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Mao Q, Zhang J, Yu L, Zhao Y, Luximon Y, Wang H. Effectiveness of sensor-based interventions in improving gait and balance performance in older adults: systematic review and meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2024; 21:85. [PMID: 38807117 PMCID: PMC11131332 DOI: 10.1186/s12984-024-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Sensor-based interventions (SI) have been suggested as an alternative rehabilitation treatment to improve older adults' functional performance. However, the effectiveness of different sensor technologies in improving gait and balance remains unclear and requires further investigation. METHODS Ten databases (Academic Search Premier; Cumulative Index to Nursing and Allied Health Literature, Complete; Cochrane Central Register of Controlled Trials; MEDLINE; PubMed; Web of Science; OpenDissertations; Open grey; ProQuest; and Grey literature report) were searched for relevant articles published up to December 20, 2022. Conventional functional assessments, including the Timed Up and Go (TUG) test, normal gait speed, Berg Balance Scale (BBS), 6-Minute Walk Test (6MWT), and Falling Efficacy Scale-International (FES-I), were used as the evaluation outcomes reflecting gait and balance performance. We first meta-analyzed the effectiveness of SI, which included optical sensors (OPTS), perception sensors (PCPS), and wearable sensors (WS), compared with control groups, which included non-treatment intervention (NTI) and traditional physical exercise intervention (TPEI). We further conducted sub-group analysis to compare the effectiveness of SI (OPTS, PCPS, and WS) with TPEI groups and compared each SI subtype with control (NTI and TPEI) and TPEI groups. RESULTS We scanned 6255 articles and performed meta-analyses of 58 selected trials (sample size = 2713). The results showed that SI groups were significantly more effective than control or TPEI groups (p < 0.000) in improving gait and balance performance. The subgroup meta-analyses between OPTS groups and TPEI groups revealed clear statistically significant differences in effectiveness for TUG test (mean difference (MD) = - 0.681 s; p < 0.000), normal gait speed (MD = 4.244 cm/s; p < 0.000), BBS (MD = 2.325; p = 0.001), 6MWT (MD = 25.166 m; p < 0.000), and FES-I scores (MD = - 2.036; p = 0.036). PCPS groups also presented statistically significant differences with TPEI groups in gait and balance assessments for normal gait speed (MD = 4.382 cm/s; p = 0.034), BBS (MD = 1.874; p < 0.000), 6MWT (MD = 21.904 m; p < 0.000), and FES-I scores (MD = - 1.161; p < 0.000), except for the TUG test (MD = - 0.226 s; p = 0.106). There were no statistically significant differences in TUG test (MD = - 1.255 s; p = 0.101) or normal gait speed (MD = 6.682 cm/s; p = 0.109) between WS groups and control groups. CONCLUSIONS SI with biofeedback has a positive effect on gait and balance improvement among a mixed population of older adults. Specifically, OPTS and PCPS groups were statistically better than TPEI groups at improving gait and balance performance, whereas only the group comparison in BBS and 6MWT can reach the minimal clinically important difference. Moreover, WS groups showed no statistically or clinically significant positive effect on gait and balance improvement compared with control groups. More studies are recommended to verify the effectiveness of specific SI. Research registration PROSPERO platform: CRD42022362817. Registered on 7/10/2022.
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Affiliation(s)
- Qian Mao
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiaxin Zhang
- School of System Design and Intelligent Manufacturing, Southern University of Science and Technology, Shenzhen, China
| | - Lisha Yu
- School of Data Science, Lingnan University, Hong Kong, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yan Luximon
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hailiang Wang
- School of Design, The Hong Kong Polytechnic University, Hong Kong, China.
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Menici V, Scalise R, Fasano A, Falotico E, Dubbini N, Prencipe G, Sgandurra G, Filogna S, Battini R. Assessment of Postural Control in Children with Movement Disorders by Means of a New Technological Tool: A Pilot Study. Bioengineering (Basel) 2024; 11:176. [PMID: 38391662 PMCID: PMC10886107 DOI: 10.3390/bioengineering11020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Considering the variability and heterogeneity of motor impairment in children with Movement Disorders (MDs), the assessment of postural control becomes essential. For its assessment, only a few tools objectively quantify and recognize the difference among children with MDs. In this study, we use the Virtual Reality Rehabilitation System (VRRS) for assessing the postural control in children with MD. Furthermore, 16 children (mean age 10.68 ± 3.62 years, range 4.29-18.22 years) were tested with VRRS by using a stabilometric balance platform. Postural parameters, related to the movements of the Centre of Pressure (COP), were collected and analyzed. Three different MD groups were identified according to the prevalent MD: dystonia, chorea and chorea-dystonia. Statistical analyses tested the differences among MD groups in the VRRS-derived COP variables. The mean distance, root mean square, excursion, velocity and frequency values of the dystonia group showed significant differences (p < 0.05) between the chorea group and the chorea-dystonia group. Technology provides quantitative data to support clinical assessment: in this case, the VRRS detected differences among the MD patterns, identifying specific group features. This tool could be useful also for monitoring the longitudinal trajectories and detecting post-treatment changes.
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Affiliation(s)
- Valentina Menici
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
- Ph.D. Programme in Clinical and Translational Sciences, University of Pisa, 56126 Pisa, Italy
| | - Roberta Scalise
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
| | - Alessio Fasano
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy
| | - Egidio Falotico
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | | | - Giuseppe Prencipe
- Department of Computer Science, University of Pisa, 56127 Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Silvia Filogna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Wang L, Li F, Tang L. Chronic effects of different exercise types on brain activity in healthy older adults and those with Parkinson’s disease: A systematic review. Front Physiol 2022; 13:1031803. [DOI: 10.3389/fphys.2022.1031803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: This study aimed to compare the regulation of brain activity by different kinds of long-term exercises (Tai Chi, treadmill training, and dancing) in healthy older adults and those with PD.Methods: From January 2000 to October 2021, the electronic databases PubMed, Web of Science, and Scopus were searched. All articles were screened throughout the inclusion and exclusion criteria, which was followed by PICOS criteria. Finally, all articles were systematically reviewed with analyses.Results: 29 studies were identified for this review, 24 of which were finally included in a group of healthy older adults, and five of which in a group of people with PD. All studies showed that significant changes were showed on people with PD and healthy older adults’ brain activity after three terms of the exercises we chose. An inverse change trend on the functional connectivity in people with PD was observed after treadmill training, whereas increased brain activity, cognitive function, memory, and emotion were noticed in healthy older adults.Conclusion: Our findings suggest that different patterns of brain activity were also observed between healthy older adults and people with PD after treadmill training. However, more robust evidence and comprehensive studies are needed to determine if there is a difference between healthy older adults and people with PD.
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Pérez VZ, Yepes JC, Vargas JF, Franco JC, Escobar NI, Betancur L, Sánchez J, Betancur MJ. Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims. SENSORS (BASEL, SWITZERLAND) 2022; 22:5602. [PMID: 35898105 PMCID: PMC9332850 DOI: 10.3390/s22155602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims.
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Affiliation(s)
- Vera Z. Pérez
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.C.Y.); (J.C.F.); (N.I.E.); (M.J.B.)
| | - Juan C. Yepes
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.C.Y.); (J.C.F.); (N.I.E.); (M.J.B.)
| | - John F. Vargas
- Facultad de Ingeniería en TIC, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.F.V.); (L.B.)
| | - Juan C. Franco
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.C.Y.); (J.C.F.); (N.I.E.); (M.J.B.)
| | - Natalia I. Escobar
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.C.Y.); (J.C.F.); (N.I.E.); (M.J.B.)
| | - Leonardo Betancur
- Facultad de Ingeniería en TIC, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.F.V.); (L.B.)
| | - Juanita Sánchez
- Grupo de Investigación Fisioter, Fundación Universitaria María Cano, Medellín 050012, Colombia;
| | - Manuel J. Betancur
- Facultad de Ingeniería Electrónica, Universidad Pontificia Bolivariana, Medellín 050031, Colombia; (J.C.Y.); (J.C.F.); (N.I.E.); (M.J.B.)
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Walia S, Kumar P, Kataria C. Efficacy of Electrical Stimulation-Augmented Virtual Reality Training in Improving Balance in Individuals with Incomplete Spinal Cord Injury: Study Protocol of a Randomized Controlled Trial. Asian Spine J 2021; 15:865-873. [PMID: 33371624 PMCID: PMC8696057 DOI: 10.31616/asj.2020.0047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This study is a single-blind, parallel, three-group, and randomized controlled trial. PURPOSE This study aimed to investigate the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with incomplete spinal cord injury (iSCI). OVERVIEW OF LITERATURE Individuals with iSCI often face significant balance and mobility impairments affecting their quality of life. Scientific studies focusing on standing balance training in the iSCI population are limited. Virtual reality-based balance training has shown positive results in several neurological populations. Electrical stimulation has also proved to be effective in improving voluntary muscle strength in partially paralyzed muscles after iSCI as well as promoting neuroplasticity. METHODS Forty-eight iSCI participants will be recruited based on the inclusion criteria. The participants will be randomly assigned to any of the three groups: virtual reality-based balance training along with the electrical stimulation group, virtual reality-based balance training along with sham stimulation group, or virtual reality-based balance training group. The intervention will be delivered as 60-minute sessions, thrice a week for 4 weeks. RESULTS The performance of the participants will be assessed using the lower extremity motor score, static and dynamic balance assessment using TechnoBody ProKin tilting platform and Berg Balance Scale, Walking Index for Spinal Cord Injury, and World Health Organization Quality of Life-BREF at pre-intervention, after 4 weeks post-intervention, and at 1-month follow-up. CONCLUSIONS The trial will provide new knowledge about the effectiveness of electrical stimulation-augmented virtual reality training in improving balance in individuals with iSCI. The study results will contribute to the design of better rehabilitation programs for individuals with iSCI.
