Video Game-based Therapy Research Articles

Video game-based therapy for stroke patients with balance problem: a scoping review

Introduction: In modern years, virtual reality has grown immensely. It is now used to provide engaging scenarios and improve adherence to therapy. Among all the types of Video Game-Based Therapy, Virtual Reality shows considerable improvement in patients with balance problems and is the most used device in stroke rehabilitation. This research’s purpose is to gather and disseminate studies that show which Video-Game Based Therapy is most efficient and widely used in terms of helping stroke patients with balance problems in clinical settings. In addition, the utilization of Video-Game Based Therapy in a clinical setting can help to motivate patients to continue with their treatment and in improving balance. Methods: The researchers used scoping review with the help of Joanna Briggs Institute (2020) and the scoping review framework by Arksey and O' Malley (2005), which provided an outline of the research methodology. The researchers used different databases such as PubMed, MEDLINE, CINAHL, EBSCO, and PT. The initial search retrieved a total of 2,569 articles from the databases. After removing duplicates and evaluating, 72 potential studies were identified. Using Joanna Briggs Institute extraction tool, two authors independently extracted the data, and another reviewer validated the data to ensure accuracy. Once the articles are selected, the following data are recorded in a spreadsheet. Results: A total of 46 reviews met the inclusion criteria. 28 articles stated that Virtual Reality is the most effective Videogame based therapy that shows significant improvements in balance and gait problems in stroke patients. It is also stated that it is most commonly used in clinical practice and was recommended in stroke guidelines. The remaining articles that researchers gathered show different Video Game Based Therapy are also effective but more expensive and it can be utilized when partnered with conventional therapy. Discussion: The research retrieved articles from eligible databases. The evidence gathered has shown promising effects that benefit the functional skills and balance problem of the patients. Although data concludes that Video-Game Based Therapy does result in significant improvement, still the help of conventional treatment is needed to show positive outcomes. Keywords: video game-based therapy, stroke, balance

Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis.

Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson’s disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.

Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review

Background: Stroke patients with motor, sensory and cognitive diseases can take profits from information and communication technologies—in particular, from the latest commercial video consoles, which are based on motion capture. These technologies are positioning themselves as complementary therapeutic tools for treating gait and balance disorders. In this paper, a systematic review of the effect of video game-based therapy on balance and gait in stroke patients is shown and compared with other types of treatments. Methods: A systematic review of prospective controlled clinical trials published in the main biomedical databases in English and Spanish between 2005 and 2020 was performed. The systematic review presented in this paper has been done following the Cochrane Manual recommendations and the PRISMA Declaration by two independent reviewers. Data about participants, intervention, outcome measurements and outcome measurement results were extracted. The quality of evidence of each study was assessed using Cochrane’s standard quality assessment format, which includes a description of the risk of bias. Additionally, the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of each paper. Results: A total of 18 papers, including 479 patients, were included in this systematic review, in which the use of video consoles (in combination with conventional rehabilitation or exclusively) was compared with conventional rehabilitation to treat balance or gait in post-stroke patients. In all studies, a tendency to improve balance was found in both intervention groups, finding, in 10 of 17 studies that analysed it, a better capacity in the experimental group that included video consoles compared to the conventional rehabilitation control group. Regarding gait, in six of seven studies that analysed it, improvements were found in both intervention groups, and these improvements were greater in the experimental group than compared to the control group in three of them. Conclusions: Commercial video game systems, in combination with conventional rehabilitation, have shown positive results on balance and gait in post-stroke patients. There were variations between the trials in terms of the video consoles used and the duration, frequency and number of sessions with commercial video games. Future studies should compare the effects of commercial video game treatments on balance and gait in stroke patients with a nonintervention group to know their real efficacy.

Upper extremity rehabilitation using video games in cerebral palsy: a randomized clinical trial.

The aim of the present study was to compare the effects of neurodevelopmental therapy (NDT)-based upper extremity rehabilitation and video game-based therapy (VGBT) using Nintendo® wii and leap motion controller (LMC) games on upper extremity function in patients with cerebral palsy (CP). The 30 patients included in the present study were randomized to two groups: VGBT group (VGBT using Nintendo® Wii and LMC games) and control group (NDT-based upper extremity rehabilitation). Both groups trained 3days a week for 8weeks. Manual dexterity was evaluated using the "Minnesota Manual Dexterity Test (MMDT)", functional ability using the "Childhood Health Assessment Questionnaire (CHAQ)" and the "Duruoz Hand Index (DEI)" and grip and pinch strengths using a dynamometer. Following treatment, significant changes were found, MMDT, grip and pinch strength, CHAQ, and DHI scores in both groups (p < 0.05); however, VGBT group was statistically superior to group II with respect to changes in MMDT (p < 0.05). VGBT using Nintendo®Wii and LMC games had slightly superior effects on manual dexterity in patients with CP while compared with NDT-based upper extremity rehabilitation. Futhermore, the effects of both treatment programs on grip strengths and functional ability were similar beneficial.

