play for tennis and boxing were on average 10 to 20 beats/minute above resting heart rate. The magnitude of EMG was relatively greater for traditional arm exercises with light weights compared with game play. CONCLUSION The selected Wii games were able to elicit upper extremity muscle activation and elevated heart rates for individuals with SCI that may be used to target therapeutic outcomes.
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Affiliation(s)
- Jeffrey P. Jaramillo
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA,Correspondence to: Jeffrey P. Jaramillo, DPT, SCI/D Research Lab Manager, Spinal Cord Injury Center (640/128), VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA; Ph: 650-493-5000, ext 62286, Fx: 650-496-2523.
| | - M. Elise Johanson
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - B. Jenny Kiratli
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
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Levac DE, Pradhan S, Espy D, Fox E, Deutsch JE. Usability of the 'Kinect-ing' with Clinicians Website: A Knowledge Translation Resource Supporting Decisions About Active Videogame Use in Rehabilitation. Games Health J 2018; 7:362-368. [PMID: 30179519 PMCID: PMC11074719 DOI: 10.1089/g4h.2017.0159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Commercially available active videogames (AVGs) are promising rehabilitation options, but lack of familiarity with game options may limit clinical integration. We evaluated content and format usability of the 'Kinect-ing' with Clinicians (KwiC) website, an online tool that characterizes commercially available games to support clinical decision-making about Kinect™ game use for rehabilitation. Materials and Methods: This study is a cross-sectional online survey of physical therapists (PTs). Participants selected a case scenario and reviewed the KwiC resource for information about five Kinect games. Based on this interaction, participants selected two games that would meet case scenario goals and answered Likert scale and open-ended questions about KwiC usability and usefulness of the content in guiding game selection for clinical case scenarios. Results: Twenty-five PTs participated, six of whom had previous AVG experience. All KwiC items achieved prespecified consensus of 80% "agree" or "strongly agree" on statements evaluating ease of understanding, usefulness, and format usability. There were no differences in ratings between those with and without AVG experience. Participants most appreciated the videos illustrating game play. Eighty-four percent strongly agreed that the KwiC helped them to make a decision about their case scenario. Participants suggested improving the KwiC by including more information about game use with rehabilitation populations. Conclusions: Positive usability feedback supports continued KwiC development efforts to add additional games, expand information about use specific to clinical populations, and broaden the online format to allow opportunities for clinicians to provide feedback and suggestions. We will then evaluate utility of the KwiC in clinical practice.
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Affiliation(s)
- Danielle E. Levac
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Debbie Espy
- Physical Therapy Program, School of Health Sciences, Cleveland State University, Cleveland, Ohio
| | - Emily Fox
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- Brooks Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida
| | - Judith E. Deutsch
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
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Derungs A, Schuster-Amft C, Amft O. Physical Activity Comparison Between Body Sides in Hemiparetic Patients Using Wearable Motion Sensors in Free-Living and Therapy: A Case Series. Front Bioeng Biotechnol 2018; 6:136. [PMID: 30386777 PMCID: PMC6199363 DOI: 10.3389/fbioe.2018.00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022] Open
Abstract
Background: Physical activity (PA) is essential in stroke rehabilitation of hemiparetic patients to avoid health risks, and moderate to vigorous PA could promote patients' recovery. However, PA assessments are limited to clinical environments. Little is known about PA in unguided free-living. Wearable sensors could reveal patients' PA during rehabilitation, and day-long long-term measurements over several weeks might reveal recovery trends of affected and less-affected body sides. Methods: We investigated PA in an observation study during outpatient rehabilitation in a day-care center. PA of affected and less-affected body sides, including upper and lower limbs were derived using wearable motion sensors. In this analysis we focused on PA during free-living and clinician guided therapies, and investigated differences between body-sides. Linear regressions were used to estimate metabolic equivalents for each limb at comparable scale. Non-parametric statistics were derived to quantify PA differences between body sides. Results: We analyzed 102 full-day movement data recordings from eleven hemiparetic patients during individual rehabilitation periods up to 79 days. The comparison between free-living and clinician guided therapy showed on average 16.1 % higher PA in the affected arm during therapy and 5.3 % higher PA in the affected leg during therapy. Average differences between free-living and therapy in the less-affected side were below 4.5 %. Conclusion: We analyzed PA of patients with a hemiparesis in two distinct rehabilitation settings, including free-living and clinician guided therapies over several weeks and compared MET values of affected and less-affected body sides. In particular, we investigated PA using individual regression models for each limb. We demonstrated that wearable motion sensors provide insights in patient's PA during rehabilitation. Although, no clear PA trends were found, our analysis showed patients' tendency to sedentary behavior, confirming previous lab study results. Our PA analysis approach could be used beyond clinical rehabilitation to devise personalized patient and limb-specific exercise recommendations in future remote rehabilitation.