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Affiliation(s)
- Shefali Walia
- Amity Institute of Physiotherapy, Amity University Uttar Pradesh, Noida,
India
- ISIC Institute of Rehabilitation Sciences, Indian Spinal Injuries Centre, New Delhi,
India
| | - Pragya Kumar
- Amity Institute of Physiotherapy, Amity University Uttar Pradesh, Noida,
India
| | - Chitra Kataria
- ISIC Institute of Rehabilitation Sciences, Indian Spinal Injuries Centre, New Delhi,
India
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Applying Game-Based Approaches for Physical Rehabilitation of Poststroke Patients: A Systematic Review. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9928509. [PMID: 34567491 PMCID: PMC8457987 DOI: 10.1155/2021/9928509] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/15/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022]
Abstract
Objective A large number of patients need critical physical rehabilitation after the stroke. This study aimed to review and report the result of published studies, in which newly emerged games were employed for physical rehabilitating in poststroke patients. Materials and Methods This systematic review study was performed based on the PRISMA method. A comprehensive search of PubMed, Scopus, IEEE Xplore Digital Library, and ISI Web of Science was conducted from January 1, 2014, to November 9, 2020, to identify related articles. Studies have been entered in this review based on inclusion and exclusion criteria, in which new games have been used for physical rehabilitation. Results Of the 1326 retrieved studies, 60 of them met our inclusion criteria. Virtual reality-oriented games were the most popular type of physical rehabilitation approach for poststroke patients. “The Nintendo Wii Fit” game was used more than other games. The reviewed games were mostly operated to balance training and limb mobilization. Based on the evaluation results of the utilized games, only in three studies, applied games were not effective. In other studies, games had effective outcomes for target body members. Conclusions The results indicate that modern games are efficient in poststroke patients' physical rehabilitation and can be used alongside conventional methods.
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Ong DSM, Weibin MZ, Vallabhajosyula R. Serious games as rehabilitation tools in neurological conditions: A comprehensive review. Technol Health Care 2021; 29:15-31. [PMID: 32804107 DOI: 10.3233/thc-202333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of serious games (SG) in rehabilitation has been on the rise in recent years and they are used as either a main interventional tool, or as an adjunct alongside conventional therapies. This is largely due to its virtue of being an electronic platform hence possessing game characteristics that facilitates patient progress. OBJECTIVE The present study aimed to provide a comprehensive review of the impact of SG on neurorehabilitation therapies as well as patients' perspectives on rehabilitation. METHODS The literature search was conducted in PubMed and Cochrane databases. The study was conducted in four different phases, consisting of the generation of MeSH terms and keywords, screening of articles, and data analysis based on the study characteristics. RESULTS This review included 47 studies that explored the use of custom designed experimental serious games (ESG) or commercially designed serious games (CSG) for rehabilitation in a few neurological conditions. The majority of CSG used Nintendo Wii as an adjunct to conventional therapies. Significant improvement in the primary outcomes such as motor functioning, balance, executive and cognitive functions were reported in 35 studies. 17 studies also indicated patient perspectives on rehabilitation. There was no difference between the overall impact of either CSG or ESG. CONCLUSION Evidently, SG are efficient exergame tools. However, future studies should explore patient perspectives that could help to design evidence-based games for rehabilitation purposes.
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Marinkovic D, Belic A, Marijanac A, Martin-Wylie E, Madic D, Obradovic B. Static and dynamic postural stability of children girls engaged in modern dance. Eur J Sport Sci 2021; 22:354-359. [PMID: 33896398 DOI: 10.1080/17461391.2021.1922503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND : Postural stability (PS) has an important role in many athletic activities. However, modern dance demands a heightened PS because of the required aesthetic quality and speed of movement. The aim of the present study was to compare the static and dynamic PS of young dancers and participants of other sporting activities. METHOD : A total of 101 girls (age: 7.91 ± 0.7 year) were divided into a Dance group (N = 53) and a physically active Control group (N = 48). Static PS was assessed with a two-leg standing test on a Force plate, and dynamic PS was assessed with a Körperkoordinationstest für Kinder (KTK) - a walking backwards test on a balance beam. RESULTS : Multivariate analysis of variance showed a general difference between the groups (F = 21.95; p ≤ 0.0001). In static PS, the Dance group was better in Total distance of center of pressure (COP) (p ≤ 0.0001; ES = -1.70), Anterior-posterior oscillation (p ≤ 0.0001; ES = -1.40), Medial-lateral oscillation (p ≤ 0.0001; ES = 1.75) and Length in function of surface (p ≤ 0.0001; ES = -0.98). Both parameters of dynamic stability, the KTK test (p ≤ 0.0001; ES = 1.28) and Motor quotients KTK test (p ≤ 0.0001; ES = 1.45), were significantly better in the Dance group. CONCLUSION : The results from the present study indicate that children girls who participate mostly in dance develop better static and dynamic PS than children girls who participate in other sport activities. These findings underline the importance of training modification toward the improvement of PS in dance.
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Affiliation(s)
- Dragan Marinkovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia.,"Foro Italico", University of Rome, Rome, Italy
| | - Aleksandra Belic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Ana Marijanac
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Ellis Martin-Wylie
- Faculty of Dance, Trinity Laban Conservatoire of Music and Dance, London, UK
| | - Dejan Madic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Borislav Obradovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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Espy D, Reinthal A, Dal Bello-Haas V. A Clinical Decision-Making Framework for the Use of Video Gaming as a Therapeutic Modality. Front Neurol 2021; 12:610095. [PMID: 34122293 PMCID: PMC8193226 DOI: 10.3389/fneur.2021.610095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Virtual reality and video gaming offer modulation of more exercise and motor learning parameters simultaneously than other modalities; however, there is a demonstrated need for resources to facilitate their effective use clinically. This article presents a conceptual framework to guide clinical-decision making for the selection, adaptation, modulation, and progression of virtual reality or gaming when used as a therapeutic exercise modality, and two cases as exemplars. This framework was developed by adapting the steps of theory derivation, whereby concepts and parent theories are brought together to describe a new structure or phenomenon of interest. Specifically, motor learning theory, integrated motor control theory, Gentile's Taxonomy of Tasks, and therapeutic exercise principles were integrated to develop this framework. It incorporates person (body segment), environmental, and task demands; each demand is comprised of realm, category, choice, and continuum parameters as motor training considerations and alternatives for decision-making. This framework: (1) provides structure to guide clinical decisions for effective and safe use of virtual reality or gaming to meet therapeutic goals and requirements, (2) is a concise and organized method to identify, document, and track the therapeutic components of protocols and client progression over time; (3) can facilitate documentation for reimbursement and communication among clinicians; and, (4) structures student learning, and (5) informs research questions and methods.
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Affiliation(s)
- Debbie Espy
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
| | - Ann Reinthal
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
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Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041819. [PMID: 33668438 PMCID: PMC7918193 DOI: 10.3390/ijerph18041819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people's multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well-being.
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Hedonic and Utilitarian Motivations of Home Motion-Sensing Game Play Behavior in China: An Empirical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238794. [PMID: 33256148 PMCID: PMC7730092 DOI: 10.3390/ijerph17238794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
As an important branch of video games and the integration of emerging motion-sensing technology, home motion-sensing games cannot only bring hedonic entertainment but also promote utilitarian benefits including exercise and social interaction for people to improve their physical and psychological health. As one of the most populous countries in the world, China has the largest number of households in the world but quite a low home game penetration rate due to the 13 year game industry winter for international enterprises. Whether Chinese customers have the intention of using motion-sensing games to improve their health status in the home environment will directly determine the commercial potential of the relevant industry in the Chinese market. In order to understand the motives of users and explore the market possibility and prospects of the game industry, this study adopts empirical research and structural equation modeling to construct a motivation model of Chinese consumers toward motion-sensing gameplay behavior in the household environment. We distributed 515 questionnaires to conduct a survey; 427 valid responses have been received, and 203 data, which meet the inclusion criteria of the required game experience, have been analyzed by SPSS25.0 and AMOS25.0. A structural equation model for the gameplay motivation has been constructed. The result shows that the three functional motivators, exercise (Path efficient = 0.40, p < 0.01), entertainment (Path efficient = 0.27, p < 0.01), and social interaction (Path efficient = 0.36, p < 0.01) of home motion-sensing games have a significantly positive impact on the user's intention to play. Furthermore, the diversity and the time-and-place flexibility variables exert an important positive influence on the users' gameplay behavior through their effects on the three main functional motive variables. To sum up, (1) exercise, (2) entertainment, and (3) social interaction are the main functional motivations of the Chinese consumers' gameplay behaviors; (4) diversity and (5) time-and-place flexibility are the two main attribute motivators. The acceptance of Chinese users for home motion-sensing games remains positive and high. The motion-sensing game industry has broad market prospects in China through its potential in promoting consumer's wellness and health in the home environment.
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Objective evaluation of Nintendo Wii Fit Plus balance program training on postural stability in Multiple Sclerosis patients: a pilot study. Int J Rehabil Res 2020; 43:199-205. [DOI: 10.1097/mrr.0000000000000408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Loughlin EK, Dutczak H, Kakinami L, Consalvo M, McGrath JJ, Barnett TA. Exergaming in Youth and Young Adults: A Narrative Overview. Games Health J 2020; 9:314-338. [PMID: 32017864 DOI: 10.1089/g4h.2019.0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Because of rapid evolution in exergaming technology and content, the literature on the benefits of exergaming needs ongoing review. Updated syntheses incorporating high-quality critical assessments of included articles can provide cutting-edge evidence to drive research and practice. The objectives were to summarize evidence from systematic reviews and meta-analyses on the association between exergaming and (1) physical activity (PA), sedentary behavior and energy expenditure (EE); and (2) body composition, body mass index (BMI), and other weight-related outcomes among persons younger than 30 years; and to summarize recommendations in the articles retained. The Elton B. Stephens Co. (ESBSCO) database for reviews was searched from January 1995 to July 2019. Data on study characteristics, findings, and recommendations for future research, game design, and intervention development were extracted from articles that met the inclusion criteria, quality scores were attributed to each article, and a narrative overview of the evidence was undertaken. Twenty-eight reviews, with 5-100 articles per review, were identified. Seventeen assessed the evidence on the association between exergaming and PA, EE, and/or sedentary behavior, and 11 examined the association with body composition, BMI, or other weight-related outcomes. There was substantial heterogeneity across reviews in objectives, definitions, and methods. A positive relationship between exergaming and EE is well documented, but whether exergaming increases PA or changes body composition is not established. The reviews retained also provide evidence that exergaming is a healthier alternative to sedentary behavior and that it can be an exciting enjoyable pastime for youth, which adds variety in PA options for health and dietary interventions. Exergaming is likely more physically health promoting than traditional videogames because of higher EE and possibly improved physical fitness and body composition. Longitudinal studies are needed to assess if exergaming reduces sedentary time, has other health benefits, or is a sustainable behavior. We recommend that exergaming interventions be designed using behavior change theory, and that future reviews use standard review criteria and include recommendations for research, game design, and intervention development.
