Serious game for locomotor rehabilitation of hemiparetic stroke patients

Abstract

Introduction: Hemiparesis post-stroke usually results in locomotor limitations. As conventional rehabilitation is monotonous, the Serious Games (SG) represents an excellent treatment strategy, allowing to perform physical training in an interesting and enjoyable way. Objective: To evaluate the effects of an exercise program using the SG developed for hemiparetic stroke patients’ locomotor rehabilitation. Method: Non-Randomized Controlled Clinical Trial. Twenty-four hemiparetic stroke patients with subacute or chronic stroke (twelve men), mean age of 57.8 ± 10.4 years (injury time of 16.8 ± 19.6 months) participated in the study. The experimental group (n = 16) participated in an exercise program with the SG for lower limb rehabilitation. The control group (n = 8) received conventional treatment (kinesiotherapy). The intervention consisted of sessions twice a week for ten weeks. The following parameters were assessed: muscle strength (dynamometry), spasticity (Modified Ashworth Scale), functional mobility (Timed Up and Go Test - TUGT), and the gait speed (GS). Results: Both groups showed improvements, but the experimental group was better in all the studied variables, the muscular strength of the lower limb paresis and of the quadriceps femoris (p = 0.002; d = 0.7); and for the hamstrings (p < 0.001; d = 1.3), TUGT (p < 0.001; d = 0.4), and GS (p = 0.001; d = 0.4). Conclusion: The exercise program with the SG was useful for the patients treated in this study. The results showed a superiority of the SG regarding the conventional treatment in all the controlled variables. This was probably because of the greater repeatability of the exercises and the increased attention and motivation.

The effects of exergames on muscle strength: A systematic review and meta‐analysis

“…After reading full‐text copies, 101 studies were excluded from this review due to the following reasons: (i) two studies applied an acute intervention; (ii) one study used a non‐validated method for strength assessment; (iii) 45 studies did not apply an exergame intervention; (iv) four studies did not apply any intervention; (v) 39 studies did not measure muscle strength according to the criteria adopted in this review; and (vi) 11 studies applied combined interventions. At the end of the process, 47 publications meeting the eligibility criteria were included for qualitative analysis 31‐46,58‐88 . Eleven 63,68,72,73,78‐80,83,86‐88 of these 47 studies applied a study design that did not allow for the comparison of exergames versus a non‐exercise control group, or exergames versus a usual care intervention, or a usual care plus exergames versus a usual care intervention.…”

“…Only one study 41 of those comparing exergames versus a non‐exercise control group measured leg press MVIC; only one study 44 of those comparing exergames versus a usual care intervention measured ankle joint isokinetic muscle strength; and only one study 71 of those comparing a usual care plus exergames versus a usual care intervention measured shoulder joint isometric muscle strength. Furthermore, four 35,36,39,76 of the 28 remaining studies 31‐40,42,46,59,61,62,64‐67,69,74‐77,81,82,84,85 provided insufficient data for the quantitative analysis and 14 studies 33,37,38,40,42,46,62,64,66,67,75,77,82,84 did not report MD and SD MD data. For this reason, the corresponding authors were contacted via email; however, only two 36,62 of the corresponding authors responded to our request, and one 46 informed us that the data were not kept as the study was closed.…”

“…For this reason, the corresponding authors were contacted via email; however, only two 36,62 of the corresponding authors responded to our request, and one 46 informed us that the data were not kept as the study was closed. For this reason, we calculated MD and SD MD values for the 13 studies 33,37,38,40,42,46,64,66,67,75,77,82,84 that did not report these data, and added these studies to the 12 studies 31,32,34,59,61,62,65,69,74,81,85 which reported/sent MD and SD MD values. Therefore, 25 studies 31‐34,36‐38,40,42,46,59,61,62,64‐67,69,74,75,77,81,82,84,85 were included in the meta‐analysis (seven studies 34,36,37,40,62,67,77 comparing exergames versus a non‐exercise control group, 15 studies 31,32,38,42,46,59,64,66,69,74,75,81,82,84,85 comparing exergames versus a usual care intervention, one study 33 comparing exergames versus both a non‐exercise control group and a usual care intervention, and two studies 61,65 comparing a usual care plus exergames versus usual care intervention) (Figure 1).…”

“…The number of participants in the studies ranged from 6 69 to 124 67 . Three studies examined exclusively men, 46,58,69 seven examined exclusively women, 34,36,45,59,74,78,80 whilst 34 31‐33,35,37‐39,41‐44,60‐68,70‐73,75,77,79,81‐83,85‐88 studies assessed a mixed sex sample of men and women, and three studies 40,76,84 did not report the participants’ sex. In total, 604 men and 1,039 women participated in the included studies.…”

“…Seven 68,73,78,83,86‐88 of the 47 included studies used a within‐group exergame study design, and one study 77 used both a within‐group (before and after a 3‐year period) and a between‐groups study design (exergames versus a non‐exercise control group after a 12‐week period). Eleven studies 34‐37,39‐41,45,62,67,70 compared exergames versus a non‐exercise control group, 19 studies 31,32,38,42‐44,46,58‐60,64,66,69,74,75,81,82,84,85 compared exergames versus a usual care intervention, four studies 61,65,71,76 compared usual care versus a usual care plus exergames intervention, and only one study 33 compared exergames versus a non‐exercise control group and versus a usual care intervention group.…”