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Affiliation(s)
- Adrian Derungs
- Lehrstuhl für Digital Health, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.,Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.,Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Oliver Amft
- Lehrstuhl für Digital Health, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Golla A, Müller T, Wohlfarth K, Jahn P, Mattukat K, Mau W. Home-based balance training using Wii Fit™: a pilot randomised controlled trial with mobile older stroke survivors. Pilot Feasibility Stud 2018; 4:143. [PMID: 30155268 PMCID: PMC6109315 DOI: 10.1186/s40814-018-0334-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Several studies have reported that using the Wii™ Balance Board can provide added value regarding balance (re-)training in neurological diseases. However, for the large group of mobile older stroke survivors, there is no evidence regarding the feasibility of an unsupervised Wii™ Balance Board training in the home setting. The aim of this study was to investigate the feasibility of a home-based Wii™ balance training for these patients and to identify methodological challenges for randomised controlled trials in the future. Methods We conducted a pilot randomised controlled trial with two intervention arms in participants' homes. Mobile stroke survivors (aged 60 years or above; 12 weeks after discharge from hospital) received a 6-week (once per week) supervised balance training at the study centre, followed by a 6-week (three times per week) unsupervised balance training at home. We used the Nintendo Wii™ Balance Board for one intervention arm and conventional balance exercises for the other intervention arm. Feasibility was assessed by recruiting rates, appropriateness of assessments regarding sensitivity to changes and acceptance of the intervention by the participants. Results In two German hospital stroke units, 349 stroke survivors were screened over a period of 6 months, 91 were eligible and 52 were interested. Twelve weeks after discharge, 14 participants agreed and 11 completed the intervention (7 men and 4 women, mean age 74 years). The Berg Balance Scale and Dynamic Gait Index showed ceiling effects already at baseline measure. The participants in both intervention arms evaluated the unsupervised training positively and feasible for self-application. No falls or injuries occurred over the intervention period, while the required scope of the exercises could largely be achieved. Conclusions In this pilot study, the recruitment of participants and the chosen assessments were not satisfactory due to selection bias and corresponding ceiling effects. However, the two home-based balance interventions proved feasible for mobile older stroke survivors with low functional limitations. Trial registration ClinicalTrials.gov, NCT02251470. Registered 29 September 2014.
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Affiliation(s)
- André Golla
- 1Institute of Rehabilitation Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
| | - Tobias Müller
- 2Department of Neurology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06097 Halle (Saale), Germany
| | - Kai Wohlfarth
- Clinic of Neurology, BG Hospital Bergmannstrost Halle (Saale), Merseburger Str. 165, 06112 Halle (Saale), Germany
| | - Patrick Jahn
- 4Nursing Research Unit, University Hospital Halle (Saale), Ernst-Grube-Str. 30, 06120 Halle (Saale), Germany
| | - Kerstin Mattukat
- 1Institute of Rehabilitation Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
| | - Wilfried Mau
- 1Institute of Rehabilitation Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
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Silva de Sousa JC, Torriani-Pasin C, Tosi AB, Fecchio RY, Costa LAR, Forjaz CLDM. Aerobic Stimulus Induced by Virtual Reality Games in Stroke Survivors. Arch Phys Med Rehabil 2018; 99:927-933. [PMID: 29428343 DOI: 10.1016/j.apmr.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/10/2018] [Accepted: 01/13/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate whether virtual reality games (VRGs) in stroke survivors produce significant and reproducible heart rate and oxygen consumption (V˙o2) responses during their execution, corresponding to an intensity between the anaerobic threshold (AT) and the respiratory compensation point (RCP). DESIGN Single-subject, repeated-measure design. SETTING Stroke survivors registered from a rehabilitation program. PARTICIPANTS Chronic hemiparetic stroke survivors (N=12; 10 men; mean age ± SD, 58±12y) rated at 3 or 4 in the Functional Ambulation Categories. INTERVENTIONS Participants underwent, in