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Affiliation(s)
- Erin K O'Loughlin
- INDI department, Concordia University, Montreal, Canada.,Department of Social and Preventive Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CRCHUM), Montreal, Canada
| | - Hartley Dutczak
- Department of Public Health, Environments and Society. Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Lisa Kakinami
- Department of Mathematics and Statistics, Concordia University, Montreal, Canada.,PERFORM Centre, Concordia University, Montreal, Canada
| | - Mia Consalvo
- Communications Department, Concordia University, Montreal, Canada
| | - Jennifer J McGrath
- PERFORM Centre, Concordia University, Montreal, Canada.,Psychology Department, Concordia University, Montreal, Canada
| | - Tracie A Barnett
- Department of Family Medicine, McGill University, Montreal, Canada.,CR du CHU Sainte-Justine, Montreal, Canada.,Centre Armand Frappier Santé Biotechnologie, Laval, Canada
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Alashram AR, Padua E, Hammash AK, Lombardo M, Annino G. Effectiveness of virtual reality on balance ability in individuals with incomplete spinal cord injury: A systematic review. J Clin Neurosci 2020; 72:322-327. [DOI: 10.1016/j.jocn.2020.01.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
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Hassett L, van den Berg M, Lindley RI, Crotty M, McCluskey A, van der Ploeg HP, Smith ST, Schurr K, Howard K, Hackett ML, Killington M, Bongers B, Togher L, Treacy D, Dorsch S, Wong S, Scrivener K, Chagpar S, Weber H, Pinheiro M, Heritier S, Sherrington C. Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial. PLoS Med 2020; 17:e1003029. [PMID: 32069288 PMCID: PMC7028259 DOI: 10.1371/journal.pmed.1003029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 01/22/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation. METHODS AND FINDINGS We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0-3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0-3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference -0.2, 95% CI -2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%-19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes. CONCLUSIONS In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted. TRIAL REGISTRATION The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN12614000936628.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maayken van den Berg
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Richard I. Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Annie McCluskey
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- StrokeEd Collaboration, Sydney, New South Wales, Australia
| | - Hidde P. van der Ploeg
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stuart T. Smith
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Karl Schurr
- StrokeEd Collaboration, Sydney, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maree L. Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Maggie Killington
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Bert Bongers
- Faculty of Design, Architecture and Building, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Leanne Togher
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Treacy
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simone Dorsch
- StrokeEd Collaboration, Sydney, New South Wales, Australia
- Physiotherapy Department and Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Physiotherapy Department and Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Katharine Scrivener
- StrokeEd Collaboration, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather Weber
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephane Heritier
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
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Sengupta M, Gupta A, Khanna M, Rashmi Krishnan UK, Chakrabarti D. Role of Virtual Reality in Balance Training in Patients with Spinal Cord Injury: A Prospective Comparative Pre-Post Study. Asian Spine J 2019; 14:51-58. [PMID: 31575113 PMCID: PMC7010509 DOI: 10.31616/asj.2019.0013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective comparative pre–post study. Purpose To evaluate the effects of game-based virtual reality (VR) training program for trunk postural control and balance in patients with spinal cord injury (SCI) and to assess the results according to the motor completeness (severity) of lesions using the American Spinal Injury Association Impairment Scale (AIS). Overview of Literature Training with VR based gaming has a role to play in improving balance in patients with SCI. Methods Patients with SCI (traumatic and non-traumatic) for <6 months were included in this hospital-based study. Participants were divided into two groups: experimental group (EG) consisting 21 patients, and control group (CG) consisting 12. Both groups underwent the conventional rehabilitation program. An additional training with semi-immersive VR therapy was conducted 5 days a week for 3 weeks in the EG with the focus on balance rehabilitation using the “Rhetoric.” The outcome measures were the Berg Balance Scale (BBS), balance section of the Tinetti Performance-Oriented Mobility Assessment (POMA-B), and Functional Reach Score (FRS). Results Both groups consisted of young participants (mean age, 28 and 30.5 years, respectively) and predominantly men (>80%). One-third of them had tetraplegia and two-third had paraplegia. Between-group analyses showed no statistically significant differences in the main effects between groups (p-value: BBS, 0.396; POMA-B, 0.238; FRS, 0.294), suggesting that the EG group did not show significant improvement in the trunk and posture at the end of training sessions than the CG group. Similarly, no significant difference was observed according to the severity (completeness) of SCI in the between-group analyses using the AIS (A/B vs. C/D). Conclusions VR is an adjunctive therapy for balance rehabilitation in patients with SCI.
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Affiliation(s)
- Madhusree Sengupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - U K Rashmi Krishnan
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhritiman Chakrabarti
- Department of Neuro Anaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India
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Ofori EK, Subramaniam S, Wang S, Bhatt T. Kinematic analysis of dance-based exergaming: effect of song pace on center of mass and joint mobility. J Phys Ther Sci 2019; 31:708-716. [PMID: 31631943 PMCID: PMC6751052 DOI: 10.1589/jpts.31.708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/15/2019] [Indexed: 12/01/2022] Open
Abstract
[Purpose] To establish a quantitative kinematic assessment method for examining postural
stability and physical mobility during dance-based exergaming. [Participants and Methods]
Fifteen young adults participated in one session of dance-based exergaming assessment
using segments from Kinect ‘Just Dance 3’ consisting of slow-, medium-, and fast-paced
songs. A motion capture system was used to record full body kinematics, and a customized
MATLAB code was used to compute the variables of interest, such as center of mass sway
area, excursion, and peaks, as well as step count and joint excursions. [Results] Total
center of mass sway area and excursion were significantly greater for slow-paced (total
sway area=1,077.6 ± 209.9 cm2; total excursion=629.8 ± 380.5 cm) and fast-paced
(total sway area=314.1 ± 133.6 cm2; total excursion=478.5 ± 149.0 cm) songs
than for the medium-paced song (total sway area=212.9 ± 346.0 cm2; total
excursion=311.2 ± 119.5 cm). Joint excursion was greater for the knee (ranging from: (slow
to fast-paced songs: 55.5°–83.1°) and hip (slow to fast-paced: 40.6°–50.4°) than for the
ankle (slow to fast-paced: 32.2°–46.7°) for all three dance paces. Additionally, step
count was significantly, positively correlated with song pace (r=0.52). [Conclusion] The
current study was able to quantify and provide normative values for postural control and
joint mobility among healthy young adults during dance-based exergaming with 3 hip-hop
songs of different paces from the Microsoft Kinect ‘Just Dance 3’. The results indicated
that different paces (intensities) of dance songs corresponded to distinct movement
kinematic trends, particularly with slow-paced song having the maximum center of mass
excursion and lowest joint excursion, while fast-paced song exhibits the reverse, along
with medium-paced song exhibiting the highest hip and ankle joint angle excursions, while
the fast-paced song had increased knee joint angle excursions.
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Affiliation(s)
- Ernest Kwesi Ofori
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
| | - Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
| | - Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
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González-González CS, Toledo-Delgado PA, Muñoz-Cruz V, Torres-Carrion PV. Serious games for rehabilitation: Gestural interaction in personalized gamified exercises through a recommender system. J Biomed Inform 2019; 97:103266. [PMID: 31408732 DOI: 10.1016/j.jbi.2019.103266] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/21/2019] [Accepted: 08/04/2019] [Indexed: 11/27/2022]
Abstract
One of the principal problems of rehabilitation is that therapy sessions can be boring due the repetition of exercises. Serious games, and in particular exergames in rehabilitation, can motivate, engage and increase patients' adherence to their treatment. Also, the automatic personalization of exercises to each patient can help therapists. Thus, the main objective of this work is to build an intelligent exergame-based rehabilitation system consisting of a platform with an exergame player and a designer tool. The intelligent platform includes a recommender system which analyzes user interactions, along with the user's history, to select new gamified exercises for the user. The main contributions of this paper focus, first, on defining a recommender system based on different difficulty levels and user skills. The recommender system offers the ability to provide the user with a personalized game mode based on his own history and preferences. The results of a triple validation with experts, users and rehabilitation center professionals reveal a positive impact on gestural interaction and rehabilitation uses. Also, different methods are presented for testing the rehabilitation recommender system.
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Affiliation(s)
| | - Pedro A Toledo-Delgado
- ITED Research Group, Department of Computer Science and Engineering, Universidad de La Laguna, Spain.
| | - Vanesa Muñoz-Cruz
- ITED Research Group, Department of Computer Science and Engineering, Universidad de La Laguna, Spain.
| | - Pablo V Torres-Carrion
- Inclusive Human Computer Interaction, Department of Computer Science and Electronics, Private Technical University of Loja, Ecuador.
