Use of Video Games in Strengthening and Functional Recovery of the Hand in Patients Submitted to Ulnar Neurorrhaphy
Authors: Fernandes Luciane Fernanda Rodrigues Martinho , Silva Vanessa Cristina , de Oliveira Aline Afonso , de Souza Luciane Aparecida Pascucci Sande , Bertoncello Dernival 
Published: September 2016

Objective: The aim of this study was to investigate the effects of video games as a therapeutic tool to strengthen the hand muscles and assist the functional recovery of patients after ulnar neurorrhaphy. Methods: Six patients with lesion of the ulnar nerve participated in this pilot study. They were divided into 2 groups: a kinesiotherapy group (KG) and a video game group (VG), which employed video games together with grip and pinch dynamometers and electromyography electrodes (E-Link Kit, Biometrics). Two evaluations were conducted, one at the beginning and the other at the end of the final stage of physical therapy (strengthening phase). Evaluation of the patients employed (1) grip and pinch strength, (2) the Rosen and Lundborg Score, and (3) the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. The strengthening program was started in the final phase of lesion recovery and was continued for 2 months, with 1-hour sessions conducted twice weekly. The 2 groups started exercises to strengthen the wrist flexors and extensors and the intrinsic/extrinsic muscles of the fingers. The KG was treated using manual resistance, resistance bands, dumbbells, hand therapy putty, and finger exercisers. The VG performed the strengthening protocol with the use of video games. A total of 4 games were selected to perform the strengthening protocol. Isotonic exercise was chosen to strengthen the abductor minimi muscle, using Myo-EX, because of muscle weakness. For simultaneous strengthening of the intrinsic and extrinsic muscles of the hand was used the H500 hand grip dynamometer. For the adductor pollicis muscle was used the H500 pinch dynamometer. In the case of the lumbrical and interosseous muscles, and in this game, isometric tripod pinch force is required. The same game was repeated 3 times (each with 10 repetitions of the exercises). At the beginning of each session, measurements were made of the forces used and the amplitudes of the electromyographic signals corresponding to each game. From these values, a decreasing strength protocol was established (75%, 50%, and 25% of the maximum load) using the modified Oxford protocol. Results: The normalized measurements of grip and pinch strength revealed gains in strength for all patients in both groups, although the average increases were greater for the VG (9.23 kgf) than KG (6.17 kgf). The motor domain values were higher than those for the sensory domain, and in the final assessment, the value obtained for the motor domain by the VG (0.94) was higher than achieved by the KG (0.72). The final score for the VG (2.25) was also higher than for the KG (1.85). In the assessment of functional disability using the DASH method, the mean baseline score was 33.8% for the KG and 14.2% for the VG, while the final assessment scores were 29% and 10.9%, respectively. Conclusion: It could be concluded that the strengthening achieved using the proposed protocol with video games was greater than obtained with conventional kinesiotherapy resistance treatment of patients after ulnar neurorrhaphy.