a random order, 2 identical sessions of VRGs (console Xbox 360 + Kinect) and 1 control session (38min watching a movie). The VRG sessions were composed of 4 sets of VRGs (3min of tennis, 1min for changing the game, and 4min of boxing) interspaced with 2 minutes of rest. MAIN OUTCOME MEASURES Heart rate and V˙o2 were measured during the experimental sessions and compared with heart rate and V˙o2 obtained at AT and RCP assessed during a maximal cardiopulmonary exercise test. RESULTS Heart rate and V˙o2 during VRGs had good reproducibility (intraclass correlation coefficients, ≥.91 and ≥.85, respectively; coefficients of variation, ≤6.7% and ≤13.7%, respectively). Heart rate during VRGs was similar to AT and significantly lower than RCP (P≤.05), while V˙o2 was significantly lower than AT and RCP (P<.05). CONCLUSIONS An acute session of VRGs composed of tennis and boxing games using the console XBox 360 + Kinect promotes reproducible responses of heart rate and V˙o2 that corresponded, respectively, to AT and below AT, characterizing a low-intensity aerobic stimulus.
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Affiliation(s)
- Julio Cesar Silva de Sousa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Camila Torriani-Pasin
- Motor Behaviour Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Amanda Barboza Tosi
- Motor Behaviour Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Rafael Yokoyama Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Augusto Riani Costa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Cláudia Lúcia de Moraes Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil.
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Bacha JMR, Gomes GCV, de Freitas TB, Viveiro LAP, da Silva KG, Bueno GC, Varise EM, Torriani-Pasin C, Alonso AC, Luna NMS, D'Andrea Greve JM, Pompeu JE. Effects of Kinect Adventures Games Versus Conventional Physical Therapy on Postural Control in Elderly People: A Randomized Controlled Trial. Games Health J 2018; 7:24-36. [DOI: 10.1089/g4h.2017.0065] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Jéssica Maria Ribeiro Bacha
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Gisele Cristine Vieira Gomes
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Tatiana Beline de Freitas
- Laboratory of Motor Behavior, School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | - Larissa Alamino Pereira Viveiro
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Keyte Guedes da Silva
- Department of Neuroscience and Behavior, Psychology Institute, University of São Paulo, São Paulo, Brazil
| | - Géssika Costa Bueno
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Eliana Maria Varise
- Department of Neuroscience and Behavior, Psychology Institute, University of São Paulo, São Paulo, Brazil
| | - Camila Torriani-Pasin
- Department of Pedagogy of the Human Body; Laboratary of Motor Behavior, School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | | | | | - Júlia Maria D'Andrea Greve
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - José Eduardo Pompeu
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Exergame Grading Scheme: Concept Development and Preliminary Psychometric Evaluations in Cancer Survivors. Rehabil Res Pract 2017; 2017:6843016. [PMID: 29098087 PMCID: PMC5643152 DOI: 10.1155/2017/6843016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/10/2017] [Indexed: 11/17/2022] Open
Abstract
The challenge of using exergames to promote physical activity among cancer survivors lies in the selection of the exergames that match their fitness level. There is a need for a standardized grading scheme by which to judge an exergame's capacity to address specific physical fitness attributes with different levels of physical engagement. The study aimed to develop an Exergame Grading Scheme and preliminarily evaluate its psychometric properties. Fourteen (14) items were created from the human movement and exergame literature. The content validity index (CVI) was rated by content experts with two consecutive rounds (N = 5 and N = 3 independently). The interrater reliability (IRR) was determined by two raters who used the Exergame Grading Scheme to determine the grading score of the five exergames performed by two cancer survivors (N = 10). Each item had a score of 1 for item-level CVI and 1 for k. For IRR, 9 items had rho values of 1, 1 item had 0.93, and 4 items had between 0.80 and 0.89. This valid and reliable Exergame Grading Scheme makes it possible to develop a personalized physical activity program using any type of exergame or fitness mobile application in rehabilitation practice to meet the needs of cancer survivors.
