TORONTO - A Wii bit of therapy using virtual reality game technology provided measurable benefits to stroke patients taking part in a small pilot study, researchers reported last week. The Canadian study focused on upper body motions, and made use of the games Wii tennis and Wii "Cooking Mama," which involves players moving as if they're cutting up vegetables, slicing meat or shredding cheese. For comparison purposes, a second group of stroke patients was assigned to non-video game recreational pursuits, including the block-stacking and balancing game Jenga and playing cards.
"The study showed that patients randomized to the virtual reality using the Wii gaming technology achieve greater performance in terms of their motor function, four weeks after the intervention," said Dr. Gustavo Saposnik, a neurologist at St. Michael's Hospital in Toronto. Changes in fine and gross motor function were shown in their speed and grip strength, he said. The findings of the study, conducted at the Toronto Rehabilitation Institute, were presented in San Antonio, Texas, at the American Stroke Association's International Stroke Conference. The study involved 20 patients aged 41 to 83 who had suffered mild to moderate strokes. Rehabilitation began within two months of the stroke, and they all received an intensive program of eight sessions, 60 minutes each, over a two-week period. Patients in both groups were seated during therapy, and they were instructed to primarily use their affected arm. Saposnik said those randomized to the Wii therapy had a seven-second difference in greater performance compared to the others, which he described as "meaningful." "In other words, imagine that you have for every task you are doing, instead of doing that in 20 seconds, it will take you 27 seconds for each activity that you do on a daily basis. That would be an impressive prolonged time.
" However, he's also quick to caution that these findings are preliminary. "The results are hopeful initial steps. But at this point we are not recommending stroke patients to play with the Wii. We are looking forward to having the results of a larger study, which is already underway." Physiotherapists in a number of locations have been incorporating video game technology into their practices in recent years. Vera Fung, a member of the Canadian Physiotherapy Association and a clinical researcher at St. John's Rehab Hospital in Toronto, says she's not surprised by the stroke research. About two years ago, her institution conducted a study asking for clinical perspectives on the use of Nintendo Wii technology for helping not only stroke patients, but also cardiac transplant patients, amputees, those in burn rehab and patients with total knee and hip replacements. "The clinicians actually were in agreement that games like Wii tennis, 'Cooking Mama,' as well as games like 'Big Brain Academy' and finally a driving simulation game, which all of the participants trialled and commented on, they all found that such games had the potential to restore motor function," she said. As well, they found there was potential to improve balance and standing tolerance, while patients were motivated to participate.
The fun factor is not to be underestimated. "We are struggling in rehab to engage people in activities that represent tasks that they need to do that are fun to do, that challenge them, and this study is encouraging from those perspectives," said Gail Creaser, also a member of the physiotherapy association and a lecturer at Dalhousie University in Halifax. The technology is not expensive compared to a lot of hospital and rehab equipment, she noted. The pilot study found no adverse effects in terms of safety. For instance, no one experienced nausea or dizziness. And Creaser said that because these systems are wireless, patients and staff don't need to worry about tripping on cords, except for the cord connecting the television to the wall outlet.
"Wii is small and can be taken to different places very, very easily. Ours is carted around on a trolley," she said. But use of virtual reality game technology is a new field and studies providing evidence of the benefits have been lacking, she noted. "To see somebody at least starting to do randomized studies is certainly hopeful," she said. Fung said a randomized controlled trial is also underway at St. John's Rehab to look at 60 knee replacement outpatients who are using the "Wii Fit" application. "It's really encouraging to know that there are centres as well as ourselves that are taking the leap to put some evidence-based clinical trials ... out there, so that we can hopefully validate the use of Nintendo Wii as an acceptable treatment intervention for rehab."(SOURCE)
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