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Abstract
Patients who require neurological rehabilitation often do not comply with conventional programs because they find the therapy uninteresting. As a result, specialized interactive video games have been designed to be more enjoyable than conventional therapy (CT) tasks. This study aimed to assess the trunk control and gait ability of patients with chronic stroke after participation in driving-based interactive video games (DBIVG). Participants included 24 chronic stroke patients allocated to an experimental group (n = 13, CT + DBIVG) or a control group (n = 11, CT + treadmill walking training). Both groups received CT five days/week; the experimental and control groups participated in DBIVG and treadmill walking training, respectively, three days/week for four weeks. The primary outcome of trunk control was measured by the trunk impairment scale (TISall) and TIS subscales, including static sitting balance (TISssb), dynamic sitting balance (TISdsb), and trunk co-ordination (TISco). Gait ability was measured by the dynamic gait index (DGI), timed walking test (TWT), and time up and go test (TUGT). Both groups demonstrated significant improvements in TISall, TISdsb, and TUGT results. The experimental group showed significantly greater improvement in TISssb, TISco, and DGI than the control group. Our findings indicate that DBIVG can improve trunk control and gait ability in patients with chronic stroke.
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Affiliation(s)
- Daegyun Lee
- Department of Physical Therapy, Graduate School, Gachon University, Incheon, Republic of Korea
| | - Youngsook Bae
- Department of Physical Therapy, Graduate School, Gachon University, Incheon, Republic of Korea.,Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
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Sung J, Trace Y, Peterson EW, Sosnoff JJ, Rice LA. Falls among full-time wheelchair users with spinal cord injury and multiple sclerosis: a comparison of characteristics of fallers and circumstances of falls. Disabil Rehabil 2019; 41:389-395. [PMID: 29069956 DOI: 10.1080/09638288.2017.1393111] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to (1) explore and (2) compare circumstances of falls among full-time wheelchair users with spinal cord injury (SCI) and multiple sclerosis (MS). METHODS A mixed method approach was used to explore and compare the circumstances of falls of 41 full-time wheelchair users with SCI (n = 23) and MS (n = 18). In addition to collecting participants' demographic information (age, gender, type of wheelchair used, duration of wheelchair use, and duration of disability), self-reported fall frequency in the past 6 months, self-reported restriction in activity due to fear of falling and the Spinal Cord Injury-Fall Concerns Scale (SCI-FCS) was collected. Qualitative data in the form of participants' responses to an open-ended question yielding information regarding the circumstances of the most recent fall were also collected. To examine differences in survey outcomes and demographic characteristics between participants with SCI and MS, independent t-tests and Pearson's Chi-square tests were used. Qualitative data were analyzed with a thematic analysis. RESULTS Statistical analysis revealed that individuals with MS (mean =3.3) had significantly higher average SCI-FCS than individuals with SCI (mean =2.4). The analysis of the participants' descriptions of the circumstances of their most recent falls resulted in three main categories: action-related fall contributors (e.g., transfer), (2) location of falls (e.g., bathroom), and (3) fall attributions (e.g., surface condition). CONCLUSIONS The results from this study helped to understand fall circumstances among full-time wheelchair users with MS and SCI. Findings from this study can inform the development of evidenced-based interventions to improve the effectiveness of clinically based treatment protocols. Implications for rehabilitation Falls are a common health concern in full-time wheelchair users living with multiple sclerosis and spinal cord injury. The circumstances surrounding falls reported by full-time wheelchair users living with multiple sclerosis and spinal cord injuries were found to be multifactorial. The complex nature of falls must be taken into consideration in the development of fall prevention programs. Findings from this study can inform the development of comprehensive evidence-based, population-specific interventions to manage falls among full-time wheelchair users living with multiple sclerosis and spinal cord injury.
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Affiliation(s)
- JongHun Sung
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Yarden Trace
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Elizabeth W Peterson
- b Department of Occupational Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Jacob J Sosnoff
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
| | - Laura A Rice
- a Department of Kinesiology and Community Health , University of Illinois at Urbana , Urbana, IL , USA
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Arora T, Oates A, Lynd K, Musselman KE. Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: A systematic review. J Spinal Cord Med 2018; 43:10-23. [PMID: 29869951 PMCID: PMC7006707 DOI: 10.1080/10790268.2018.1481692] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT Comprehensive balance measures with high clinical utility and sound psychometric properties are needed to inform the rehabilitation of individuals with spinal cord injury (SCI). OBJECTIVE To identify the balance measures used in the SCI population, and to evaluate their clinical utility, psychometric properties and comprehensiveness. METHODS Medline, PubMed, Embase, Scopus, Web of Science, and the Allied and Complementary Medicine Database were searched from the earliest record to October 19/16. Two researchers independently screened abstracts for articles including a balance measure and adults with SCI. Extracted data included participant characteristics and descriptions of balance measures. Quality was evaluated by considering study design, sampling method and adequacy of description of research participants. Clinical utility of all balance measures was evaluated. Comprehensiveness was evaluated using the modified Systems Framework for Postural Control. RESULTS 2820 abstracts were returned and 127 articles included. Thirty-one balance measures were identified; 11 evaluated a biomechanical construct and 20 were balance scales. All balance scales had high clinical utility. The Berg Balance Scale and Functional Reach Test were valid and reliable, while the mini-BESTest was the most comprehensive. CONCLUSION No single measure had high clinical utility, strong psychometric properties and comprehensiveness. The mini-BESTest and/or Activity-based Balance Level Evaluation may fill this gap with further testing of their psychometric properties.
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Affiliation(s)
- Tarun Arora
- Health Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Canada,School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - Kaylea Lynd
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Kristin E. Musselman
- Health Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Canada,School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada,Correspondence to: Kristin E. Musselman PT, PhD, SCI Mobility Lab, Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, ON, Canada, M4G 3V9; Ph: (416) 597-3422 x6190.
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Välimäki M, Mishina K, Kaakinen JK, Holm SK, Vahlo J, Kirjonen M, Pekurinen V, Tenovuo O, Korkeila J, Hämäläinen H, Sarajuuri J, Rantanen P, Orenius T, Koponen A. Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study. J Med Internet Res 2018; 20:e77. [PMID: 29555622 PMCID: PMC5881042 DOI: 10.2196/jmir.7618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/15/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a major health problem that often requires intensive and long-term rehabilitation. Objective The aim of this study was to determine whether rehabilitative digital gaming facilitates cognitive functioning and general well-being in people with TBI. Methods A total of 90 Finnish-speaking adults with TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The participants were randomly allocated to one of the three groups: a rehabilitation gaming group (n=29, intervention), an entertainment gaming group (n=29, active control), or a passive control group (n=32). The gaming groups were instructed to engage in gaming for a minimum of 30 min per day for 8 weeks. Primary and secondary outcomes were measured at three time points: before the intervention, after the intervention, and 3 months following the intervention. The primary outcome was cognitive status measured by processing speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks). Secondary outcomes were attention and executive functions (Simon task), working memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT), depression (Patient Health Questionnaire-9), self-efficacy (General Self-efficacy Scale), and executive functions (Behavior Rating Inventory of Executive Function-Adult Version). Feasibility information was assessed (acceptability, measurement instruments filled, dropouts, adherence, usability, satisfaction, and possible future use). Cognitive measurements were conducted in face-to-face interviews by trained psychologists, and questionnaires were self-administered. Results The effects of rehabilitation gaming did not significantly differ from the effects of entertainment gaming or being in a passive control group. For primary outcomes and PASAT tests, the participants in all three groups showed overall improvement in test scores across the three measurement points. However, depression scores increased significantly between baseline and after 8 weeks and between baseline and after 3 months in the rehabilitative gaming group. No differences were found in patients’ self-efficacy between the three measuring points in any of the groups. Participants did use the games (rehabilitation group: 93%, 27/29; entertainment group 100%, 29/29). Games were seen as a usable intervention (rehabilitation group: 70%, 14/29; entertainment group: 83%, 20/29). The rehabilitation group was less satisfied with the gaming intervention (68%, 13/29 vs 83%, 20/29), but they were more willing to use the game after the intervention period (76%, 16/29 vs 63%, 15/29). Total time spent on gaming during the intervention period was low (15.22 hour rehabilitation gaming group, 19.22 hour entertainment gaming group). Conclusions We did not find differences between the groups in improvement in the outcome measures. The improvements in test performance by all three groups may reflect rehearsal effects. Entertainment gaming had elements that could be considered when rehabilitative games are designed for, implemented in, and assessed in larger clinical trials for persons with TBI. Trial Registration ClinicalTrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH)
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Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kaisa Mishina
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Johanna K Kaakinen
- Department of Psychology, Faculty of Social Sciences, University of Turku, Turku, Finland
| | - Suvi K Holm
- Department of Psychology, Faculty of Social Sciences, University of Turku, Turku, Finland
| | - Jukka Vahlo
- Turku School of Economics, Centre for Collaborative Research, University of Turku, Turku, Finland
| | - Markus Kirjonen
- Department of Psychology, Faculty of Social Sciences, University of Turku, Turku, Finland
| | - Virve Pekurinen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Olli Tenovuo
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
| | - Jyrki Korkeila
- Faculty of Medicine, University of Turku, Turku, Finland.,Psychiatric Care Division, Satakunta Hospital District, Harjavalta, Finland
| | - Heikki Hämäläinen
- Department of Psychology, Faculty of Social Sciences, University of Turku, Turku, Finland
| | | | | | - Tage Orenius
- Orton Orthopaedic Hospital, Orton, Helsinki, Finland
| | - Aki Koponen
- Turku School of Economics, Centre for Collaborative Research, University of Turku, Turku, Finland
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Hamilton C, Lovarini M, McCluskey A, Folly de Campos T, Hassett L. Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review. Disabil Rehabil 2018. [DOI: 10.1080/09638288.2018.1446187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Caitlin Hamilton
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Meryl Lovarini
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Tarcisio Folly de Campos
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Leanne Hassett
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia
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White MP, Yeo NL, Vassiljev P, Lundstedt R, Wallergård M, Albin M, Lõhmus M. A prescription for "nature" - the potential of using virtual nature in therapeutics. Neuropsychiatr Dis Treat 2018; 14:3001-3013. [PMID: 30510422 PMCID: PMC6231506 DOI: 10.2147/ndt.s179038] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Many studies suggest that increased exposure to urban greenness is associated with better population health. Accessing nature can in some circumstances, however, be difficult, especially for individuals with mobility constraints. Therefore, a growing body of work is investigating the ways to replace the in vivo experience with forms of "virtual" contact, in order to provide these individuals with at least some benefits of the natural environment. The aim of this paper is to provide a review of previous use of virtual reality (VR) nature in health and care settings and contemplate the potential use of this technology in future. Our central question is whether engaging with virtual nature can contribute to enhanced physical and emotional well-being in housebound or mobility-constrained individuals. We conclude that while contact with real-world nature is preferred, VR use can be an alternative in cases when in vivo contact with nature is not possible. There are many possibilities for the use of VR technology in psychiatric and medical care; however, the risks, benefits, and cost efficiency of these attempts should be carefully assessed and the outcomes should be measured in a scientifically valid manner. The current review has nonetheless demonstrated that VR nature could play a role in each of the proposed mediating mechanisms linking natural environments and health.