Video game-based therapy for the non-dominant hand improves manual skills and grip strength

The study was designed to investigate the effect of virtual reality-supported training on manual skills and grip strength in the non-dominant hand in healthy participants. Thirty participants were randomized into two groups: ErgoActive group (n=15) and control group (n=15). The ErgoActive study group received 8 weeks of training with leap motion controller-based virtual reality games. The training was done 1 day per week for 30min. The participants' hand function was evaluated using the Jebsen Taylor Hand Function Test (JTHFT), while grip strength was evaluated with a Jamar Hand Dynamometer and Pinchmeter. After 8 weeks, the ErgoActive and control groups had significantly different JTHFT, Jamar and Pinchmeter results (P<0.05). When leap motion controller-based virtual reality applications are used, healthy subjects have increased manual skills and grip strength in their non-dominant hand. These virtual reality games are an effective and fun way of improving patients' hand functions.

Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson\u2019s disease: a feasibility study

BackgroundNon-immersive video games are currently being used as technological rehabilitation tools for individuals with Parkinson’s disease (PD). The aim of this feasibility study was to evaluate the effectiveness of the Leap Motion Controller® (LMC) system used with serious games designed for the upper limb (UL), as well as the levels of satisfaction and compliance among patients in mild-to-moderate stages of the disease.MethodsA non-probabilistic sampling of non-consecutive cases was performed. 23 PD patients, in stages II-IV of the Hoehn & Yahr scale, were randomized into two groups: an experimental group (n = 12) who received treatment based on serious games designed by the research team using the LMC system for the UL, and a control group (n = 11) who received a specific intervention for the UL. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, as well as satisfaction and compliance, were assessed in both groups pre-treatment and post-treatment.ResultsWithin the experimental group, significant improvements were observed in all post-treatment assessments, except for Box and Blocks test for the less affected side. Clinical improvements were observed for all assessments in the control group. Statistical intergroup analysis showed significant improvements in coordination, speed of movements and fine motor dexterity scores on the more affected side of patients in the experimental group.ConclusionsThe LMC system and the serious games designed may be a feasible rehabilitation tool for the improvement of coordination, speed of movements and fine UL dexterity in PD patients. Further studies are needed to confirm these preliminary findings.

DMCN 2017 highlights: advances in cerebral palsy, encephalitis, paediatric stroke, and more

During the past year, we have refined the editorial processes of Developmental Medicine & Child Neurology, in part by optimizing statistical reviews and by setting up a group of systematic review advisors in collaboration with the American Academy of Cerebral Palsy and Developmental Medicine. Indeed, we have strengthened links with all the societies for which DMCN is the official journal (see our front cover for details) and were happy in 2017 to welcome the Australasian Academy of Cerebral Palsy and Developmental Medicine into the fold. We have also enhanced journal content in various ways. Abstracts of all our articles are now provided in Spanish and Portuguese translations, courtesy of the Latin-American Academy of Child Development and Disabilities (ALDID). Our YouTube video channel hosts a growing collection of author and editor podcasts with contributions from eminent experts including Aaron Ciechanower, Nobel prizewinner in Chemistry. Interactivity with the journal's readership has been strengthened through social media and Letters to the Editor are now posted on our website to foster debate and discussion. This year has been marked by clarification of the practical implications of physical activity, participation (which was the topic of a Virtual Issue), the validation of various outcome measures, delineation of the neurophysiological and neuroimaging signature of several neurodevelopmental conditions, refinements in genotype–phenotype associations (‘comorbid’ attention-deficit–hyperactivity disorder and autistic features were critically documented in a number of conditions), and more evidence for efficacy and safety for specific modalities of immunotherapy or tone-modulating agents. Alongside excellent original articles and critical commentaries, we have had systematic reviews on a wide range of important topics from immunoglobulins in neurological disorders, to taping procedures and outcome of scoliosis surgery in cerebral palsy. We have also had state-of-the-art reviews on such promising approaches to disability as stem cell treatment and videogame-based therapy. My Editor's Choice for the first issue of the year was a study demonstrating that following a paediatric stroke protocol improves timeliness of accurate diagnosis and appropriate treatment.1 Other papers in the 2017 volume have presented and discussed new sets of paediatric stroke guidelines and documented various outcome aspects. Assessment and classification of hand function has been another guiding thread throughout the year. One work I particularly liked for its topic, methodology, and useful result – another Editor's Choice – developed a patient-reported outcome measure assessing upper limb function related to real-life activities of individuals with Duchenne muscular dystrophy.2 This measure should usefully document the individual's self-reported evolution and evaluate the efficacy of interventions. The value of several functional classification systems has been established for children in addition to the groups addressed in the original validations, including a Mini-Manual Ability Classification System for hand function in children with cerebral palsy under 4 years and the Communication Function Classification System for communication in preschool children with speech and language disorders. Stability of the Gross Motor Function Classification System over time has been confirmed3 and the validity of the concept of cerebral palsy has also been reaffirmed. An important contribution to the debate on paediatric traumatic brain injury was provided by Minns et al.'s study of the relationship between raised intracranial pressure and retinal haemorrhage,4 and the ensuing discussion. The review on anti-N-methyl-d-aspartate receptor encephalitis following herpes simplex encephalitis5 clarifies the biphasic course of the condition with a parainfectious immune-mediated disorder amenable to immunomodulatory treatment. Looking at the novel findings and advances in the fields of paediatric neurology and neurodisability that made up the fabric of DMCN in 2017, we can foresee further important developments in 2018 and beyond.