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Mat Rosly M, Halaki M, Mat Rosly H, Cuesta V, Hasnan N, Davis GM, Husain R. Exergaming for Individuals with Spinal Cord Injury: A Pilot Study. Games Health J 2017; 6:279-289. [DOI: 10.1089/g4h.2017.0028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maziah Mat Rosly
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Mark Halaki
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Hadi Mat Rosly
- Department of Mechatronics Engineering, Faculty of Engineering, International Islamic University, Kuala Lumpur, Malaysia
| | - Victor Cuesta
- Graduate School of System Design and Management, Keio University, Yokohama, Japan
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Glen M. Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ruby Husain
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors: A Focused Review. Am J Phys Med Rehabil 2017; 95:459-74. [PMID: 26829074 PMCID: PMC4866584 DOI: 10.1097/phm.0000000000000438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite aggressive conventional therapy, lasting hemiplegia persists in a large percentage of stroke survivors. The aim of this article is to critically review the rationale behind targeting multiple sites along the motor learning network by combining robotic therapy with pharmacotherapy and virtual reality–based reward learning to alleviate upper extremity impairment in stroke survivors. Methods for personalizing pharmacologic facilitation to each individual’s unique biology are also reviewed. At the molecular level, treatment with levodopa was shown to induce long-term potentiation-like and practice-dependent plasticity. Clinically, trials combining conventional therapy with levodopa in stroke survivors yielded statistically significant but clinically unconvincing outcomes because of limited personalization, standardization, and reproducibility. Robotic therapy can induce neuroplasticity by delivering intensive, reproducible, and functionally meaningful interventions that are objective enough for the rigors of research. Robotic therapy also provides an apt platform for virtual reality, which boosts learning by engaging reward circuits. The future of stroke rehabilitation should target distinct molecular, synaptic, and cortical sites through personalized multimodal treatments to maximize motor recovery.
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Virtual Reality and Serious Games in Neurorehabilitation of Children and Adults: Prevention, Plasticity, and Participation. Pediatr Phys Ther 2017; 29 Suppl 3:S23-S36. [PMID: 28654475 PMCID: PMC5488703 DOI: 10.1097/pep.0000000000000387] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Use of virtual reality (VR) and serious games (SGs) interventions within rehabilitation as motivating tools for task specific training for individuals with neurological conditions are fast-developing. Within this perspective paper we use the framework of the IV STEP conference to summarize the literature on VR and SG for children and adults by three topics: Prevention; Outcomes: Body-Function-Structure, Activity and Participation; and Plasticity. Overall the literature in this area offers support for use of VR and SGs to improve body functions and to some extent activity domain outcomes. Critical analysis of clients' goals and selective evaluation of VR and SGs are necessary to appropriately take advantage of these tools within intervention. Further research on prevention, participation, and plasticity is warranted. We offer suggestions for bridging the gap between research and practice integrating VR and SGs into physical therapist education and practice.