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Affiliation(s)
- Matthew P White
- The European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital Treliske, Truro, Cornwall TR1 3HD, UK
| | - Nicola L Yeo
- The European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital Treliske, Truro, Cornwall TR1 3HD, UK
| | - Peeter Vassiljev
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, 51014 Tartu, Estonia
| | - Rikard Lundstedt
- Department of Design Science, Division of Ergonomics and Aerosol Technology, Lund University, 22100 Lund, Sweden
| | - Mattias Wallergård
- Department of Design Science, Division of Ergonomics and Aerosol Technology, Lund University, 22100 Lund, Sweden
| | - Maria Albin
- Faculty of Medicine, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, 22363 Lund, Sweden, .,Institute of Environmental Medicine, Karolinska Institute, 17177 Stockholm, Sweden, .,Centre for Occupational and Environmental Medicine, Stockholm County Council, 11365 Stockholm, Sweden,
| | - Mare Lõhmus
- Faculty of Medicine, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, 22363 Lund, Sweden, .,Institute of Environmental Medicine, Karolinska Institute, 17177 Stockholm, Sweden, .,Centre for Occupational and Environmental Medicine, Stockholm County Council, 11365 Stockholm, Sweden,
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25
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Khurana M, Walia S, Noohu MM. Study on the Effectiveness of Virtual Reality Game-Based Training on Balance and Functional Performance in Individuals with Paraplegia. Top Spinal Cord Inj Rehabil 2017; 23:263-270. [PMID: 29339902 DOI: 10.1310/sci16-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To determine whether there is any difference between virtual reality game-based balance training and real-world task-specific balance training in improving sitting balance and functional performance in individuals with paraplegia. Methods: The study was a pre test-post test experimental design. There were 30 participants (28 males, 2 females) with traumatic spinal cord injury randomly assigned to 2 groups (group A and B). The levels of spinal injury of the participants were between T6 and T12. The virtual reality game-based balance training and real-world task-specific balance training were used as interventions in groups A and B, respectively. The total duration of the intervention was 4 weeks, with a frequency of 5 times a week; each training session lasted 45 minutes. The outcome measures were modified Functional Reach Test (mFRT), t-shirt test, and the self-care component of the Spinal Cord Independence Measure-III (SCIM-III). Results: There was a significant difference for time (p = .001) and Time × Group effect (p = .001) in mFRT scores, group effect (p = .05) in t-shirt test scores, and time effect (p = .001) in the self-care component of SCIM-III. Conclusions: Virtual reality game-based training is better in improving balance and functional performance in individuals with paraplegia than real-world task-specific balance training.
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Affiliation(s)
| | - Shefali Walia
- ISIC Institute of Rehabilitation Sciences, New Delhi, India
| | - Majumi M Noohu
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
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26
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A meta-analysis and systematic literature review of virtual reality rehabilitation programs. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.01.013] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Santos PBR, Vigário PS, Mainenti MRM, Ferreira AS, Lemos T. Seated limits-of-stability of athletes with disabilities with regard to competitive levels and sport classification. Scand J Med Sci Sports 2017; 27:2019-2026. [PMID: 28150870 DOI: 10.1111/sms.12847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Abstract
In this study, we asked whether wheelchair rugby (WR) classification and competitive level influence trunk function of athletes with disabilities, in terms of seated limits-of-stability (LoS). Twenty-eight athletes were recruited from international- and national-level WR teams, with each group exhibiting marked differences in years of sports practice and training volume. Athletes were also distributed into three groups according their classification: low-point (0.5-1.5-point); mid-point (2.0-2.5-point); and high-point (3.0-3.5-point). Athletes were asked to sit on a force platform and to lean the body as far as possible in eight predefined directions. Center of pressure (COP) coordinates were calculated from the ground reaction forces acquired with the force platform. LoS were computed as the area of ellipse adjusted to maximal COP excursion achieved for the eight directions. ANOVAs reveal that LoS were not different when international- and national-level players were compared (P=.744). Nevertheless, LoS were larger in players from the high-point group than from the low-point group (P=.028), with the mid-point group being not different from both (P>.194). In summary, (i) competitive level does not impact LoS measures and (ii) LoS are remarkably distinct when comparing both extremes of the WR classification range. Our results suggest that, as a training-resistant measure, LoS could be a valid assessment of trunk impairment, potentially contributing to the development of an evidence-based WR classification.
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Affiliation(s)
- P B R Santos
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brasil
| | - P S Vigário
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brasil
| | - M R M Mainenti
- Divisão de Pesquisa e Extensão, Escola de Educação Física do Exército (EsEFEx), Rio de Janeiro, Brasil
| | - A S Ferreira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brasil
| | - T Lemos
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brasil
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28
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Roosink M, Robitaille N, Jackson PL, Bouyer LJ, Mercier C. Interactive virtual feedback improves gait motor imagery after spinal cord injury: An exploratory study. Restor Neurol Neurosci 2016; 34:227-35. [PMID: 26890097 PMCID: PMC4927914 DOI: 10.3233/rnn-150563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: Motor imagery can improve motor function and reduce pain. This is relevant to individuals with spinal cord injury (SCI) in whom motor dysfunction and neuropathic pain are prevalent. However, therapy efficacy could be dependent on motor imagery ability, and a clear understanding of how motor imagery might be facilitated is currently lacking. Thus, the aim of the present study was to assess the immediate effects of interactive virtual feedback on motor imagery performance after SCI. Methods: Nine individuals with a traumatic SCI participated in the experiment. Motor imagery tasks consisted of forward (i.e. simpler) and backward (i.e. more complex) walking while receiving interactive versus static virtual feedback. Motor imagery performance (vividness, effort and speed), neuropathic pain intensity and feasibility (immersion, distraction, side-effects) were assessed. Results: During interactive feedback trials, motor imagery vividness and speed were significantly higher and effort was significantly lower as compared static feedback trials. No change in neuropathic pain was observed. Adverse effects were minor, and immersion was reported to be good. Conclusions: This exploratory study showed that interactive virtual walking was feasible and facilitated motor imagery performance. The response to motor imagery interventions after SCI might be improved by using interactive virtual feedback.
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Affiliation(s)
- Meyke Roosink
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada
| | - Nicolas Robitaille
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada
| | - Philip L Jackson
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada.,School of Psychology, Laval University, Québec, QC, Canada
| | - Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
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29
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Sugiyama T, Liew SL. The Effects of Sensory Manipulations on Motor Behavior: From Basic Science to Clinical Rehabilitation. J Mot Behav 2016; 49:67-77. [PMID: 27935445 DOI: 10.1080/00222895.2016.1241740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Modifying sensory aspects of the learning environment can influence motor behavior. Although the effects of sensory manipulations on motor behavior have been widely studied, there still remains a great deal of variability across the field in terms of how sensory information has been manipulated or applied. Here, the authors briefly review and integrate the literature from each sensory modality to gain a better understanding of how sensory manipulations can best be used to enhance motor behavior. Then, they discuss 2 emerging themes from this literature that are important for translating sensory manipulation research into effective interventions. Finally, the authors provide future research directions that may lead to enhanced efficacy of sensory manipulations for motor learning and rehabilitation.
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Affiliation(s)
- Taisei Sugiyama
- a Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy , University of Southern California , Los Angeles , California
| | - Sook-Lei Liew
- a Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy , University of Southern California , Los Angeles , California.,b Division of Biokinesiology and Physical Therapy , University of Southern California , Los Angeles , California.,c Department of Neurology , University of Southern California , Los Angeles , California
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30
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Wiloth S, Lemke N, Werner C, Hauer K. Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia. JMIR Serious Games 2016; 4:e12. [PMID: 27432746 PMCID: PMC4969551 DOI: 10.2196/games.5696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exergames often used for training purpose can also be applied to create assessments based on quantitative data derived from the game. A number of studies relate to these use functionalities developing specific assessment tasks by using the game software and provided good data on psychometric properties. However, (1) assessments often include tasks other than the original game task used for training and therefore relate to similar but not to identical or integrated performances trained, (2) people with diagnosed dementia have insufficiently been addressed in validation studies, and (3) studies did commonly not present validation data such as sensitivity to change, although this is a paramount objective for validation to evaluate responsiveness in intervention studies. OBJECTIVE Specific assessment parameters have been developed using quantitative data directly derived from the data stream during the game task of a training device (Physiomat). The aim of this study was to present data on construct validity, test-retest reliability, sensitivity to change, and feasibility of this internal assessment approach, which allows the quantification of Physiomat training effects on motor-cognitive functions in 105 multimorbid patients with mild-to-moderate dementia (mean age 82.7±5.9). METHODS Physiomat assessment includes various tasks at different complexity levels demanding balance and cognitive abilities. For construct validity, motor-cognitive Physiomat assessment tasks were compared with established motor and cognitive tests using Spearman's rank correlations (rs). For test-retest reliability, we used intra-class correlations (ICC3,1) and focused on all Physiomat tasks. Sensitivity to change of trained Physiomat tasks was tested using Wilcoxon statistic and standardized response means (SRMs). Completion rate and time were calculated for feasibility. RESULTS Analyses have mostly shown moderate-to-high correlations between established motor as well as cognitive tests and simple (rs=-.22 to .68, P ≤.001-.03), moderate (rs=-.33 to .71, P ≤.001-.004), and complex motor-cognitive Physiomat tasks (rs=-.22 to .83, P ≤.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ≤.001) indicating good test-retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ≤.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. CONCLUSIONS Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game.
