Maintained hand function and forearm bone health 14 months after an in-home virtual-reality videogame hand telerehabilitation intervention in an adolescent with hemiplegic cerebral palsy

Virtual reality videogames can be used to motivate rehabilitation, and telerehabilitation can be used to improve access to rehabilitation. These uses of technology to improve health outcomes are a burgeoning area of rehabilitation research. So far, there is a lack of reports of long-term outcomes of these types of interventions. The authors report a 15-year-old boy with hemiplegic cerebral palsy and epilepsy because of presumed perinatal stroke who improved his plegic hand function and increased his plegic forearm bone health during a 14-month virtual reality videogame hand telerehabilitation intervention. A total of 14 months after the intervention ended, repeat evaluation demonstrated maintenance of both increased hand function and forearm bone health. The implications of this work for the future of rehabilitation in children with neurological disabilities are discussed in this article

Activity-promoting gaming systems in exercise and rehabilitation

Commercial activity-promoting gaming systems provide a potentially attractive means to facilitate exercise and rehabilitation. The Nintendo Wii, Sony EyeToy, Dance Dance Revolution, and Xbox Kinect are examples of gaming systems that use the movement of the player to control gameplay. Activity-promoting gaming systems can be used as a tool to increase activity levels in otherwise sedentary gamers and also be an effective tool to aid rehabilitation in clinical settings. Therefore, the aim of this current work is to review the growing area of activity-promoting gaming in the context of exercise, injury, and rehabilitation

Use of commercial gaming console WII for rehabilitation of hand impairments in young adults with Cerebral Palsy

Abstract The purpose of this study examined the feasibility of using a low-cost, commercially available gaming platform, the Wii® on improving the hand dexterity impairments in young adults with cerebral palsy. The study included 5 young adults with spastic cerebral palsy with a score of 1-3 on the GMFCS scale and a score of 1-2 on the MACS scale. The participants underwent an 8-week training intervention using the Wii™ for approximately 30 min/day 2 times a week. Training was performed using the Wii™ sports games software, including boxing, tennis, bowling, and archery. Three outcomes measures for hand impairments were used and tested during the study: such as the Hand dynamometer for the grip strength, Purdue peg board for the fine finger dexterity and the Box and Block test for the manual gross dexterity pre-and post- intervention as well as the family-reported activities of daily living before and after the interventions. A student’s t-test was used to analyse the pre- and the post-test results. The feasibility of using the virtual reality (Wii™) in the rehabilitation settings for young adults with CP showed positive outcomes in improving their hand impairments and manual ability. Additional hypotheses were proposed from the study for additional research

Effects of exercise in people with cerebral palsy. A review.

Regardless the advances in medical science, it seems that the prevalence of cerebral palsy (CP) has been increasing during the last forty years. Cerebral palsy is associated with muscle weakness and impaired circulation that leads to muscle spasticity and deficits in motor control, thereby limiting the individual¿s ability to perform not only leisure, social or occupational activities but also basic daily tasks. In this sense, exercise is gaining popularity as an intervention choice for this population. Literature aiming to improve the quality of life of patients suffering from cerebral pathologies such as cerebral palsy has observed that both strength and aerobic training lead to significant benefits that improve the quality of life of these patients via a reduction in dependency, muscular deficits and improved cardiorespiratory capacity

The use of the Nintendo Wii in motor rehabilitation for virtual reality interventions:a literature review

Several review articles have been published on the use of Virtual Reality (VR) in motor rehabilitation. The majority of these focus on the effectiveness of VR on improving motor function using relatively expensive commercial tools and technologies including robotics, cybergloves, cybergrasps, joysticks, force sensors and motion capture systems. However, we present the case in this chapter that game sensors and VR technologies which can be customized and reconfigured, such as the Nintendo Wii, provide an alternative and affordable VR intervention for rehabilitation. While the performance of many of the Wii based interventions in motor rehabilitation are currently the focus of investigation by researchers, an extensive and holistic discussion on this subject does not yet exist. As such, the purpose of this chapter is to provide readers with an understanding of the advantages and limitations of the Nintendo Wii game sensor device (and its associated accessories) for motor rehabilitation and in addition, to outline the potential for incorporating these into clinical interventions for the benefit of patients and therapists

The Effects of Virtual Reality on the Upper Extremity Skills of Girls with Rett Syndrome: A Single Case Study

Introduction: Rett Syndrome (RTT) is a genetic disorder primarily seen in females that inhibits the use of a girl's hands in everyday activities. A girl with RTT spends the majority of her day engaged in stereotypical hand wringing/mouthing movements at midline of the body. The probable cause behind the neurological effects of RTT is a mutation in the gene that encodes for methyl-CpG protein 2 (MeCP2). The hand wringing/mouthing behaviors preclude a girl with RTT from using the upper extremities in purposeful tasks such as school work, play skills, and other activities of daily living.Objectives: To develop a virtual reality (VR)-based therapeutic intervention that 1) decreases upper extremity stereotypies (repetitive movements that serve no function) that interfere with purposeful arm and hand use and 2) promotes purposeful, goal-directed arm function; improve upper extremity motor skills in girls with RTT.Materials and Methods: Using FAAST Software and Microsoft Kinect sensor, one girl with RTT participated in a 12-week IVR intervention (1 hour/session, 3 sessions/week, 36 total hours). Pre- and post-assessments were administered to examine any changes in upper extremity function.Results: The VR intervention led to improvements in use of the upper extremities to complete self-care activities, an increased number of reaches completed in a 15-minute period, and decreased time engaged in stereotypical hand movements.Conclusion: Future work will add additional support to determine the effectiveness of virtual reality as an intervention for girls with RTT

In-Home Delivery of Constraint-Induced Movement Therapy via Virtual Reality Gaming

Purpose: People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game. Methods: Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of the stronger arm via a padded restraint mitt; and 3) a transfer package to reinforce arm use. Feasibility of the intervention was evaluated through comparison to traditional CI therapy and through participants’ subjective responses. The primary outcome measures were the Wolf Motor Function Test (WMFT) and the Motor Activity Log quality of movement scale (MAL-QOM). Results: On average, participants completed 17.2 ± 8 hours and 19,436 repetitions of motor practice. No adverse events were reported. Of 7 feasibility criteria, 4 were met. WMFT rate and MAL-QOM increased, with effect size (Cohen’s d) of 1.5 and 1.1, respectively. Conclusions: This model of delivering CI therapy using a custom, avatar-based virtual reality game was feasible, well received, and showed preliminary evidence of being a safe intervention to use in the home for persons with chronic hemiparesis