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Malone LA, Padalabalanarayanan S, McCroskey J, Thirumalai M. Assessment of Active Video Gaming Using Adapted Controllers by Individuals With Physical Disabilities: A Protocol. JMIR Res Protoc 2017. [PMID: 28623186 PMCID: PMC5493786 DOI: 10.2196/resprot.7621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Individuals with disabilities are typically more sedentary and less fit compared to their peers without disabilities. Furthermore, engaging in physical activity can be extremely challenging due to physical impairments associated with disability and fewer opportunities to participate. One option for increasing physical activity is playing active video games (AVG), a category of video games that requires much more body movement for successful play than conventional push-button or joystick actions. However, many current AVGs are inaccessible or offer limited play options for individuals who are unable to stand, have balance issues, poor motor control, or cannot use their lower body to perform game activities. Making AVGs accessible to people with disabilities offers an innovative approach to overcoming various barriers to participation in physical activity. Objective Our aim was to compare the effect of off-the-shelf and adapted game controllers on quality of game play, enjoyment, and energy expenditure during active video gaming in persons with physical disabilities, specifically those with mobility impairments (ie, unable to stand, balance issues, poor motor control, unable to use lower extremity for gameplay). The gaming controllers to be evaluated include off-the-shelf and adapted versions of the Wii Fit balance board and gaming mat. Methods Participants (10-60 years old) came to the laboratory a total of three times. During the first visit, participants completed a functional assessment and became familiar with the equipment and games to be played. For the functional assessment, participants performed 18 functional movement tasks from the International Classification of Functioning, Disability, and Health. They also answered a series of questions from the Patient Reported Outcomes Measurement Information System and Quality of Life in Neurological Conditions measurement tools, to provide a personal perspective regarding their own functional ability. For Visit 2, metabolic data were collected during an initial 20-minute baseline, followed by 40 minutes of game play. The controller (balance board or gaming mat) played was randomly selected. A set of games was played for 10 minutes, followed by 5 minutes of rest, and then another set of games was played for 10 minutes, followed by rest. Quality of game play was observed and documented for each set. During rest, the participant completed questions regarding enjoyment. Following the same procedures, the participant then played the two sets of games using the other version (off-the-shelf or adapted) of the controller. The entire procedure was repeated during Visit 3 with the controller that was not played. Results Enrollment began in February 2016 and ended in September 2016. Study results will be reported in late 2017. Conclusions We hypothesized that the adapted versions of the Wii Fit balance board and gaming mat would produce greater quality of game play, enjoyment, and energy expenditure in persons with mobility impairments compared to off-the-shelf versions. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6qpPszPJ7)
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Affiliation(s)
- Laurie A Malone
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | | | - Justin McCroskey
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
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Chanpimol S, Seamon B, Hernandez H, Harris-Love M, Blackman MR. Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI. Arch Physiother 2017; 7:6. [PMID: 28824816 PMCID: PMC5560163 DOI: 10.1186/s40945-017-0033-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/09/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. METHODS A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. RESULTS Dynamic balance, characterized by the DGI, increased during the intervention phase χ2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = < .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. CONCLUSIONS Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. TRIAL REGISTRATION Clinicaltrial.gov ID - NCT02889289.
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Affiliation(s)
- Shane Chanpimol
- Neurology Service, Veterans Affairs Medical Center, Washington, DC USA
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
| | - Bryant Seamon
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
| | - Haniel Hernandez
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
| | - Michael Harris-Love
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center - Human Performance Research Unit, Veterans Affairs Medical Center, Washington, DC USA
- Geriatrics and Extended Care Service/Research Service, Veterans Affairs Medical Center, Washington, DC USA
- Department of Exercise and Nutritional Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Marc R. Blackman
- Research Service, Veterans Affairs Medical Center, Washington, DC USA
- Departments of Medicine, Biochemistry and Molecular Medicine, George Washington University School of Medicine, Washington, DC USA
- Departments of Medicine and Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC USA
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Abstract
The aim of this paper was to investigate the effect of commercial video games (VGs) in physical rehabilitation of motor functions. Several databases were screened (Medline, SAGE Journals Online, and ScienceDirect) using combinations of the following free-text terms: commercial games, video games, exergames, serious gaming, rehabilitation games, PlayStation, Nintendo, Wii, Wii Fit, Xbox, and Kinect. The search was limited to peer-reviewed English journals. The beginning of the search time frame was not restricted and the end of the search time frame was 31 December 2015. Only randomized controlled trial, cohort, and observational studies evaluating the effect of VGs on physical rehabilitation were included in the review. A total of 4728 abstracts were screened, 275 were fully reviewed, and 126 papers were eventually included. The following information was extracted from the selected studies: device type, number and type of patients, intervention, and main outcomes. The integration of VGs into physical rehabilitation has been tested for various pathological conditions, including stroke, cerebral palsy, Parkinson's disease, balance training, weight loss, and aging. There was large variability in the protocols used (e.g. number of sessions, intervention duration, outcome measures, and sample size). The results of this review show that in most cases, the introduction of VG training in physical rehabilitation offered similar results as conventional therapy. Therefore, VGs could be added as an adjunct treatment in rehabilitation for various pathologies to stimulate patient motivation. VGs could also be used at home to maintain rehabilitation benefits.