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Affiliation(s)
- Stefanie Wiloth
- AGAPLESION Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Heidelberg, Germany.
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31
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Hassett L, van den Berg M, Lindley RI, Crotty M, McCluskey A, van der Ploeg HP, Smith ST, Schurr K, Killington M, Bongers B, Howard K, Heritier S, Togher L, Hackett M, Treacy D, Dorsch S, Wong S, Scrivener K, Chagpar S, Weber H, Pearson R, Sherrington C. Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial. BMJ Open 2016; 6:e012074. [PMID: 27266776 PMCID: PMC4908951 DOI: 10.1136/bmjopen-2016-012074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION People with mobility limitations can benefit from rehabilitation programmes that provide a high dose of exercise. However, since providing a high dose of exercise is logistically challenging and resource-intensive, people in rehabilitation spend most of the day inactive. This trial aims to evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation units compared to usual care alone. METHODS AND ANALYSIS A pragmatic, assessor blinded, parallel-group randomised trial recruiting 300 consenting rehabilitation patients with reduced mobility will be conducted. Participants will be individually randomised to intervention or control groups. The intervention group will receive technology-based exercise to target mobility and physical activity problems for 6 months. The technology will include the use of video and computer games/exercises and tablet applications as well as activity monitors. The control group will not receive any additional intervention and both groups will receive usual inpatient and outpatient rehabilitation care over the 6-month study period. The coprimary outcomes will be objectively assessed physical activity (proportion of the day spent upright) and mobility (Short Physical Performance Battery) at 6 months after randomisation. Secondary outcomes will include: self-reported and objectively assessed physical activity, mobility, cognition, activity performance and participation, utility-based quality of life, balance confidence, technology self-efficacy, falls and service utilisation. Linear models will assess the effect of group allocation for each continuously scored outcome measure with baseline scores entered as a covariate. Fall rates between groups will be compared using negative binomial regression. Primary analyses will be preplanned, conducted while masked to group allocation and use an intention-to-treat approach. ETHICS AND DISSEMINATION The protocol has been approved by the relevant Human Research Ethics Committees and the results will be disseminated widely through peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12614000936628. Pre-results.
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Affiliation(s)
- Leanne Hassett
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Maayken van den Berg
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Richard I Lindley
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Hidde P van der Ploeg
- Department of Public & Occupational Health and EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- School of Public Health/Sydney Medical School The University of Sydney, Sydney, New South Wales, Australia
| | | | - Karl Schurr
- Faculty of Arts and Business, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
- Physiotherapy Department and Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Maggie Killington
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Bert Bongers
- Faculty of Design, Architecture and Building, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health/Sydney Medical School The University of Sydney, Sydney, New South Wales, Australia
| | - Stephane Heritier
- Department of Epidemiology and Preventive Medicine/Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Maree Hackett
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Treacy
- Physiotherapy Department and Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simone Dorsch
- School of Physiotherapy Faculty of Health Sciences/Australian Catholic University, Sydney, New South Wales, Australia
| | - Siobhan Wong
- Physiotherapy Department and Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Katharine Scrivener
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sakina Chagpar
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Heather Weber
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Ross Pearson
- Consumer Advisor, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Sakuraba Y, Tomonaga M, Hayashi M. A new method of walking rehabilitation using cognitive tasks in an adult chimpanzee (Pan troglodytes) with a disability: a case study. Primates 2016; 57:403-12. [PMID: 27150249 DOI: 10.1007/s10329-016-0541-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
There are few studies of long-term care and rehabilitation of animals which acquired physical disabilities in captivity, despite their importance for welfare. An adult male chimpanzee named Reo at the Primate Research Institute of Kyoto University, developed acute myelitis, inflammation of the spinal cord, which resulted in impaired leg function. This report describes a walking rehabilitation system set up in a rehabilitation room where he lives. The rehabilitation apparatus consisted of a touch monitor presenting cognitive tasks and a feeder presenting food rewards at a distance of two meters from the monitor, to encourage him to walk between the monitor and the feeder repeatedly. Initially, Reo did not touch the monitor, therefore we needed adjustment of the apparatus and procedure. After the habituation to the monitor and cognitive tasks, he started to show behaviors of saving food rewards without walking, or stopping participation to the rehabilitation. Finally it took seven phases of the adjustment to determine the final setting; when the monitor automatically displayed trials in 4-h, AM (1000-1200 hours) and PM (1400-1600 hours) sessions through a day, Reo spontaneously walked from the monitor to the feeder to receive rewards, and returned to the monitor to perform the next trial. Comparison of Reo's locomotion in a no-task period and under the final setting revealed that the total travel distance increased from 136.7 to 506.3 m, movement patterns became multiple, and the percentage of walking increased from 1.2 to 27.2 % in PM session. The findings of this case study suggest that cognitive tasks may be a useful way to rehabilitate physically disabled chimpanzees, and thus improve their welfare in captivity.
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Affiliation(s)
- Yoko Sakuraba
- Primate Research Institute, Kyoto University, 41-2, Kanrin, Inuyama, Aichi, 484-8506, Japan. .,Japan Society for the Promotion of Science, 5-3-1, Kojimachi, Chiyoda, Tokyo, 102-0083, Japan.
| | - Masaki Tomonaga
- Primate Research Institute, Kyoto University, 41-2, Kanrin, Inuyama, Aichi, 484-8506, Japan
| | - Misato Hayashi
- Primate Research Institute, Kyoto University, 41-2, Kanrin, Inuyama, Aichi, 484-8506, Japan
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Välimäki M, Korkeila J, Kauppi K, Kaakinen JK, Holm S, Vahlo J, Tenovuo O, Hämäläinen H, Sarajuuri J, Rantanen P, Orenius T, Koponen A. Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Protocol of a Feasibility Study. JMIR Res Protoc 2016; 5:e6. [PMID: 26860741 PMCID: PMC4764786 DOI: 10.2196/resprot.4841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/07/2015] [Accepted: 09/20/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a critical public health problem. The recovery process for people with TBI is typically slow and dependent on complex and intensive assisted rehabilitation programs. OBJECTIVE To evaluate the effects and feasibility of digital games for cognitive functioning and general well-being among people with traumatic brain injury. METHODS This is a single-site feasibility study conducted in Finland, which uses a pragmatic, randomized controlled trial with three arms, and will recruit patients from the Turku University Hospital, Division of Clinical Neurosciences in Finland. Participants must meet the following inclusion criteria: (1) a Finnish speaking adult, aged 18-65 years; (2) diagnosed with a traumatic brain injury (diagnostic criteria ICD-10, S06.X, T90.5) in the University Hospital; (3) access to a TV, a computer, and the Internet at home; (4) not an active digital gamer (5 hours or less a week); (5) willing to participate in the study. Participants must have been discharged from the neurologic treatment period for traumatic brain injury for over 12 months before the commencement of the trial, and they may not have actively participated in cognitive rehabilitation during the 3 months prior to the trial. Written informed consent will be mandatory for acceptance into the trial. Exclusion criteria are as follows: (1) sensory, cognitive, or physical impairment (eg, severe cognitive impairment); (2) a deficiency restricting the use of computers or computer game control system unaided (eg, impairment in vision, severe astigmatism, hemiplegia, disorder in visuospatial perception, dysfunction of the central vestibular system); (3) apathy identified in previous neuropsychological evaluations; (4) diagnosed severe mental disorders (eg, schizophrenia or severe depressive disorders to be identified in medical records as the secondary diagnosis). RESULTS The preparatory phase for the study is fulfilled. Recruitment started in June 2015 and finished November 2015. Results will be reported in 2016. CONCLUSIONS The specific outcomes such as primary outcome measures were selected because they are widely used psychological tests and thought to be sensitive to changes in the cognitive functions related to TBI. TRIAL REGISTRATION Clinicaltrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH).
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Affiliation(s)
- Maritta Välimäki
- Faculty of Medicine, Department of Nursing Science, University of Turku, Finland.
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Lee M, Suh D, Son J, Kim J, Eun SD, Yoon B. Patient perspectives on virtual reality-based rehabilitation after knee surgery: Importance of level of difficulty. ACTA ACUST UNITED AC 2016; 53:239-52. [DOI: 10.1682/jrrd.2014.07.0164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 07/15/2015] [Indexed: 11/05/2022]
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van den Berg M, Sherrington C, Killington M, Smith S, Bongers B, Hassett L, Crotty M. Video and computer-based interactive exercises are safe and improve task-specific balance in geriatric and neurological rehabilitation: a randomised trial. J Physiother 2016; 62:20-8. [PMID: 26701163 DOI: 10.1016/j.jphys.2015.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/19/2015] [Accepted: 11/16/2015] [Indexed: 11/16/2022] Open
Abstract
QUESTION Does adding video/computer-based interactive exercises to inpatient geriatric and neurological rehabilitation improve mobility outcomes? Is it feasible and safe? DESIGN Randomised trial. PARTICIPANTS Fifty-eight rehabilitation inpatients. INTERVENTION Physiotherapist-prescribed, tailored, video/computer-based interactive exercises for 1 hour on weekdays, mainly involving stepping and weight-shifting exercises. OUTCOME MEASURES The primary outcome was the Short Physical Performance Battery (0 to 3) at 2 weeks. Secondary outcomes were: Maximal Balance Range (mm); Step Test (step count); Rivermead Mobility Index (0 to 15); activity levels; Activity Measure for Post Acute Care Basic Mobility (18 to 72) and Daily Activity (15 to 60); Falls Efficacy Scale (10 to 40), ED5D utility score (0 to 1); Reintegration to Normal Living Index (0 to 100); System Usability Scale (0 to 100) and Physical Activity Enjoyment Scale (0 to 126). Safety was determined from adverse events during intervention. RESULTS At 2 weeks the between-group difference in the primary outcome (0.1, 95% CI -0.2 to 0.3) was not statistically significant. The intervention group performed significantly better than usual care for Maximal Balance Range (38mm difference after baseline adjustment, 95% CI 6 to 69). Other secondary outcomes were not statistically significant. Fifty-eight (55%) of the eligible patients agreed to participate, 25/29 (86%) completed the intervention and 10 (39%) attended > 70% of sessions, with a mean of 5.6 sessions (SD 3.3) attended and overall average duration of 4.5hours (SD 3.1). Average scores were 62 (SD 21) for the System Usability Scale and 62 (SD 8) for the Physical Activity Enjoyment Scale. There were no adverse events. CONCLUSION The addition of video/computer-based interactive exercises to usual rehabilitation is a safe and feasible way to increase exercise dose, but is not suitable for all. Adding the exercises to usual rehabilitation resulted in task-specific improvements in balance but not overall mobility. REGISTRATION ACTRN12613000610730.
