Evaluation of the Effects of Rehabilitation Using the Wii on Upper Limb Kinematics in Chronic Stroke Patients.

Study Overview
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Brief Summary
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The purpose of this study is to evaluate changes in strategies of hemiparetic upper limb movement in chronic stroke patients following rehabilitation using the Nintendo Wii. The investigators hypothesize that patients will increase their use of compensatory strategies following this rehabilitation.

Detailed Description
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The principal aim of this study is to evaluate changes in strategies of hemiparetic upper limb movement in chronic stroke patients following twelve one hour sessions of rehabilitation using the Nintendo Wii over a period of four weeks, and to compare with a group of patients receiving traditional upper limb rehabilitation of the same duration. The investigators hypothesize that the use of compensatory strategies will increase in the group receiving the Wii rehabilitation while they will decrease in the group receiving traditional rehabilitation. The investigators further hypothesize that this will have an impact on the functional benefit with a greater improvement of function in the group receiving traditional rehabilitation.

Official Title
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Evaluation of the Effects of Rehabilitation Using the Wii on Upper Limb Kinematics in Chronic Stroke Patients.

Conditions
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Post-stroke Hemiparetic Patients (at Least 6 Months Post Stroke), Age Between 18-75 Years

Intervention / Treatment
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* Behavioral: WII Rehabilitation
* Behavioral: Traditional rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 to 75 years Right handed Hemiparesis following vascular lesions of a single hemisphere of more than 6 months duration. Not a regular 'Wii' user Able to bring the hand to the mouth. No botulinum toxin injections within the previous 3 months Having given informed consent Exclusion Criteria: Major cognitive or perceptive deficits Cerebellar syndrome Epileptic fits within the previous year Pacemaker user Un-corrected visual deficits No social security

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rehabilitation using Nintendo-Wii<br>30 patients will receive rehabilitation using Nintendo-Wii. | Behavioral: WII Rehabilitation<br>* 30 patients will receive Wii rehabilitation of 15 minutes (tennis, boxing and golf), in comparison with 10 healthy subjects.<br>|
| Active Comparator: Traditional physiotherapy<br>30 patients will receive traditional physiotherapy. | Behavioral: Traditional rehabilitation<br>* 30 patients will receive the traditional rehabilitation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Degree of elbow extension during an active reaching task |  | 6 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical | Pain (VAS) (evaluated at the beginning and end of each session) Borg scale of perceived effort (evaluated at the end of each session) Fugl-Meyer (upper limb section) (evaluated before and after the rehabilitation period) Box and Block test (evaluated before and after the rehabilitation period) Action Research Arm Test (ARAT) (evaluated before and after the rehabilitation period) Motor Activity Log (MAL) (evaluated before and after the rehabilitation period) Stroke Impact scale (SIS) (evaluated before and after the rehabilitation period) Satisfaction (VAS) (evaluated at the end of the rehabilitation period) | 1 hour and half | 
| Kinematic measures | Parameters relating to hand trajectory (smoothness, curvature, velocity) and upper limb joint angles (trunk flexion, shoulder abduction) during an active reaching task using an electromagnetic motion capture system. (evaluated before and after the rehabilitation period) | 45 minutes | 
| Kinetic measures | Capacity to regulate grip force during a visuo-motor task using an instrumented device. (evaluated before and after the rehabilitation period) | 45 minutes | 
| Movement strategies during 'Wii rehabilitation' | The number and extent of the movements made with the upper limb during 'wii rehabilitation' will be recorded using accelerometers. | 45 minutes | 
| MRI | The extent and localization of the lesions will be evaluated using MRIcro and correlations will be sought between the lesion locations and the kinematic and kinetic characteristics of the patients. Evaluations will be carried out during the week preceding and the week following the rehabilitation period. The evaluating therapist will be blinded to the type of rehabilitation received by the patient. | 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hemiparesis,, Rehabilitation,, WII,, Upper limb,, Movement strategies.