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Mat Rosly M, Mat Rosly H, Davis OAM GM, Husain R, Hasnan N. Exergaming for individuals with neurological disability: a systematic review. Disabil Rehabil 2016; 39:727-735. [DOI: 10.3109/09638288.2016.1161086] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Maziah Mat Rosly
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hadi Mat Rosly
- Department of Mechatronics Engineering, Faculty of Engineering, International Islamic University, Selangor, Malaysia
| | - Glen M. Davis OAM
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Ruby Husain
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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High metabolic cost and low energy expenditure for typical motor activities among individuals in the chronic phase after stroke. J Neurol Phys Ther 2015; 38:226-32. [PMID: 25198864 DOI: 10.1097/npt.0000000000000053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Energy variables, such as metabolic cost (MC) and energy expenditure (EE), are important characteristics of motor activities that can influence daily activity and have implications for health. In individuals poststroke, these variables have previously been described only for walking. Our goal was to characterize the MC and EE of typical motor activities among individuals in the chronic phase poststroke and compare them with those of able-bodied individuals. METHODS Eleven individuals with poststroke and 8 able-bodied individuals participated in this study. Four activities were tested: sit-to-walk-to-sit, walking over an obstacle course, walking at a comfortable speed, and reaching for an object while in a standing position. Each activity was performed repeatedly for 8 minutes, while oxygen consumption was recorded. The MC of the activities was calculated by dividing the mean oxygen consumption by walking speed or the number of repetitions. The EE was represented by metabolic equivalents. RESULTS There was a significant interaction effect of group and activity on MC and EE (P = 0.001 and P = 0.007, respectively). In the participants poststroke, the MC of mobility activities ranged from 0.24 (0.06) to 0.3 (0.06) mL/kg/m, and the MC of the standing activity was 0.1 (0.03) mL/kg/repetition. The MC was higher for the participants poststroke than for the able-bodied participants (P < 0.001). The EE of the participants poststroke ranged from 1.96 (0.4) to 3.83 (0.6) metabolic equivalents and was lower compared with the able-bodied participants (P = 0.001). DISCUSSION AND CONCLUSIONS Individuals poststroke have high MC and low EE across various motor activities. These findings suggest that rehabilitation programs need to specifically address the energetic domain.Video Abstract available. See Video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A75) for more insights from the authors.
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Swanson LR, Whittinghill DM. Intrinsic or Extrinsic? Using Videogames to Motivate Stroke Survivors: A Systematic Review. Games Health J 2015; 4:253-8. [PMID: 26182071 DOI: 10.1089/g4h.2014.0074] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The main objective of this study was to explore, via a systematic review of available literature, the effectiveness of videogame-based rehabilitation interventions on the motivation and health outcomes of stroke patients. MATERIALS AND METHODS Using a systematic literature review of 18 articles, we sought to address three key research questions: (1) Do videogames improve function or health outcomes among stroke survivors? (2) Do videogames increase stroke patients' motivation to engage in rehabilitation exercise and activities? (3) Which motivational techniques, principles, and theoretical frameworks have been applied in the reviewed studies? A key word search was conducted, and articles were coded for inclusion of motivational theories or principles, intervention effectiveness, and participants' motivation to perform tasks. Three motivational frameworks and principles were used (self-determination theory [SDT], flow theory, and operant conditioning) to investigate intrinsic and extrinsic approaches. RESULTS Past research suggests videogame-based interventions are effective at improving and increasing a variety of health-related outcomes, including motor functioning, energy expenditure, muscle strength, and recovery times in stroke patients. CONCLUSIONS Past evidence shows videogame-based interventions are a promising tool to motivate stroke patients' engagement in effective rehabilitation activities. This study also identifies an opportunity for future research to apply motivational theories from SDT to studies on stroke rehabilitation and videogames.
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Cleveland S, Driver S, Swank C, Macklin S. Classifying physical activity research following stroke using the behavioral epidemiologic framework. Top Stroke Rehabil 2015; 22:289-98. [PMID: 26258454 DOI: 10.1179/1074935714z.0000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. OBJECTIVE To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. METHODS Specific key words were identified and then searched through EBSCO host, PubMed, and Google Scholar. Physical activity and stroke literature from 2000-2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. RESULTS A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). CONCLUSION Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.
