Xbox Kinect Virtual Reality and Motor Imagery on Lower Limb Function in Chronic Stroke Patients
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      As virtual reality has therapeutic benefits and improves motor learning by practicing
      exercises in environment that analogue and mimic occasions and events of real world, as VR is
      designed and tailored according to the need of patient so it may address the individual
      issues whereas motor imagery uses explicit learning process for muscle activation and
      movement. Therefore their combination may yield better outcomes in terms of lower limb
      function and dynamic mobility, so there is a need to assess the combined effects of Xbox
      kinect gaming with motor imagery in chronic stroke patients.
    

Detailed description: 
      Stroke is focal neurological disorder that occurs due to the compromised blood flow to the
      brain. It results in mobility deficit, functional and gait impairment. Multiple
      rehabilitation methods have been designed and used, motor imagery (MI) and virtual reality
      (VR) are among the emerging techniques that are being used for the rehabilitation of patients
      with neurological conditions that improve motor learning through explicit and implicit
      processes.

      After stroke the residual symptoms such as muscle hyper tonicity, attention deficiency, hemi
      neglect, abnormal reflexes and sensorimotor functional impairment may persist. Additional to
      these neurological symptoms certain balance issues may cause decrease in proprioception,
      muscle strength, increased load on non-paretic extremity and postural oscillations. It has
      been reported that every year approximately 25.7 million people survive stroke attacks, 6.5
      million die because of stroke and 113 million people have disability-adjusted life-years.

      Kinect based rehabilitation and virtual feedback have shown relevant activation changes in
      the primary sensorimotor cortex and can be responsible for that part of brain reorganization
      for improving in upper limb in stroke patients. Use of exer gaming is one of the emerging
      technologies that are being used for the physical, cognitive and motor rehabilitation of
      stroke patients. It is combination of video games and motion sensors incorporated in a
      virtual reality environment that engage the patients and improves motor learning therefore
      activating the motor areas of the brain for long term results.

      Non immersive virtual reality gaming has been used for improving balance among the stroke
      patients. Not only is it considered more beneficial as compared to the conventional therapies
      but also maintains the interest of patients in their rehabilitation protocol. The Kinect
      based games use sensors that catch movements of the patients and they are able to watch them
      in real time with immediate feedback that becomes a source of motivation for them.

      Xbox Kinect virtual gaming creates 3D environment with sensors and requires no controllers
      for patients to perform exercise whereas motor imagery is a state in which a particular motor
      action is internally activated without any motor output. Not only is VR and MI training
      motivating as compare to conventional therapies but also provide positive learning experience
      and neuroplasticity. With xbox kinect based VR therapies and MI, the exercise plan is
      tailored according to the needs of the patient.

      It will be a single blinded randomized control trial in which control group will be given
      conventional physiotherapy protocol for 30 minutes and experimental group will receive the VR
      and MI training with conventional treatment for a total 60 minutes, 3 days a week for 6
      weeks. Motor function will be assessed by fugl-meyer scale (LE), dynamic mobility by berg
      balance scale and 6 minute walk test, quality of life by barthel index and gait with dynamic
      gait index. Patient will be assessed at baseline and at the end of six weeks. The data will
      be analyzed using SPSS 25 software.
    

Intervention name(s): Virtual reality training with motor imagery; Conventional physical therapy
Intervention type(s): Other; Other
Intervention description(s): comprised of 30 minutes, VRT (15 minutes) and MI (15 minutes) daily for 3 days respectively. Five Xbox Kinect gaming will be selected and explained to the patients for the virtual training session and additional 15 minutes will be given to them for practice. The games consists of 20,000 water leaks, river rush, reflex ridge, soccer and football for the patients.; range of motion exercises, muscle strengthening, functional training, balance training, and gait training. The specific tasks will be selected by the therapist based on the requirement of each patient. It will be performed for 30 minutes for 3 days a week for 6 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stroke