Virtual reality for stroke rehabilitation (Review)

THIS IS NOT THE MOST RECENT VERSION OF THIS PROTOCOL please see: http://hdl.handle.net/2328/39189 Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is made available in accordance with Cochrane Database of Systematic Review's repositories policyBackground Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. Objectives To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke. Search methods We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers. Selection criteria Randomised and quasi‐randomised trials of virtual reality ('an advanced form of human‐computer interface that allows the user to 'interact' with and become 'immersed' in a computer‐generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function. Data collection and analysis Two review authors independently selected trials based on pre‐defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information. Main results We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. Primary outcomes: results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies. Secondary outcomes: results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited. Authors' conclusions We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii)

Personal Health Practices Around Physical Activity as Perceived by the Aboriginal Children of Prince Edward Island

During the past decade, there have been several health surveys involving Canada’s Aboriginal people. In many of these studies, the Aboriginal population of Prince Edward Island (P.E.I.) has not been adequately represented. Given the lack of information regarding the health status of this population, the Abegweit and Lennox Island First Nations bands collaborated with the University of Prince Edward Island’s Faculty of Education, School of Nursing, and Department of Family and Nutritional Sciences to gain a more comprehensive profile of the perceptions, health behaviours and needs of Aboriginal children living on reserve in both of these Island communities.The study focused primarily on three of the determinants of health: early childhood development, education, and personal health practices and coping. Individuals from the two P.E.I. communities were interviewed, including 18 children in the 6-8 year age group, 22 children in the 9-12 year age group, 28 youth in the 13-18 year age group, 27 parents or caregivers, and 6 pregnant mothers.This research is important as there is little, if any, research undertaken with the Mi’kmaq communities of P.E.I. Unique features of this study are the inclusion of children as informants, the use of a multidisciplinary team and the active involvement of the Mi’kmaq community in all stages of the project.The purpose of this article is to disseminate some of the personal health practices around physical activity as perceived by the Aboriginal children and to identify current health behaviours and/or needs of active, healthy lifestyles.Therefore, only the results focusing on these children’s perceptions of their health, and their perceptions and behaviours about physical activities, will be discussed