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Wiemeyer J, Deutsch J, Malone LA, Rowland JL, Swartz MC, Xiong J, Zhang FF. Recommendations for the Optimal Design of Exergame Interventions for Persons with Disabilities: Challenges, Best Practices, and Future Research. Games Health J 2015; 4:58-62. [PMID: 26181682 PMCID: PMC4601672 DOI: 10.1089/g4h.2014.0078] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A group discussion of individuals with expertise working in the field of exergaming and rehabilitation focused on the issue of designing exergames for persons with disabilities as well as appropriate interventions using exergames. The purpose of these discussions was to develop recommendations for the design, evaluation, and application of exergames in therapy serving as potential guidelines for researchers, developers, and therapists. The following key issues were addressed: (1) Challenges in exergame design for persons with disabilities, (2) adaptation of exergames for persons with disabilities, (3) exergame interventions, and (4) future research directions. It is the hope of the group that the results of these recommendations will help improve the quality of exergame design and interventions and thereby increase opportunities for persons with disabilities to engage sustainably in exergaming.
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Affiliation(s)
- Josef Wiemeyer
- Institute of Sport Science, Technische Universität Darmstadt, Darmstadt, Germany
| | - Judith Deutsch
- Rutgers Behavioral Health Sciences University, Newark, New Jersey
| | | | | | - Maria C. Swartz
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Taylor MJD, Griffin M. The use of gaming technology for rehabilitation in people with multiple sclerosis. Mult Scler 2014; 21:355-71. [PMID: 25533296 DOI: 10.1177/1352458514563593] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Gaming technology - exergaming - is a novel tool to facilitate exercise, improve balance, and encourage rehabilitation training. This review will describe some of the key exergame research to promote physical activity and its use in rehabilitation in other diseases or clinical populations. We will then describe the current state of research in exergaming in people with multiple sclerosis and describe the theories for the mechanism behind some of the improvements in outcomes seen after using exergaming. Lastly, we will identify gaps in the literature and provide directions for future work in this growing area. The current work is contradictory and there is no consensus with regards to training duration/intensity and the outcomes used to assess the clinical effectiveness. This in part is due to the off-the-shelf nature of the games used. A more satisfactory approach would be the development of bespoke games which match a clinical need. Exergames are seen as enjoyable and could be effective in enhancing adherence to rehabilitation. However, the definitive RCT has yet to be carried out comparing exergaming to traditional exercise.
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Affiliation(s)
- M J D Taylor
- School of Biological Sciences, University of Essex Colchester, UK
| | - M Griffin
- School of Biological Sciences, University of Essex Colchester, UK
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Deutsch JE, Guarrera-Bowlby P, Myslinski MJ, Kafri M. Is There Evidence That Active Videogames Increase Energy Expenditure and Exercise Intensity for People Poststroke and with Cerebral Palsy? Games Health J 2014; 4:31-7. [PMID: 26181678 DOI: 10.1089/g4h.2014.0082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article asked and answered the question of whether there was evidence to support the use of videogames for promotion of wellness and fitness for people poststroke and those with cerebral palsy (CP). A literature search of PubMed, CINAHL, and PEDro using a population, intervention, and outcome (PIO) approach and the key words "stroke (or CP) AND video games (and synonyms) AND energy expenditure (EE) (and synonyms)" was conducted. It yielded two relevant references for people poststroke and five references for people with CP. The literature extraction and synthesis by the categories of the PIO indicated that most studies used only the population of interest, except two that compared the EE with that of healthy controls. The main finding is that both people poststroke (moderate severity) and people with CP (mild severity) can achieve moderate EE playing Wii(™) (Nintendo, Kyoto, Japan), PlayStation(®) (Sony, Tokyo, Japan), and Kinect(™) (Microsoft, Redmond, WA) games. Adults with CP of mild severity played the videogames at vigorous levels, whereas those with severe CP played them at low levels. There appears to be an interaction between development and severity that influences the exercise intensity measured by EE. The findings suggests that videogames are a gateway for wellness promotion.
