Xbox Kinect™ Training for Stroke Rehabilitation
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Commercial interactive game consoles including the Nintendo Wii™ and the Sony Playstation
      Eyetoy™ have been used in stroke rehabilitation with variable success and seemed to be safe,
      feasible and effective treatment options. The more recently released Xbox Kinect™ game
      console has superiorities to the others such as not requiring any special controller and
      having a more sensitive sensor which provides more accurate motion-capturing. However, there
      is limited evidence on clinical utility of the Xbox Kinect™ in stroke rehabilitation.
      Currently it has been designed for physically and mentally healthy people just like previous
      consoles. Therefore, the safety and feasibility of the system should be evaluated in first
      place before using it as an alternative or adjunctive training method in stroke patients. To
      the best of our knowledge, no studies have evaluated the clinical feasibility of the Xbox
      Kinect™ in stroke rehabilitation. The aim of this pilot study was to evaluate the feasibility
      and safety of the Xbox Kinect™ training of upper extremity in subacute stroke rehabilitation.
      The secondary aim was to evaluate its efficacy on upper extremity motor and functional
      recovery.
    

Detailed description: 
      This study was planned as a single-blind, randomized controlled, pilot trial. It was approved
      by the Ankara University Faculty of Medicine Ethics Committee and was conducted in accordance
      with the Declaration of Helsinki. Stroke patients who were hospitalized for inpatient
      rehabilitation at the Ankara University Faculty of Medicine, Cebeci Research and Application
      Hospital, Physical Medicine and Rehabilitation Clinic from December 2012 to March 2014, were
      assessed to determine their eligibility for the study. All patients were diagnosed with
      stroke by a neurologist according to World Health Organization stroke definition and
      confirmed by neuroimaging (computed tomography or magnetic resonance imaging). All patients
      who fulfilled the inclusion criteria received a detailed explanation of the study and written
      informed consent was obtained from all participants prior to enrollment. Patient
      characteristics were collected at baseline including socio-demographic features (age, gender,
      marital status, educational level, vocation), stroke type, time from stroke onset to
      enrollment, affected side, handedness, comorbid conditions, spasticity grade (according to
      Modified Ashworth Scale) and motor recovery stages according to Brunnstrom Motor Assessment
      Scale (BMAS). Affected upper extremity was examined using the Box and Blocks Test (BBT) and
      the Wolf Motor Function Test (WMFT). Baseline level of functional independence was assessed
      using the Functional Independence Measure (FIM). Participants were randomly allocated to two
      groups; the experimental group and the control group. Both the experimental group and the
      control group received a conventional rehabilitation program for 4 weeks (60 minutes/day, 5
      days/week). The experimental group underwent an additional training with the Xbox Kinect™ for
      4 weeks (60 minutes/day, 5 days/week). The primary outcome measures of this pilot study are
      related to feasibility and safety of the Xbox Kinect™ in subacute stroke rehabilitation.
      Treatment attendance ratio, which is the proportion of the completed training time to the
      planned training time, was used as the primary feasibility outcome. The treatment attendance
      ratios were calculated for three different measurements: total training time, training time
      per session and the number of sessions. In addition, the result obtained from patient
      feedback survey was also used as a feasibility outcome. The ratio of patients who had adverse
      events related to the intervention or any serious adverse event during the study was defined
      as the primary safety outcome. Rating of perceived exertion measured according to the Borg 10
      Point Scale was also used as a safety outcome. To determine the efficacy of the intervention,
      BBT, WMFT, FIM, BMAS were used as secondary outcome measures. Mean, standard deviation,
      median, min-max and percentile values were calculated for the socio-demographic and clinical
      features, primary and secondary outcome measures by descriptive statistics. The Shapiro-Wilk
      test was used for normality testing. The Wilcoxon signed rank test was used to evaluate
      differences within groups. The Mann Whitney U test was used to evaluate differences between
      groups. P value of less than .05 was considered as statistically significant.
    

Intervention name(s): Xbox Kinect™ training; Conventional rehabilitation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Xbox Kinect™ (Xbox 360, Microsoft, United States) game console which is one of the commercial interactive game consoles was used. It was comprised of 3 components; Kinect™ sensor, Xbox 360™ game console and 42 inch Liquid crystal display (LCD) television.; The conventional rehabilitation program consisted of passive and active range of motion exercises, therapeutic stretching, muscle strengthening, neurophysiologic exercises, sitting, standing, balance and gait exercises, occupational therapy and activities of daily living training such as eating, grooming, dressing, toileting and transfer.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stroke; Rehabilitation; Serious games; Virtual reality; Xbox Kinect™