-
[show abstract]
[hide abstract]
ABSTRACT: Effective stroke rehabilitation must be early, intensive and repetitive, which can lead to problems with patient motivation
and engagement. The design of video games, often associated with good user engagement, may offer insights into how more effective
systems for stroke rehabilitation can be developed. In this paper we identify game design principles for upper limb stroke
rehabilitation and present several games developed using these principles. The games use low-cost video-capture technology
which may make them suitable for deployment at home. Results from evaluating the games with both healthy subjects and people
with stroke in their home are encouraging.
The Visual Computer 04/2012; 25(12):1085-1099. · 0.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the feasibility of a trial to investigate the effectiveness of virtual reality-mediated therapy compared to conventional physiotherapy in the motor rehabilitation of the arm following stroke, and to provide data for a power analysis to determine numbers for a future main trial.
Pilot randomized controlled trial.
Clinical research facility.
Eighteen people with a first stroke, 10 males and 8 females, 7 right and 2 left side most affected. Mean time since stroke 10.8 months.
Participants were randomized to a virtual reality group or a conventional arm therapy group for nine sessions over three weeks.
The upper limb Motricity Index and the Action Research Arm Test were completed at baseline, post intervention and six weeks follow-up.
Outcome data were obtained from 95% of participants at the end of treatment and at follow-up: one participant withdrew. Compliance was high; only two people reported side-effects from virtual reality exposure. Both groups demonstrated small (7-8 points on upper limb Motricity Index and 4 points on the Action Research Arm Test), but non-significant, changes to their arm impairment and activity levels.
A randomized controlled trial of virtual reality-mediated therapy comparable to conventional therapy would be feasible, with some suggested improvements in recruitment and outcome measures. Seventy-eight participants (39 per group) would be required for a main trial.
Clinical Rehabilitation 01/2012; 26(9):798-806. · 2.12 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Stroke is a leading cause of severe physical disability, causing a range of impairments. Frequently stroke survivors are left with partial paralysis on one side of the body and movement can be severely restricted in the affected sidepsilas hand and arm. We know that effective rehabilitation must be early, intensive and repetitive, which leads to the challenge of how to maintain motivation for people undergoing therapy. This paper discusses why games may be an effective way of addressing the problem of engagement in therapy and analyses which game design patterns may be important for rehabilitation. We present a number of serious games that our group has developed for upper limb rehabilitation. Results of an evaluation of the games are presented which indicate that they may be appropriate for people with stroke.
Games and Virtual Worlds for Serious Applications, 2009. VS-GAMES '09. Conference in; 04/2009
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the utility of virtual reality (VR) in stroke rehabilitation.
The Medline, Proquest, AMED, CINAHL, EMBASE and PsychInfo databases were electronically searched from inception/1980 to February 2005, using the keywords: Virtual reality, rehabilitation, stroke, physiotherapy/physical therapy and hemiplegia. Articles that met the study's inclusion criteria were required to: (i) be published in an English language peer reviewed journal, (ii) involve the use of VR in a stroke rehabilitation setting; and (iii) report impairment and/or activity oriented outcome measures. Two assessors independently assessed each study's quality using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) grading system.
Eleven papers met the inclusion criteria: Five addressed upper limb rehabilitation, three gait and balance, two cognitive interventions, and one both upper and lower limb rehabilitation. Three were judged to be AACPDM Level I/Weak, two Level III/Weak, three Level IV/Weak and three Level V quality of evidence. All articles involved before and after interventions; three randomized controlled trials obtained statistical significance, the remaining eight studies found VR-based therapy to be beneficial. None of the studies reported any significant adverse effects.
VR is a potentially exciting and safe tool for stroke rehabilitation but its evidence base is too limited by design and power issues to permit a definitive assessment of its value. Thus, while the findings of this review are generally positive, the level of evidence is still weak to moderate, in terms of research quality. Further study in the form of rigorous controlled studies is warranted.
Disability and Rehabilitation 08/2007; 29(14):1139-46; discussion 1147-52. · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our group has developed a relatively low-cost virtual reality (VR) system for rehabilitation of the upper limb following stroke. Our system is immersive in that the participant views a representation of their arm and hand, reaching and retrieving objects in the virtual environment (VE), through a head-mounted display (HMD). This is thought to increase the participant's sense of presence in the VE and may lead to improved rehabilitation outcomes. However, use of immersion, particularly with our low-cost system, may increase the incidence of side effects reported. Therefore, the aim of this project was to assess the interaction of healthy users and those following stroke, in terms of their experience of presence in the VE and the rate of self-reported side effects. Differences in rates of perceived exertion, levels of enjoyment, and sense of control between both groups were also explored.
CyberPsychology & Behavior 05/2006; 9(2):137-41. · 2.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to assess the feasibility of an RCT to investigate VR mediated therapy in comparison to standard physiotherapy alone in the motor rehabilitation of the upper limb following stroke, and to provide data to inform a power analysis to determine numbers for a future trial. A single blinded randomised controlled trial was conducted. Participants were recruited from two hospital stroke units and members of local Northern Ireland Chest, Heart and Stroke Association clubs. The Upper Limb Motricity Index, Action Research Arm Test were completed at baseline, post-intervention and 6 weeks follow-up. 18 participants were randomised to either a VR mediated upper limb therapy group or a standard therapy group. No significant between group differences were noted. Both groups reported some small changes to their upper limb activity levels. Both interventions seemed to have been acceptable to participants. This study demonstrated the feasibility of a randomised controlled trial of virtual reality mediated therapy for the upper limb compared to standard therapy. Forty-eight participants (24 per group) would be needed to complete an adequately powered study.