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Affiliation(s)
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, The University of Sydney
| | - Maggie Killington
- Department of Rehabilitation, Aged and Extended Care, Flinders University
| | - Stuart Smith
- Faculty of Arts and Business, University of the Sunshine Coast, Sippy Downs
| | - Bert Bongers
- Faculty of Design, Architecture and Building, University of Technology, Sydney, Australia
| | - Leanne Hassett
- The George Institute for Global Health, Sydney Medical School, The University of Sydney
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University
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Abstract
Background. Adaptation and customization are two related but distinct concepts that are central to virtual rehabilitation if this motor therapy modality is to succeed in alleviating the demand for expert supervision. These two elements of the therapy are required to exploit the flexibility of virtual environments to enhance motor training and boost therapy outcome. Aim. The chapter provides a non-systematic overview of the state of the art regarding the evolving manipulation of virtual rehabilitation environments to optimize therapy outcome manifested through customization and adaptation mechanisms. Methods. Both concepts will be defined, aspects guiding their implementation reviewed, and available literature suggesting different solutions discussed. We present “Gesture Therapy”, a platform realizing our contributions to the field and we present results of the adaptation techniques integrated into it. Less explored additional dimensions such as liability and privacy issues affecting their implementation are briefly discussed. Results. Solutions to implement decision-making on how to manipulate the environment are varied. They range from predefined system configurations to sophisticated artificial intelligence (AI) models. Challenge maintenance and feedback personalization is the most common driving force for their incorporation to virtual rehabilitation platforms. Conclusions. Customization and adaptation are the main mechanisms responsible for the full exploitation of the potential of virtual rehabilitation environments, and the potential benefits are worth pursuing. Despite encouraging evidence of the many solutions proposed thus far in literature, none has yet proven to substantially alter the therapy outcome. In consequence, research is still on going to equip virtual rehabilitation solutions with efficacious tailoring elements.
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Wall T, Feinn R, Chui K, Cheng MS. The effects of the Nintendo™ Wii Fit on gait, balance, and quality of life in individuals with incomplete spinal cord injury. J Spinal Cord Med 2015; 38:777-83. [PMID: 25613853 PMCID: PMC4725811 DOI: 10.1179/2045772314y.0000000296] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
PURPOSE To assess the effects of virtual reality using the NintendoTM Wii Fit on balance, gait, and quality of life in ambulatory individuals with incomplete spinal cord injury (iSCI). RELEVANCE There is a need for continued research to support effective treatment techniques in individuals with iSCI to maximize each individual's potential functional performance. SUBJECTS Five males with a mean age of 58.6 years who had an iSCI and were greater than one-year post injury. METHODS An interrupted time series design with three pre-tests over three weeks, a post-test within one week of the intervention, and a four-week follow up. Outcome measures: gait speed, timed up and go (TUG), forward functional reach test (FFRT) and lateral functional reach test (LFRT), RAND SF-36. Intervention consisted of one-hour sessions with varied games using the Nintendo Wii Fit twice per week for seven weeks. Survey data was also collected at post-test. Results There were statistically significant changes found in gait speed and functional reach. The changes were also maintained at the four-week follow up post-test. Survey reports suggested improvements in balance, endurance, and mobility with daily tasks at home. CONCLUSION All subjects who participated in training with the NintendoTM Wii Fit demonstrated statistically significant improvements in gait speed and functional reach after seven weeks of training. Given the potential positive impact that the NintendoTM Wii Fit has on functional reach and gait speed in patients with iSCI, physical therapists may want to incorporate these activities as part of a rehabilitation program.
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Affiliation(s)
- Tracy Wall
- Schools of Health Science and Medicine, Quinnipiac University, Hamden, CT, USA,Correspondence to: Tracy Wall, School of Health Science, Quinnipiac University, 275 Mt Carmel Ave, Hamden 06518, CT.
| | - Richard Feinn
- Schools of Health Science and Medicine, Quinnipiac University, Hamden, CT, USA
| | - Kevin Chui
- College of Health Professions, Sacred Heart University, Fairfield, CT, USA
| | - M. Samuel Cheng
- College of Health Care Science, Nova Southeastern University, Ft Lauderdale-Davie, FL, USA
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Whyatt C, Merriman NA, Young WR, Newell FN, Craig C. A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults. Games Health J 2015; 4:423-33. [PMID: 26469308 PMCID: PMC4624248 DOI: 10.1089/g4h.2015.0006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Falls and fall-related injuries are symptomatic of an aging population. This study aimed to design, develop, and deliver a novel method of balance training, using an interactive game-based system to promote engagement, with the inclusion of older adults at both high and low risk of experiencing a fall. Study Design: Eighty-two older adults (65 years of age and older) were recruited from sheltered accommodation and local activity groups. Forty volunteers were randomly selected and received 5 weeks of balance game training (5 males, 35 females; mean, 77.18 ± 6.59 years), whereas the remaining control participants recorded levels of physical activity (20 males, 22 females; mean, 76.62 ± 7.28 years). The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments. Results: Balance game training had a significant effect on levels of functional balance and balance confidence (P < 0.05). This was further demonstrated in participants who were deemed at high risk of falls. The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls. Conclusions: Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population.
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Affiliation(s)
- Caroline Whyatt
- 1 School of Psychology, Queen's University Belfast , Belfast, United Kingdom
| | - Niamh A Merriman
- 2 School of Psychology and Institute of Neuroscience, Trinity College Dublin , Dublin, Ireland
| | - William R Young
- 3 The Institute of Environment, Health and Societies, Brunel University London , London, United Kingdom
| | - Fiona N Newell
- 2 School of Psychology and Institute of Neuroscience, Trinity College Dublin , Dublin, Ireland
| | - Cathy Craig
- 1 School of Psychology, Queen's University Belfast , Belfast, United Kingdom
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Harris DM, Rantalainen T, Muthalib M, Johnson L, Teo WP. Exergaming as a Viable Therapeutic Tool to Improve Static and Dynamic Balance among Older Adults and People with Idiopathic Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2015; 7:167. [PMID: 26441634 PMCID: PMC4561514 DOI: 10.3389/fnagi.2015.00167] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/17/2015] [Indexed: 11/25/2022] Open
Abstract
The use of virtual reality games (known as “exergaming”) as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson’s disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I2 statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563–1.576), postural control (SMD 0.826, 95% CI 0.481–1.170), and dynamic balance (SMD −0.808, 95% CI −1.192 to −0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI −0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534–3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more large-scale trials are needed to determine if the same is true for people with IPD.
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Affiliation(s)
- Dale M Harris
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
| | - Timo Rantalainen
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
| | - Makii Muthalib
- Movement to Health (M2H) Laboratory, Euromov, University of Montpellier , Montpellier , France
| | - Liam Johnson
- Clinical Exercise Science Research Program, Institute of Sport Exercise and Active Living (ISEAL), Victoria University , Melbourne, VIC , Australia ; The Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne, VIC , Australia
| | - Wei-Peng Teo
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
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Baud-Bovy G, Tatti F, Borghese NA. Ability of Low-Cost Force-Feedback Device to Influence Postural Stability. IEEE TRANSACTIONS ON HAPTICS 2015; 8:130-9. [PMID: 25398181 DOI: 10.1109/toh.2014.2369057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Low-cost gaming technology offers promising devices for the rehabilitation of stroke patients at home. While several attempts have been made to use low-cost motion tracking devices (Kinect) or balance boards (Wii Board), the potential of low-cost haptic devices has yet to be explored in this context. The objective of this study was to investigate whether it is possible to influence postural stability with a low-cost device despite its technical limitations, and to explore the most promising modes of haptic interaction to increase and decrease postural stability. Two groups of younger subjects used a high-end (Omega.3) and a low-cost (Falcon) device respectively. A third group of older subjects used the Falcon. We show that light touch contact with the device improves stability, whereas the force tasks decrease it. The effects of the different tasks are consistent in the two age groups. Although there are differences in the participants' interaction with the two devices, the effect of the devices on postural stability is comparable. We conclude that a low-cost haptic device can be used to increase or decrease postural stability of healthy subjects with an age similar to that of typical stroke patients, in a safe and controllable way.
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Physiological and psychophysiological responses to an exer-game training protocol. J Sci Med Sport 2015; 19:267-271. [PMID: 25824058 DOI: 10.1016/j.jsams.2015.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/18/2015] [Accepted: 03/05/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Exer-games and virtual reality offer alternative opportunities to provide neuro-rehabilitation and exercise that are fun. Our goal was to determine how effective they are in achieving motor learning goals and fitness benefits as players gain experience. DESIGN We employed a repeated measures design to determine changes in physical exertion and engagement with training. METHODS Fourteen healthy adults trained on the XBOX Kinect video game Dance Central using a skill-based protocol to examine changes in energy expenditure (EE), heart rate (HR), METs, limb movement, game proficiency, and player engagement in initial, post-training, and transfer-testing of a full-body dance exer-game. Data were analyzed using repeated measures analysis of variance, p<0.05. RESULTS Both EE, HR, and METs increased from initial (EE 4.89±1.35, HR 103±18, METs 4.25±0.72) to post-training (EE 5.92±1.25, HR 110±15, METs 5.05±0.75) and were greatest during transfer-testing (EE 6.34±1.35, HR 115±17, METs 5.42±0.88, p≤0.001). Proficiency, measured by game scores, also increased from initial to post-training and transfer-testing (p≤0.002). Limb movement and player engagement remained unchanged. CONCLUSIONS It is important to understand whether player physiological and psychophysiological responses change with continued game-play. Although Dance Central involves whole-body movement, physical exertion remained at moderate levels after training. As exer-game and virtual reality systems move from their initial novelty, research about how players react to continued involvement with a game can guide game developers to maintain a freshness through game progression that preserves the participant's attentional focus, minimizes attrition and maintains a prescribed level of energy exertion.
