Multi-Exergames to Set Targets and Supplement the Intensified Conventional Balance Training in Patients With Stroke: A Randomized Pilot Trial

Cikajlo, Imre; Rudolf, Marko; Mainetti, Renato; Borghese, N. Alberto

doi:10.3389/fpsyg.2020.00572

Cited by 20 publications

(18 citation statements)

References 41 publications

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“…Recently, exergame intervention (EI) has been implemented as a novel rehabilitative strategy for those who have cognitive-motor impairments (e.g., Parkinson and stroke) and demonstrated the great potential of enhancing balance control [ 13 – 15 ]. Interactive exergaming consists of a series of cognitive and motor tasks with biofeedback technology (e.g., virtual reality, step-mat, sensor) interacting with users in real-time fashion [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis

Chen

Zhang

Guo

et al. 2021

J NeuroEngineering Rehabil

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Objective Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has emerged to prevent falls by enhancing both physical and cognitive functions in older adults. Therefore, we aim to quantitatively assess and compare the effects of PT and EI on the performance of balance control and fall prevention in healthy older adults via meta-analysis. Methods A search strategy based on the PICOS principle was used to find the publication in the databases of PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE. The quality and risk of bias in the studies were independently assessed by two researchers. Results Twenty studies consisting of 845 participants were included. Results suggested that as compared to PT, EI induced greater improvement in postural control (sway path length, SMD = − 0.66, 95% CI − 0.91 to − 0.41, P < 0.001, I2 = 0%; sway speed, SMD = − 0.49, 95% CI − 0.71 to − 0.27, P < 0.001, I2 = 42%) and dynamic balance (SMD = − 0.19, 95% CI − 0.35 to − 0.03, P = 0.02, I2 = 0%) in healthy older adults. The EI with 90–119 min/week for more than 8-week significantly reduced falls. Subgroup analyses revealed that exergames, which were designed by the two principles of repeatedly performing diversified tasks and gradually increase the difficulty of the task, induced significant effects in improving balance control and falls prevention respectively (P = 0.03, P = 0.009). In addition, intervention that combines EI and PT induced significant improvement in postural control (P = 0.003). Conclusion The exergame intervention, especially the combination of EI and PT, is a promising strategy to improve balance control and reduce falls in healthy older adults. Future studies with rigorous design, larger sample size, and follow-up assessments are needed to further assess the effectiveness of diverse exergame interventions in fall prevention and to quantify the “dose-effect” relationship, as well as the carry-over effect of such intervention, which will ultimately help optimize the rehabilitative strategies to improve balance control and prevent falls.

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Section: Introductionmentioning

confidence: 99%

Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis

Chen

Zhang

Guo

et al. 2021

J NeuroEngineering Rehabil

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“…These interactive exercises are for the lower and upper limbs as well as for the head and trunk particularly with respect to trunk balance. 40 , 41 They follow simple and safe principles, which make them suitable for a home setting. Such exercises required the patients to be in a sitting or standing position, with or without support, with constant support (e.g.…”

Section: Outcome Measuresmentioning

confidence: 99%

The WeReha Project for an Innovative Home-Based Exercise Training in Chronic Stroke Patients: A Clinical Study

Fulle

Paolucci

Saggino

et al. 2020

J Cent Nerv Syst Dis

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Background: Telerehabilitation (TR) in chronic stroke patients has emerged as a promising modality to deliver rehabilitative treatment-at-home. The primary objective of our methodical clinical study was to determine the efficacy of a novel rehabilitative device in terms of recovery of function in daily activities and patient satisfaction and acceptance of the medical device provided. Methods: A 12-week physiotherapy program (balance exercises, upper and lower limb exercises with specific motor tasks using a biofeedback system and exergaming) was administered using the WeReha device. Twenty-five ( N = 25) chronic stroke outpatients were enrolled, and the data of 22 patients was analyzed. Clinical data and functional parameters were collected by Berg Balance scale (BBS), Barthel Index (BI), Fugl-Meyer scale (FM), Modified Rankin scale (mRS), and Technology Acceptance Model (TAM) questionnaire at baseline (T0), after treatment (T1), and at the 12-week follow-up (T2). Statistical tests were used to detect significant differences ( P < .05), and Cohen’s (Co) value was calculated. Results: BI scores improved significantly after treatment ( P = .036; Co 0.776, medium), as well as BBS scores ( P = .008; Co 1.260, high). The results in FM scale ( P = .003) and mRS scores ( P = .047) were significant post treatment. Follow-up scores remained stable across all scales, except the BI. The A and C sub-scales of the TAM correlated significantly to only a T2 to T1 difference for BI scores with P = .021 and P = .042. Conclusion: Currently, the WeReha program is not the conventional therapy for stroke patients, but it could be an integrative telerehabilitative resource for such patients as a conventional exercise program-at-home. ClinicalTrials.gov identifier: NCT03964662.

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“…Examples include training for function led tasks (e.g., crossing a road, or shopping in a supermarket) (Corbetta et al, 2015;Dawson and Marcotte, 2017;Parsons et al, 2017), and construct led tasks, sometimes referred to as "exergames" (Dawson and Marcotte, 2017). Both function led, and construct led tasks can be managed safely (Fox et al, 2009;Borrego et al, 2016), and provide additional motivation in VR (Cikajlo et al, 2020), thus reducing patient boredom, increase patient motivation and compliance to engage with therapeutic activities (Chen et al, 2020). Although, VR supports a variety of different therapeutic activities, explicit instructions are often provided verbally to guide a patient through a task (Johnson et al, 2013;Jie et al, 2018;Mak et al, 2018;Kleynen et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

The Use of Embedded Context-Sensitive Attractors for Clinical Walking Test Guidance in Virtual Reality

Croucher¹,

Powell²,

Dicks³

et al. 2021

Front. Virtual Real.

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Virtual reality is increasingly used in rehabilitation and can provide additional motivation when working toward therapeutic goals. However, a particular problem for patients regards their ability to plan routes in unfamiliar environments. Therefore, the aim of this study was to explore how visual cues, namely embedded context-sensitive attractors, can guide attention and walking direction in VR, for clinical walking interventions. This study was designed using a butterfly as the embedded context-sensitive attractor, to guide participant locomotion around the clinical figure of eight walk test, to limit the use of verbal instructions. We investigated the effect of varying the number of attractors for figure of eight path following, and whether there are any negative impacts on perceived autonomy or workload. A total of 24 participants took part in the study and completed six attractor conditions in a counterbalanced order. They also experienced a control VE (no attractors) at the beginning and end of the protocol. Each VE condition lasted a duration of 1 min and manipulated the number of attractors to either singular or multiple alongside, the placement of turning markers (virtual trees) used to represent the cones used in clinical settings for the figure of eight walk test. Results suggested that embedded context-sensitive attractors can be used to guide walking direction, following a figure of eight in VR without impacting perceived autonomy, and workload. However, there appears to be a saturation point, with regards to effectiveness of attractors. Too few objects in a VE may reduce feelings of intrinsic motivation, and too many objects in a VE may reduce the effectiveness of attractors for guiding individuals along a figure of eight path. We conclude by indicating future research directions, for attractors and their use as a guide for walking direction.

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Multi-Exergames to Set Targets and Supplement the Intensified Conventional Balance Training in Patients With Stroke: A Randomized Pilot Trial

Cited by 20 publications

References 41 publications

Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis

Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis

The WeReha Project for an Innovative Home-Based Exercise Training in Chronic Stroke Patients: A Clinical Study

The Use of Embedded Context-Sensitive Attractors for Clinical Walking Test Guidance in Virtual Reality

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