After stroke, people often have difficulty moving one arm and hand, but movement can improve with considerable practice. Arm movements may need to be repeated upwards of 2500 times for a person to approach his/her peak level of motor function.
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Video-gaming technology can effectively deliver engaging, high-repetition movement practice. Use of video games for rehabilitation can be as effective as more conventional approaches.2
There are 2 types of inexpensive, commonly available gaming systems that can be integrated into rehabilitation programs: controller based and camera tracking. In order for the systems to be used most effectively, it is necessary for therapists and/or individuals with stroke to assess both system types to determine which system best suits their needs and impairments.
The following are examples of systems and games that incorporate movements that may be useful for rehabilitation. This is not intended to be an exhaustive list, as new games and gaming systems are constantly being introduced to the market.
Table 1Comparison of Gaming Systems
| Comparison Criteria | Controller-Based Systems (eg, Nintendo Wii, PlayStation Move) | Camera-Tracking/Motion Capture Systems (eg, Microsoft Kinect) |
|---|---|---|
| System description |
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| Advantages |
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| Limitations |
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| Appropriate candidates |
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| Impairments targeted |
Authorship
“Virtual Reality Video Games to Promote Movement Recovery in Stroke Rehabilitation: A Guide for Clinicians” was developed by Kelly R. Anderson, OTR/L, Michelle L. Woodbury, PhD, OTR/L, Kala Phillips, BA, and Lynne V. Gauthier, PhD. This information/education page may be reproduced for noncommercial use for health care professionals to share with patients and their caregivers. Any other reproduction is subject to approval by the publisher.
Disclaimer
This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.
Table 2Examples of how Games can be used in Rehabilitation
| System Games or Packages | Game Description | Body Part Targeted | Speed/Difficulty of Game | Movement Goals Addressed | To Control the Game, the Player Must Be Able to: |
|---|---|---|---|---|---|
| Wii Games | |||||
| Wii Sports (package) | Players imitate the motions required in various sports (eg, imitating the swing required for golf, tennis, and baseball). | One or both arms (game dependent) | Varies by game; some are self-paced, while others require movements in reaction to a target. | Upper extremity movement speed, coordination, endurance, and range of motion | Maintain grasp on the hand-held controller and push/release buttons during arm motion. |
| Wii Fit (package) | Players engage in balance (simple yoga poses), aerobic exercise (running in place), and strength-training activities (pushups or leg lifts). | Full body (emphasis on trunk stability) | Self-paced | Balance, weight shift, leg lifts, strength, endurance, weight-bearing through arms | Grasp a hand-held controller and push/release buttons. Maintain balance to stand or sit on a balance board that is the size of a small step. |
| Just Dance (game) | Players follow sequences of whole-body dance moves to receive a score. | Full body | Speed determined by song/dance selected | Imitation of whole-body postures with rhythmic full-body movements | Maintain grasp on the hand-held controller and push/release small buttons while simultaneously performing full-body movements. |
| Zumba Fitness (game) | Players follow dance-like exercise routines. | Full body | 3 levels—based on speed and movement complexity | Imitation of whole-body postures with rhythmic full-body movements | Maintain grasp on the controller while imitating movements. |
| Wii Ware Arcade Games (package) | Players simulate arcade games (pool, air hockey, bowling, or snooker) by moving their arm(s) as they would in the real-world game. | One or both arms | Varies by game; some games are self-paced, while others require movements in reaction to a target. | Upper extremity movement speed, coordination, endurance, and range of motion | Maintain grasp on the hand-held controller and push/release small buttons during arm movements. |
| Kinect Games | |||||
| Kinect Sports–Bowling | Players use 1 arm to imitate a bowling swing. Rotating the arm in different ways during the swing can create ball spin. | One arm | Self-paced | Targeted reaching, movement timing | Extend the arm away from the body and direct arm movement toward a virtual target. |
| Kinect Sports–Boxing | Players use 2 arms to punch or block opponent punches. | Bilateral arm use | Must react to opponent's movements. Speed increases with player success. | Movement speed, reaction to target | Perform punching and blocking motions with the arms while dodging and blocking opponent's movements. |
| Kinect Sports–Table Tennis | Players swing 1 arm as if to hit balls as they bounce or fly across the table. | One arm | Must react to opponent's volley. Speed increases with player success. | Targeted reaching, movement timing | Extend the arm away from the body in a swinging motion in response to a moving target on the screen. |
| Kinect Adventures–20,000 Leaks | Players use their limbs, head, and trunk to cover holes and cracks that cause leaks in an underwater tank. | Full body | Must react quickly to new leaks. Speed increases with player success. | Fast-paced forward, sideways, and overhead reaching | Move arms, legs, head, and trunk to plug “leaks” throughout the reachable workspace while standing. |
| Child of Eden | Players navigate through space to destroy and avoid targets using arm movements. Different arm movements activate different “weapons” to destroy targets. Both arms raised together overhead creates a large explosion. | Bilateral arm use | Must react to targets as they appear on the screen | Fast-paced forward, sideways, and overhead reaching | Extend one or both arms overhead and away from the body to destroy moving targets on the screen. |
References
- Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study.Neurorehabil Neural Repair. 2010; 24: 620-635
- Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy.PLoS One. 2014; 9: e93318
- Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle.Stroke. 2010; 41: 1477-1484
- Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study.J Rehabil Med. 2011; 43: 527-533
- A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke.J Rehabil Med. 2010; 42: 437-441
- Feasibility of Wii Fit training to improve clinical measures of balance in older adults.Clin Interv Aging. 2013; 8: 775-781
- Does the inclusion of virtual reality games within conventional rehabilitation enhance balance retraining after a recent episode of stroke?.Rehabil Res Pract. 2013; 2013: 649561
- Arm motor recovery using a virtual reality intervention in chronic stroke: randomized control trial.Neurorehabil Neural Repair. 2013; 27: 13-23
Kiper P, Agostini M, Luque-Moreno C, Tonin P, Turolla A. Reinforced feedback in virtual environment for rehabilitation of upper extremity dysfunction after stroke: preliminary data from a randomized controlled trial. Biomed Res Int 2014;2014:752128.
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© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