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Affiliation(s)
- Judith E Deutsch
- 1 Rivers Lab, Rutgers University , Newark, New Jersey, USA.,2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Phyllis Guarrera-Bowlby
- 1 Rivers Lab, Rutgers University , Newark, New Jersey, USA.,2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Mary Jane Myslinski
- 2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Michal Kafri
- 3 Program in Physical Therapy, University of Haifa , Haifa, Israel
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The efficacy of balance training with video game-based therapy in subacute stroke patients: a randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:580861. [PMID: 24877116 PMCID: PMC4026958 DOI: 10.1155/2014/580861] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/25/2014] [Accepted: 04/06/2014] [Indexed: 11/18/2022]
Abstract
The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results, whereas little information is available regarding the use of this therapy in subacute stroke patients. The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase. Fifty adult stroke patients participated to the study: 25 subjects were randomly assigned to balance training with Wii Fit, and the other 25 subjects were assigned to usual balance therapy. Both groups were also treated with conventional physical therapy (40 min 2 times/day). The main outcome was functional balance (Berg Balance Scale-BBS), and secondary outcomes were disability (Barthel Index-BI), walking ability (Functional Ambulation Category), and walking speed (10-meters walking test). Wii Fit training was more effective than usual balance therapy in improving balance (BBS: 53 versus 48, P = 0.004) and independency in activity of daily living (BI: 98 versus 93, P = 0.021). A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke.
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Xian Y, Kakinami L, Peterson ED, Mustian KM, Fernandez ID. Will Nintendo “Wii Fit” Get You Fit? An Evaluation of the Energy Expenditure from Active-Play Videogames. Games Health J 2014. [DOI: 10.1089/g4h.2013.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Ying Xian
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Lisa Kakinami
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Karen M. Mustian
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - I. Diana Fernandez
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
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Pompeu JE, Arduini LA, Botelho AR, Fonseca MBF, Pompeu SMAA, Torriani-Pasin C, Deutsch JE. Feasibility, safety and outcomes of playing Kinect Adventures!™ for people with Parkinson's disease: a pilot study. Physiotherapy 2013; 100:162-8. [PMID: 24703891 DOI: 10.1016/j.physio.2013.10.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/14/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the feasibility, safety and outcomes of playing Microsoft Kinect Adventures™ for people with Parkinson's disease in order to guide the design of a randomised clinical trial. DESIGN Single-group, blinded trial. SETTING Rehabilitation Center of São Camilo University, Brazil. PARTICIPANTS Seven patients (six males, one female) with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). INTERVENTIONS Fourteen 60-minute sessions, three times per week, playing four games of Kinect Adventures! MAIN OUTCOME MEASURES The feasibility and safety outcomes were patients' game performance and adverse events, respectively. The clinical outcomes were the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and Parkinson's Disease Questionnaire (PDQ-39). RESULTS Patients' scores for the four games showed improvement. The mean [standard deviation (SD)] scores in the first and last sessions of the Space Pop game were 151 (36) and 198 (29), respectively [mean (SD) difference 47 (7), 95% confidence interval 15 to 79]. There were no adverse events. Improvements were also seen in the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and PDQ-39 following training. CONCLUSION Kinect-based training was safe and feasible for people with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). Patients improved their scores for all four games. No serious adverse events occurred during training with Kinect Adventures!, which promoted improvement in activities (balance and gait), body functions (cardiopulmonary aptitude) and participation (quality of life).
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Affiliation(s)
- J E Pompeu
- University of São Paulo; School of Medicine; Department of Physical Therapy, Speech and Occupational Therapy, São Paulo, Brazil.
| | - L A Arduini
- University of São Paulo; School of Medicine; Department of Physical Therapy, Speech and Occupational Therapy, São Paulo, Brazil
| | - A R Botelho
- University of São Paulo; School of Medicine; Department of Physical Therapy, Speech and Occupational Therapy, São Paulo, Brazil
| | - M B F Fonseca
- University of São Paulo; School of Medicine; Department of Physical Therapy, Speech and Occupational Therapy, São Paulo, Brazil
| | - S M A A Pompeu
- University of São Paulo; School of Medicine; Department of Physical Therapy, Speech and Occupational Therapy, São Paulo, Brazil
| | - C Torriani-Pasin
- School of Physical Education and Sports, Motor Behavior Laboratory, University of Sao Paulo, Brazil
| | - J E Deutsch
- Department of Rehabilitation and Movement Science of Rutgers University, United States of America
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