Abstract
BackgroundStroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation.MethodsIn this prospective case–control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category.ResultsComparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70).ConclusionThe Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke.Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.
Highlights
Stroke survivors need continuing exercise intervention to maintain functional status
The present study aimed to examine the feasibility and effectiveness of the interactive telerehabilitation exergaming program on balance in individuals with chronic stroke compared to the effects of conventional one-on-one physiotherapy
Brunnstrom recovery stages are defined as: I) Evidence of flaccidity; II) Increased resistance due to spasticity and limb synergies performed voluntarily; III) Spasticity begins to develop; IV) Spasticity is less evident than stage III; V) Minimal resistance from spasticity, and individual as well as complex movement combinations are possible independent of synergy; VI) Spasticity is difficult to demonstrate unless movements are performed with rapidity, and synergies do not interfere with performance [31]
Summary
Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in indi‐ viduals with chronic stroke, compared to conventional one-on-one rehabilitation. Stroke is a leading cause of disability that imposes a substantial burden on the daily life of those who survive [1, 2]. Disability in individuals with chronic stroke may. Total recovery from disability is not guaranteed after restorative rehabilitation in the acute and subacute stages of stroke [9]. To maximize functional recovery and maintenance of function, patients with chronic stroke must undergo continual rehabilitation or exercise intervention. Home-based telerehabilitation may help stroke survivors maintain longitudinal continuity of exercise rehabilitation at home, and help reduce therapist workload [12]
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