The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial

Abstract

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.

A Prospective, Randomized Trial to Evaluate the Efficacy of Virtual Reality Treatment Versus Traditional Balance Treatment in Patients with Stroke

“…There is low and very low evidence that VR therapy improves walking ability [6,7,13,19]. According to our findings, training with Nintendo Wii™ on postural balance probably had positive effects on reducing the need for aids and/or supervision during walking for avoiding the risk of falling [19].…”

“…Compare to conventional balance therapy, Wii Fit gaming is effective on walking ability (FAC) and functional balance (FMBS) improvements in our study group. In an earlier study, partial benefits were observed in walking ability recovery on the follow-up [19]. There is low and very low evidence that VR therapy improves walking ability [6,7,13,19].…”

Comparison of scores obtained in videogame with biomechanical variables in stroke

“…The results presented in the previous studies, 8,12 which applied only scales as tools for evaluating the balance, indicated the improvement of PC after the intervention with Wii Fit, however the studies which applied the posturography for evaluating the PC did not find significant statistical differences in the variables analyzed in the force platform, except for Barcala et al…”

“…7 The treatment methods for rehabilitating patients with stroke are based on the motor learning principles, in which the repetitive and intensive practice of a specific task induces cerebral plasticity modifications and influences the functional recovery of the deficits. 8,9 It is known, however, that the conventional therapies promote a limited amount of repetitions, 9 whereas therapies with virtual reality (VR) [10][11][12] have become promising, once they allow intensive and repetitive training of one single task. 8 VR is described as form of interface between the user and the computer that simulates a real environment and that allows the patients to interact with it.…”

Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study

“…Because of the potential relevant characteristics of VR for motor learning and neuroplasticity [14], VR may be of even more added value during the earlier rehabilitation phase. Three studies [24][25][26] that investigated the effect of VR in this time period after stroke indicated a positive effect of commercially available VR systems (Nintendo Wii Fit or IREX) on balance and/or gait recovery. However, the results of these studies cannot be generalised to the whole population of patients with stroke because included participants had a relatively high functional level regarding balance and gait at the start of the VR intervention.…”