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Background: Post-stroke recovery benefits from structured, intense, challenging, and repetitive therapy. Exergames have emerged as promising to achieve sustained therapy practice and patient motivation. This study assessed the usability and effects of exergames on balance and gait. Subjects and Methods: Sixteen elderly participants were provided with the study intervention based on five newly developed exergames. The participants were required to attend 36 training sessions; lasting for 20 minutes each. Adherence, attrition and acceptance were assessed together with (1) Berg Balance Scale, (2) 7-m Timed Up and Go, (3) Short Physical Performance Battery, (4) force platform stance tests, and (5) gait analysis. Results: Thirteen participants completed the study (18.8 percent attrition), without missing a single training session (100 percent adherence). Participants showed high acceptance of the intervention. Only minor adaptations in the program were needed based on the users' feedback. No changes in center of pressure area during quiet stance on both stable and unstable surfaces and no changes of walking parameters were detected. Scores for the Berg Balance Scale (P = 0.007; r = 0.51), the 7-m Timed Up and Go (P = 0.002; r = 0.56), and the Short Physical Performance Battery (P = 0.013; r = 0.48) increased significantly with moderate to large effect sizes. Conclusion: Participants evaluated the usability of the virtual reality training intervention positively. Results indicate that the intervention improves gait-and balance-related physical performance measures in untrained elderly. The present results warrant a clinical explorative study investigating the usability and effectiveness of the exergame-based program in stroke patients.

Abstract-Computer games are a promising tool to support rehabilitation at home. It is widely recognized that rehabilitation games should (i) be nicely integrated in general-purpose rehabilitation stations, (ii) adhere to the constraints posed by the clinical protocols, (iii) involve movements that are functional to reach the rehabilitation goal, and (iv) adapt to the patients' current status and progress. However, the vast majority of existing rehabilitation games are stand-alone applications (not integrated in a patient station), that rarely adapt to the patients' condition. In this paper, we present the first prototype of the patient rehabilitation station we developed that integrates video games for rehabilitation with methods of computational intelligence both for on-line monitoring the movements' execution during the games and for adapting the gameplay to the patients' status. The station employs a fuzzy system to monitor the exercises execution, on-line, according to the clinical constraints defined by the therapist at configuration time, and to provide direct feedback to the patients. At the same time, it applies real-time adaptation (using the Quest Bayesian adaptive approach) to modify the gameplay according both (i) to the patient current performance and progress and (ii) to the exercise plan specified by the therapist. Finally, we present one of the games available in our patient stations (designed in tight cooperation with therapists) that integrates monitoring functionalities with in-game self-adaptation to provide the best support possible to patients during their routine.

We show here how integrating novel natural user interfaces, like Microsoft Kinect, with a fully adappatient's current statustive game engine, a system that can be used for rehabilitation at home can be built. A wide variety of game scenarios, a balanced scoring system, quantitative and qualitative exercise evaluation, automatic gameplay level adaptation to patient's current status, and audiovisual feed-back are all implemented inside the Intelligent Game Engine for Rehabilitation here introduced, and are aimed at maximizing patient's motivation and rehabilitation effectiveness. The system is integrated into a multi-level platform that provides continuous monitoring by the hospital and it has been developed inside the framework of the EU funded Rewire project

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BackgroundUse of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames—games based on therapeutic principles—aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility.ObjectivesThe goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke.MethodsA total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention.ResultsThe median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%).ConclusionsThe high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations—for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.

Purpose: Virtual Reality (VR) platforms gained a lot of attention in the rehabilitation field due to their ability to engage patients and the opportunity they offer to use real world scenarios. As neglect is characterized by an impairment in exploring space that greatly affects daily living, VR could be a powerful tool compared to classical paper and pencil tasks and computer training. Nevertheless, available platforms are costly and obstructive. Here we describe a low cost platform for neglect rehabilitation, that using consumer equipments allows the patient to train at home in an intensive fashion. Method: We tested the platform on IB, a chronic neglect patient, who did not benefit from classical rehabilitation. Results: Our results show that IB improved both in terms of neglect and attention. Importantly, these ameliorations lasted at a follow up evaluation 5 months after the last treatment session and generalized to everyday life activities. Conclusions: VR platforms built using equipment technology and following theoretical principles on brain functioning may induce greater ameliorations in visuo-spatial deficits than classical paradigms possibly thanks to the real world scenarios in association with the “visual feedback” of the patient’s own body operating in the virtual environment.

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