Comparison of Exergaming Training With Visual Feedback Training on Upper Limb Functions in Post Stroke Patients

Stroke is classically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system (CNS) by a vascular cause, including transient ischemic attack, cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage. It is a major cause of disability and death worldwide. The main purpose of this study to determine the effect of exergaming training compared to visual feedback training on improvement in upper limb function.

Stroke patients have various problems such weight. The loss of motion element involved on ﬁne functions, and the above-mentioned problems can lead to decreased muscle cooperativity of the lower limbs while walking and may also result in an asymmetric gait due to imbalance in the ability to perform exercises. Recent studies on the treatment of stroke patients reported that approaches such as more intensive and repetitive training as compared to conventional general and passive intervention, training related to reality, intervention involving motivation and active participation and forced induction exercise, visual exercise feedback, purpose-oriented training, and task-oriented training are more effective in promoting function after stroke onset. Virtual reality (VR) is frequently used in different disease groups at the clinic for rehabilitation purposes. Xbox Kinect, Nintendo Wii, Sony PlayStation, and Cyber Glove are among the most commonly used VR applications in rehabilitation. Several studies reported that VR applications improved both upper and lower extremity functions and promoted independence in performing activities of daily living.

Games based on virtual reality for stroke rehabilitation are mainly focused on motor rehabilitation. Nevertheless, interest in the integration of cognitive and motor rehabilitation has grown. Research shows that the use of virtual reality-based games improves the range of motion as well as the memory and attention of stroke patients. Benefits of virtual reality games include diverse and intensive exercises, designing exercises tailored to patients' abilities, monitoring patients' progress, and boosting patients' motivation. Game-based virtual reality is an emerging technology in healthcare allowing users to interact with a dynamic 3D environment. Studies show that this technology is an effective, feasible and safe solution which makes rehabilitation more convenient. In addition, computer games increase motivation, satisfaction and involvement of patients.

Eligibility Criteria:
Inclusion Criteria:

* Both genders

  * Subacute and chronic patients of stroke (\> 4 weeks).
  * Age: 40-70 years
  * Able to follow verbal instructions related to the visual feedback training.
  * MMSE score \>21
  * Modified Ashworth scale (MAS) level 1-3
  * Brunnstrom stages 1-4
  * Fugyl Meyer score limit for upper limb

Exclusion Criteria:

Patients with

* Cognitive and Visual impairments
* Psychological disorder
* History of other neurological disorders
* Pusher's syndrome
* Hemineglect
* Abnormal synergic pattern
* Rheumatoid arthritis or other hand impairments