# Exercise as it relates to Disease/Computer gaming for stroke rehabilitation
### Prevalence

Stroke is Australia’s second biggest killer after coronary heart disease, and a leading cause of disability. In 2012, there were over 420,000 people living with the effects of stroke. Two thirds of these people sustained a disability that impeded their ability to carry out activities of daily living unassisted. By 2032 there will be around 709,000 Australians living with stroke, or 2.4% of the population.

### Three Major Types of Stroke

Ischemic stroke - Sudden blockage of arteries supplying the brain
* Thrombotic - Clot forms within the artery due to atherosclerosis.
* Embolic - Clot formed in another part of the circulation, which follows the blood stream until it obstructs arteries in the brain.
Intracerebral haemorrhage - Bleeding from one of the brain’s arteries into the brain tissue.
Subarachnoid haemorrhage - Arterial bleeding in the space between the two meninges, pia mater and arachnoidea.

### Stroke Risk Factors

| Non-Controllable Factors | Medical Factors | Lifestyle Factors |
| Age Gender Family History | Transient Icshaemic Attack (mini-stroke) Irregular Pulse Diabetes Fibromuscular Dysplasia | Smoking and Alcohol Consumption High blood pressure (hypertension) High cholesterol (hyperlipidemia /dyslipidemia) Obesity/being overweight Poor Diet and Physical Inactivity |

## Effects of Stroke

* Development of epilepsy
* Hemiplegia (Paralysis of one side of the body)
* Chronic pain
* Dysphagia (inability or difficulty swallowing)
* Cognitive deficits including dyspraxia (difficulty with coordination), aphasia (impaired ability to understand or produce speech), memory loss and inability to keep attention
* Recognition deficits (impairment of the senses)

## Current Rehabilitation Program Recommendations

| Exercise | Workload |
| Aerobic | 3–7 days a week. 20-60mins a session or multiple 10min sessions |
| Strength | 2–3 days a week. 1-3 sets of 10-15 reps |
| Flexibility & Neuromuscular | 2–3 days a week. |

## Barriers to rehabilitation

The effects of a stroke creates many barriers to physical activity for rehabilitation.These factors include:
* Limb paralysis
* Impaired movement coordination and balance
* Motivation/Depression
* Cardiovascular endurance
* Time and ability to access facilities for rehabilitation

## Computer Games for Rehabilitation

Adherence to rehabilitation is a main issue in stroke rehabilitation with cost, time and access to facilities key problems. Computer games or exergames such as the Nintendo Wii console with Wii Sports game and Wii Fit balance board have become popular tools in stroke rehabilitation as they are low cost and can be used at home. Not only are these computer games an affordable and convenient way of assisting rehabilitation they also have physiological and psychological benefits. These include:
* Improving balance. and motor function
* Improving quality of life
* Improving rehabilitation compliance as it enables the sufferer to take their mind of their disabilities, focus on playing & enjoying the game and have a greater interaction with friends and family
* Meeting physical activity guideline recommendations.

## Recommendations

* Computer games should be done to compliment traditional rehabilitation programs involving aerobic and resistance training especially in the immediate months following the stroke.
* Computer gaming session duration should mimic those of traditional rehabilitation sessions going for 20-60mins or mulitple 10min sessions & played with friends or family to increase enjoyment and adherence

## Further Information

* Neurosciene Research Australia Website and Computer games aren't just for kids
* Stroke Foundation Website Video: Wii-based Movement Therapy for stroke rehabilitation

## References

* ↑ Deloitte Access Economics (2013)'The economic impact of stroke in Australia'. p ii
* 1 2 3 World Health Organization (2006). WHO STEPS Stroke Manual: The WHO STEPwise approach to stroke surveillance. Geneva, World Health Organization p 13
* 1 2 3 Hughes, M. et al. (2008) ‘Stroke and thromboembolism in atrial fibrillation: A systemic review of stroke risk factors,risk stratification schema and cost effectiveness data. Thrombosis and Haemostasis. pp 295-304
* 1 2 3 Greenland, K. et al. (2004) ‘Prevalence of Heart Disease and Stroke Risk Factors in Persons With Prehypertension in the United States, 1999-2000. Journal of American Medical Association vol 164 pp 2113-2118
* 1 2 3 Yoon, S. et al. (2001) ‘Knowledge of Stroke Risk Factors, Warning Symptoms, and Treatment Among an Australian Urban Population. Journal of American Heart Association. vol 32 pp 1926-1930
* ↑ Myint, P. et al. (2006) ‘Post‐stroke seizure and post‐stroke epilepsy. Postgraduate Medical Journal.vol 82 pp 568-572
* 1 2 3 4 Gordon, N. et al. (2004) ‘Physical Activity and Exercise Recommendations for Stroke Survivors: An American Heart Association Scientific Statement’ Journal of the American Heart Association. Vol. 109. pp 2031 – 2040
* ↑ Kong, K. et al. (2004) ‘Prevalence of Chronic Pain and Its Impact on Health-Related Quality of Life in Stroke Survivors’ Journal of the American Congress of Rehabilitation Medicine. Vol. 85. pp 35-40
* ↑ Martino, R. et al. (2005) ‘Dysphagia After Stroke:Incidence,Diagnosis and Pulmonary Complications’ Journal of the American Heart Association. Vol. 36. pp 2756 – 2763
* 1 2 Riddich, J. et al. (1995) ‘Cognitive Deficits Following Stroke’ Journal of Physiotherapy. Vol. 81. pp 465 – 473
* 1 2 3 4 Taylor, M. et al. (2011) ‘Activity-promoting gaming systems in exercise and rehabilitation’ Journal of Rehabilitation research and development. Vol. 48. pp 1171 – 1186
* ↑ Sugarman,H. et al. (2009) ‘Use of the nintendo wii fit for the treatment of balance problems in an elderly patient with stroke: A case report’ International Journal of Rehabilitation research. Vol. 32 pp. 109-110
* ↑ Gil-Gomes,J. et al. (2011) ‘Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury’ Journal of Neuroengineering and Rehabilitation. Vol. 8 0
* 1 2 3 4 5 Lange, B. et al. (2009) ‘Game-based telerehabilitation’ European Journal of Physical Rehabilitaion. Vol. 45. pp 143 – 151
* 1 2 Saposnik,G. et al. (2010) ‘Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation: A Pilot Randomized Clinical Trial and Proof of Principle’ Journal of The American Heart Association. Vol. 41 pp 1477-1484
* 1 2 3 Hurkmans,H. et al. (2011) ‘Activity-promoting gaming systems in exercise and rehabilitation’ Journal of Neuroengineering and Rehabilitation. Vol. 8