Virtual reality video games to help with balance after a stroke

Posted on 13th March 2014 by Christiana

I thoroughly enjoy working in the inpatient rehab environment with a large variety of patients. One group that I enjoy working with are patients who are recovering from a stroke. Each person is different in what connects with him or her during the recovery period. In my experience, most people become frustrated when they work specifically on balance; however, I noticed that when a person was play an interactive video game such as the Wii or Xbox Connect, that person was able to work on balance without the frustration.

Does the Inclusion of Virtual Reality Games within Conventional Rehbilitation Enhance Balance Retraining after a Recent Episode of Stroke? By B.S. Rajaratnam, J. Gui kaiEn, K. Lee JiaKin, S. Sim FenRu, Lee Enting, E. Ang YiHsia, Ng KeatHwee, Su Yungfeng, W. Woo YingHowe, and S. Teo Siao Ting in Rehabiliation Research and Practice. From April 2013.

Background:

Stroke is a condition that can happen to anyone, but is more likely to happen in those who are obese, have vascular problems, uncontrolled diabetes, or hypertension. This condition can change a person and their family’s way of life. One impairment patients struggle with after a stoke is their balance. As physical therapists, it is our job to help return the patient to their normal life, and we can do that through working on their balance. Researchers have assessed various ways to increase balance in patients with stroke. One thought to increase balance is through virtual reality games. Not only are they interactive and fun, but they also work on cognition and improving balance. The purpose of this study was to evaluate the effectiveness of introducing low cost interactive virtual reality balance related games within a conventional rehabilitation program to contribute to balance recovery after recent episode of stroke without increasing therapy time.

How it was performed:

Over a two-year period, a total of 19 in-patients who had a recent (~ 14.85 days post stroke) moderate to severe stroke from a community rehabilitation hospital in Singapore participated in the study. The average age of the patients was 61 years old. In order to participate in the study, the patients had to score greater than 23 on the Mini Mental State Examination to demonstrate they had the ability to understand how to safely use the virtual reality games. Each patient was tested before and after the intervention with these outcome measures: Functional Reach Test (FRT), Timed UP and Go (TUG), Berg Balance Scale (BBS), Center of Pressure (CoP), and Modified Barthel Index (MBI).

The participants were randomly divided into two groups: the control and the experimental. The protocol for the both groups included 15 sessions of either 60 minutes of conventional rehab (control) or 40 minutes of conventional rehab plus 20 minutes of interactive virtual reality balance related games (experimental group). For the experimental group, the patients used either Nintendo Wii-fit or Kinect. Wii-fit required subjects to weight shift during standing in response to game while the Kinect required constant change of center of mass in both sitting and standing.

What they found:

The researchers found a statistical significance between the control and experimental groups in the FRT. This difference suggests that those who engaged in virtual reality games had an increase in balance. In addition to differences between the two groups, the researchers looked at differences within the experimental group. There was a statistical significance within experimental group with TUG, FRT, and MBI. If the researched had included which game system the participants used, then the results may have suggested that one virtual reality may be superior to another.

Study limitations:

While this study potentially had a great design, there were limitations preventing it from being an excellent article. The researchers did not include specific protocols such as what games the experimental group played, how much assistance they were given, or which systems each patient used.

Take home message:

The study is definitely a brick that has been laid in the path to improving balance in patients with stroke. Working with virtual reality systems is a great way to engage older adults in their rehabilitation while working on balance. Future researches on this topic should include more participants (~100), specific activities, specific systems, and assistance required. Before using this intervention, one should definitely look into more articles addressing the topic of virtual reality.

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