Interactive Video Games are an Effective Supplementary to Pediatric Clinical Exercise Rehabilitation for Cerebral Palsy: Knowledge Translation of Video Game-based Therapy

To increase physical activity participation in children with cerebral palsy, the concept of video game-therapy has been introduced as a supplementary to physical rehabilitation programs. Evidence suggests that video game-based therapy is a safe, enjoyable and feasible strategy to increase movement experiences in children with developmental disabilities. Commercial video game consoles provide a platform for users to participate in repetitive movement tasks, which have been suggested to drive neuroplastic changes towards motor development in children with cerebral palsy. This evidence-based review is a supplementary to a knowledge translation video designed to educate the general public on the health-related benefits that can be accrued from playing interactive video games as an adjunct therapy to clinical exercise rehabilitation for children with cerebral palsy.

Leap motion controlled videogame-based therapy for rehabilitation of elderly patients with subacute stroke: a feasibility pilot study

Background:The leap motion controller (LMC) is a new optoelectronic system for capturing motion of both hands and controlling a virtual environment. Differently from previous devices, it optoelectronically tracks the fine movements of fingers neither using glows nor markers.Objective:This pilot study explored the feasibility of adapting the LMC, developed for videogames, to neurorehabilitation of elderly with subacute stroke.Methods:Four elderly patients (71.50 ± 4.51 years old) affected by stroke in subacute phase were enrolled and tested in a cross-over pilot trial in which six sessions of 30 minutes of LMC videogame-based therapy were added on conventional therapy. Measurements involved participation to the sessions, evaluated by means of the Pittsburgh Rehabilitation Participation Scale, hand ability and grasp force evaluated respectively by means of the Abilhand Scale and by means of the dynamometer.Results:Neither adverse effects nor spasticity increments were observed during LMC training. Participation to the sessions was excellent in three patients and very good in one patient during the LMC trial. In this period, patients showed a significantly higher improvement in hand abilities (P = 0.028) and grasp force (P = 0.006).Conclusions:This feasibility pilot study was the first one using leap motion controller for conducting a videogame-based therapy. This study provided a proof of concept that LMC can be a suitable tool even for elderly patients with subacute stroke. LMC training was in fact performed with a high level of active participation, without adverse effects, and contributed to increase the recovery of hand abilities.

The efficacy of balance training with video game-based therapy in subacute stroke patients: a randomized controlled trial.

The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results, whereas little information is available regarding the use of this therapy in subacute stroke patients. The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase. Fifty adult stroke patients participated to the study: 25 subjects were randomly assigned to balance training with Wii Fit, and the other 25 subjects were assigned to usual balance therapy. Both groups were also treated with conventional physical therapy (40 min 2 times/day). The main outcome was functional balance (Berg Balance Scale-BBS), and secondary outcomes were disability (Barthel Index-BI), walking ability (Functional Ambulation Category), and walking speed (10-meters walking test). Wii Fit training was more effective than usual balance therapy in improving balance (BBS: 53 versus 48, P = 0.004) and independency in activity of daily living (BI: 98 versus 93, P = 0.021). A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke.

Usual and Virtual Reality Video Game-based Physiotherapy for Children and Youth with Acquired Brain Injuries

ABSTRACTLittle is known about how therapists promote learning of functional motor skills for children with acquired brain injuries. This study explores physiotherapists’ description of these interventions in comparison to virtual reality (VR) video game-based therapy. Six physiotherapists employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using thematic analysis. Physiotherapists describe using interventions that motivate children to challenge performance quality and optimize real-life functioning. Intervention strategies are influenced by characteristics of the child, parent availability to practice skills outside therapy, and therapist experience. VR use motivates children to participate, but can influence therapist use of verbal strategies and complicate interventions. Physiotherapists consider unique characteristics of this population when providing interventions that promote learning of motor skills. The VR technology has advantageous features but its use with this population can be challenging; further research is recommended.