virtual environment rehabilitation for chronic stroke

Conditions: Stroke

Summary: more than half of individuals post-stroke have residual movement disabilities, including reduced mobility, balance, and increased risk of falling. there is a need for innovative, long-term and economically-feasible interventions for those with chronic stroke. recently, a focus has been placed on the use of virtual reality and interactive gaming as a low cost and effective manner of treating movement disorders. yet few studies have investigated interactive gaming platforms effect on balance following stroke. the proposed study is a randomized, single-blind, control group cross-over study for individuals with chronic stroke designed to examine an innovative therapeutic approach by investigating the effects of commercially-available gaming systems on balance, mobility and fear of falling in a sample of individuals with chronic motor deficits following stroke.

objective: to determine if playing active video games results in improved balance and motor performance. design: randomized-matched, single-blind, control group cross-over study setting: laboratory patients: participants with chronic hemiparesis post-stroke were randomly assigned to a gaming group or normal activity control group. interventions: gaming systems provided an interactive interface of real-time movement of either themselves or an avatar on the screen. participants played games 1 hour/day, 4 days/week, for 5 weeks, totaling 20 hours of game-play. the intervention was strictly game-play without physical therapy. all games were played in standing position and trainers supervised to protect against loss of balance. measurements: both groups were tested prior to and following the 5 weeks (post-test) and 3 months following the completion of the intervention/control. outcome measures included: fugl-meyer motor exam, single leg stance time, symmetrical weight bearing, berg balance scale, dynamic gait index, timed up and go, six minute walk, 3 meter walk, step length differential, and perception of recovery.

Eligibility criteria:
inclusion criteria: * greater than 6 months following stroke * ability to walk 10 feet with or without assistance * 18 years of age or older * clinical presentation of unilateral hemiplegia post-stroke * ability to follow simple two-step instructions exclusion criteria: * unable to ambulate 150 feet prior to stroke * history of serious chronic obstructive pulmonary disease or oxygen dependence * severe weight bearing pain * lower-extremity amputation * non-healing ulcers on the lower extremity * renal dialysis or end stage liver disease * legal blindness or deafness or severe visual or hearing impairment * a history of significant psychiatric illness defined by diagnosis of bipolar affective disorder, psychosis, or schizophrenia * life expectancy less than one year * severe arthritis or orthopaedic problems that limit passive ranges of motion of lower extremity: knee flexion contracture of -10 degrees, knee flexion rom \ 25 degrees, ankle plantar flexion contracture \> 15 degrees * history of deep venous thrombosis or pulmonary embolism within 6 months * uncontrollable diabetes: diabetic coma, frequent insulin reactions * severe hypertension with systolic \> 200mmhg and diastolic \> 110mmhg at rest * intracranial hemorrhage related to aneurysm rupture or an arteriovenous malformation (hemorrhagic infarctions will not be excluded) * history of severe seizure disorder; other neurological conditions such as multiple sclerosis or parkinson's disease * pain that is scored greater than 5 out of 10 on a visual analog scale and limits daily activity * any health problems judged by their screening physician to put the client at significant risk of harm during the study