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da Silva Ribeiro NM, Ferraz DD, Pedreira É, Pinheiro Í, da Silva Pinto AC, Neto MG, Dos Santos LRA, Pozzato MGG, Pinho RS, Masruha MR. Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients. Top Stroke Rehabil 2015; 22:299-305. [PMID: 26258455 DOI: 10.1179/1074935714z.0000000017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed. OBJECTIVE To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients. METHODS The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl-Meyer scales were used to evaluate the patients. RESULTS After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl-Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner. CONCLUSION Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.
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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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Virtual feedback for motor and pain rehabilitation after spinal cord injury. Spinal Cord 2014; 52:860-6. [DOI: 10.1038/sc.2014.160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/05/2014] [Accepted: 08/27/2014] [Indexed: 12/25/2022]
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Putnam C, Cheng J, Seymour G. Therapist Perspectives: Wii Active Videogames Use in Inpatient Settings with People Who Have Had a Brain Injury. Games Health J 2014; 3:366-70. [PMID: 26192643 DOI: 10.1089/g4h.2013.0099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Brain injuries (BIs) are a major public health issue. Clinical experience and literature have identified that it is often challenging to motivate people who have had a BI to engage in repetitive exercises commonly prescribed for rehabilitation. As a result, some therapists include commercial active videogames (AVGs) in their therapy sessions to help make repetitive actions fun and engaging. In this project, we explored how the therapists used commercial AVGs to better understand the major barriers and enablers of use. MATERIALS AND METHODS We interviewed 17 therapists from two rehabilitation hospitals who work with people who have had a BI. After the interviews were transcribed, we identified salient themes. RESULTS At the time of the interviews, therapists were using only the Nintendo(®) (Kyoto, Japan) Wii™ console. Common therapeutic goals included balance and weight shifting. Several patient factors, such as cognitive and physical abilities, age, and previous gaming experience, were considered important considerations when deciding to use games. Therapists also indicated many desired changes to games, including better control/interface, better feedback, and the ability to adjust timing, challenge, and stimulation levels. CONCLUSIONS When considering therapy-centered game design, the needs of both therapists and patients should be considered. There is a necessary balance to consider in game design: They need to (a) be perceived as fun, (b) meet therapy goals, and (c) address therapists' needs (e.g., adjustability to address a range of patient abilities). Additionally, there is a need for a wide variety of available games to address novelty and personal preferences.
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Affiliation(s)
- Cynthia Putnam
- 1 College of Computing and Digital Media, DePaul University , Chicago, Illinois
| | - Jinghui Cheng
- 1 College of Computing and Digital Media, DePaul University , Chicago, Illinois
| | - Gregory Seymour
- 2 Program in Occupational Therapy, Washington University School of Medicine , St. Louis, Missouri
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Jaume-i-Capó A, Martínez-Bueso P, Moyà-Alcover B, Varona J. Improving vision-based motor rehabilitation interactive systems for users with disabilities using mirror feedback. ScientificWorldJournal 2014; 2014:964576. [PMID: 25295310 PMCID: PMC4177771 DOI: 10.1155/2014/964576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/05/2014] [Accepted: 08/22/2014] [Indexed: 11/18/2022] Open
Abstract
Observation is recommended in motor rehabilitation. For this reason, the aim of this study was to experimentally test the feasibility and benefit of including mirror feedback in vision-based rehabilitation systems: we projected the user on the screen. We conducted a user study by using a previously evaluated system that improved the balance and postural control of adults with cerebral palsy. We used a within-subjects design with the two defined feedback conditions (mirror and no-mirror) with two different groups of users (8 with disabilities and 32 without disabilities) using usability measures (time-to-start (T(s)) and time-to-complete (T(c))). A two-tailed paired samples t-test confirmed that in case of disabilities the mirror feedback facilitated the interaction in vision-based systems for rehabilitation. The measured times were significantly worse in the absence of the user's own visual feedback (T(s) = 7.09 (P < 0.001) and T(c) = 4.48 (P < 0.005)). In vision-based interaction systems, the input device is the user's own body; therefore, it makes sense that feedback should be related to the body of the user. In case of disabilities the mirror feedback mechanisms facilitated the interaction in vision-based systems for rehabilitation. Results recommends developers and researchers use this improvement in vision-based motor rehabilitation interactive systems.
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Affiliation(s)
- Antoni Jaume-i-Capó
- Unitat de Gràfics, Visió i Intelligència Artificial, Department de Ciències Matemàtiques i Informàtica, Universitat de les Illes Balears, E07122 Palma, Spain
| | - Pau Martínez-Bueso
- Grup d'Investigació d'Evidència, Estils de Vida i Salut, Department d'Infermeria i Fisioteràpia, Universitat de les Illes Balears, E07122 Palma, Spain
| | - Biel Moyà-Alcover
- Unitat de Gràfics, Visió i Intelligència Artificial, Department de Ciències Matemàtiques i Informàtica, Universitat de les Illes Balears, E07122 Palma, Spain
| | - Javier Varona
- Unitat de Gràfics, Visió i Intelligència Artificial, Department de Ciències Matemàtiques i Informàtica, Universitat de les Illes Balears, E07122 Palma, Spain
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Pietrzak E, Pullman S, McGuire A. Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. Games Health J 2014; 3:202-14. [PMID: 26192369 DOI: 10.1089/g4h.2014.0013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eva Pietrzak
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Stephen Pullman
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Annabel McGuire
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
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Rego PA, Moreira PM, Reis LP. A Serious Games Framework for Health Rehabilitation. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2014. [DOI: 10.4018/ijhisi.2014070101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Serious Games is a field of research that has evolved substantially with valuable contributions to many application domains and areas. Patients often consider traditional rehabilitation approaches to be repetitive and boring, making it difficult for them to maintain their ongoing interest and to assure the completion of the treatment program. This paper reviews Serious Games and the natural and multimodal user interfaces for the health rehabilitation domain. Specifically, it details a framework for the development of Serious Games that integrates a rich set of features that can be used to improve the designed games with direct benefits to the rehabilitation process. Highlighted features include natural and multimodal interaction, social skills (collaboration and competitiveness) and progress monitoring. Due to the rich set of features supported by the framework, the games' rehabilitation efficacy can be enhanced primarily from an increase in the patient's motivation when exercising the rehabilitation tasks.
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Affiliation(s)
- Paula Alexandra Rego
- School of Technology and Management, Polytechnic Institute of Viana do Castelo, Viana do Castelo, Portugal and Laboratory of Artificial Intelligence and Computer Science, Porto, Portugal
| | - Pedro Miguel Moreira
- School of Technology and Management, Polytechnic Institute of Viana do Castelo, Viana do Castelo, Portugal and Laboratory of Artificial Intelligence and Computer Science, Porto, Portugal
| | - Luís Paulo Reis
- DSI/EEUM-Department of Information Systems, School of Engineering, University of Minho, Guimarães, Portugal and LIACC-Laboratory of Artificial Intelligence and Computer Science, Porto, Portugal
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Jaume-i-Capo A, Martinez-Bueso P, Moya-Alcover B, Varona J. Interactive Rehabilitation System for Improvement of Balance Therapies in People With Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2014; 22:419-27. [DOI: 10.1109/tnsre.2013.2279155] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Plow M, Finlayson M. Potential benefits of nintendo wii fit among people with multiple sclerosis: a longitudinal pilot study. Int J MS Care 2014; 13:21-30. [PMID: 24453702 DOI: 10.7224/1537-2073-13.1.21] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the potential of Nintendo Wii Fit (Nintendo Co, Ltd, Kyoto, Japan) to increase physical activity (PA) behavior and health among people with multiple sclerosis (MS). The study consisted of a repeated-measures design with a baseline control period and involved 30 people with MS who had the ability to walk 25 feet with or without a cane (26 individuals were included in the analyses). Nintendo Wii was set up in the homes of participants, who were prescribed a Wii Fit exercise program lasting 14 weeks, 3 days a week. The Physical Activity and Disability Survey, Modified Fatigue Impact Scale, and 36-item Short Form Health Status Survey were administered three times before participants gained access to Wii Fit (control period, at 2-week intervals), and three times after they received Wii Fit (posttest 1: immediately after; posttest 2: 7 weeks after; posttest 3: 14 weeks after). Mobility, balance, strength, and weight were assessed at the first pretest, immediately prior to obtaining access to Wii Fit, and 7 weeks after obtaining access to Wii Fit. Results from the questionnaires indicated that PA significantly improved at week 7, but at week 14, PA levels declined relative to week 7 and the difference was no longer significant compared with the control period. Physical assessments indicated that balance and strength significantly improved at week 7. One adverse event was reported (repetitive knee injury). Physical assessments indicated that people with MS may be able to improve their fitness levels by using Wii Fit. Future studies should incorporate behavior change strategies to promote long-term use of Wii Fit, and explore whether individuals with more severe symptoms of MS can safely use Wii Fit.
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Affiliation(s)
- Matthew Plow
- Department of Biomedical Engineering and Department of Physical Medicine and Rehabilitation, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA (MP); and Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA (MF)
| | - Marcia Finlayson
- Department of Biomedical Engineering and Department of Physical Medicine and Rehabilitation, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA (MP); and Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA (MF)
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