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Virtual Reality and Video Gaming in Rehab

Class Presentation

Abraham Gower

on 25 June 2013

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Transcript of Virtual Reality and Video Gaming in Rehab

Video Gaming and Virtual Reality Exercises
Video gaming and virtual reality exercises are becoming more and more prominent, particularly in rehabilitation.
They provide an opportunity to practice certain activities in a clinical setting that would otherwise be unachievable.
There are specialized virtual reality programs that exist which are specifically designed for rehabilitation processes. (Laver et al. 2011)
They are readily available and open to the public to purchase.
What Is It?
Xbox/Xbox Kinect
Playstation/Playstation Move
Any other video-gaming console
Rehab Specific Devices:
Gait Rehabilitation
See Me Program
Among others.

See Me
Why It's Used/How Does It Work?
Neuroplasticity principles.

The 'use it to improve it’ principle teaches us that training that drives a specific brain function can lead to an enhancement of that function’ (Kleim and Jones 2008).
Repitition matters, simply engaging a neural circuit in a task specific performance is not sufficient to drive plasticity (Kleim & Jones 2008).
Transference is the ability of plasticity within a set of neural circuits to promote concurrent or subsequent plasticity (Kleim & Jones 2008).
How Do We Know It Works?
Effectiveness of Interventions
How To Implement It
Improvements/Further Studies
Gait Rehabilitation
Partial weight supports act as a safety device to protect a patient from falling.
Enables a patient to practise walking with a more normal pattern and at higher speeds. (Behrman et al. 2005)
Difficulty levels can be adjusted.
Provides feedback. (Shumway-Cook & Woollacott 2001)
Neuroplasticity Principles
Use it or lose it
Use it to improve it
Repetition matters
Timing matters
Salience matters
Age matters

Other Benefits
Accessible (use it at home, or hospital).
No negative consequences.
Practice decision making in safe environment.
Feedback (knowledge of results and performance).
Multiple interventions in one machine.
Less strain on the body.

Grip Strength + Gait Speed (3 studies):
No statistically significant effects for grip strength or gait speed.

Global Motor Function (3 studies):
Unable to determine the effect on global motor function due to insufficient numbers of comparable studies.

Secondary outcomes: results were statistically significant for activities of daily living (ADL) outcome.

Cognitive Function
Unable to pool results for cognitive function, participation restriction and quality of life or imaging studies.

VR and VG's can be implemented both in the clinic and at home
Finger dissociation
Static and dynamic balance
Gait retraining
Reaching out of BOS
Hand-eye coordination
Aerobic training
Weight shift
Grading of movements
Cognitive impairments (memory/problem solving/multitasking)
Can be implemented in most to improve:
UL function (Laver et. al. 2011)
Vestibular Rehab
Gait Rehab (Laver et. al. 2011)
There is Limited evidence on the effectiveness when targeting other areas, however it is still often implemented.

Parkinson’s Disease and Extra-pyramidal syndrome
Brain tumour operations
Muscular atrophy
Muscle weakness due to lack of mobility
Endo-prosthesis for hip, knee, elbow and shoulder joints
Following stable fractures of vertebrae and/or extremities
Limb amputations with or without prosthesis
Balance and equilibrium disturbances
See Me: Indications
Behrman, AL., Lawless-Dixon, AR, Davis, SB, et al. 2005 ‘Loco Motor Training Progression and Outcomes After Incomplete Spinal Cord Injury’, Journal of Physical Therapy, vol. 85, pp.1356-1371.

Kleim, J & Jones, T, 2008, ‘Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage’, Journal of Speech, Language and Hearing Research, vol. 51, no. 1, pp. 225-239.

Laver, K, George, S, Thomas, S, Deutsch, JE & Crotty, M 2011, ‘Virtual Reality for Stroke Rehabilitation’, Stroke: Journal of the American Heart Association, vol. 43, no. 2, pp. e20-e21.

Laver, K, George, S, Thomas, S, Duetsch, J & Crotty M, 2011, ‘Virtual Reality for Stroke Rehabilitation’, The Chochrane Collaboration, vol. 9.

Langhorne, P, Coupar, F & Pollock, A 2009, ‘Motor recovery after stroke: a systematic review’ Lancet Neurology, vol. 8, no. 1, pp. 741–754.

Saposnik, G. et al. 2010, ‘Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation: A Pilot Randomized Clinical Trial and Proof of Principle’, Stroke, pp. 1477-1484.

SeeMe Program 2013, viewed 25 June 2013, <http://www.virtual-reality-rehabilitation.com/>.

Shumway-Cook, A & Woollacott, M 2001 ‘Motor Control: Theory and Practical Applications’, Lippincott Williams & Wilkins, Philadelphia.

Tierney, NW, Crouch, J, Garcia, H, Walker, M, Van Lunen, B, DeLeo, G, Maihafer, G & Ringleb, S 2004 ‘Virtual Reality in Gait Rehabilitation’, viewed June 18 2013, <http://www.cs.odu.edu/~jrcrouch/papers/GaitRehab.pdf>.

Yong Joo, L, Soon Yin, T, Xu, D, Thia, E, Fen Chia, P, Wee Keong Kuah, C & Keng He, K 2010, ‘A Feasibility Study Using Interactive Commercial Off-The Shelf Computer Gaming in Upper Limb Rehabilitation in Patients After Stroke’, Journal of Rehabilitation Medicine, vol. 42, no. 5, pp. 437-441.

Very few adverse effects caused by the virtual reality interventions (Laver et. al. 2011):
Motion sickness
Fatigue when combined with traditional interventions (Yong Joo et. al. 2010)
Therapies should be implemented carefully as a precaution for people who have:
Inner ear problems (Meniere’s disease, BPPV etc.)
Other balance issues
Clients who fatigue quickly (Chronic Fatique Syndrome etc.) If another interventions still need to be implemented.
Pain syndromes.

Gait rehabilitation VR: (Tierney et al. 2004)
Scoring system.
Interactive hemispheres for those post stroke.
Sensors to track leg motion.
Tracking of patients progress.
Predictions of prognosis.
Further studies needed for: (Yong Joo et al. 2010)
Comparison of VR and VG to conventional rehab methods.
Transferrence of skills gained in VR/VG.
Motivation and participation as measures in studies.
Creation of protocols for implementation in clinics.

(Tierney et al. 2004)
(Laver et al. 2011)
Arm Function
(7 studies with 205 participants)
Primary outcomes: results were statistically significant for arm function
(Laver et al. 2011)
Shoulder flexion and extension (bowling and tennis).
Shoulder rotation (tennis).
Elbow extension and flexion (Cooking Mama).
Wrist supination and pronation (tennis and Cooking Mama).
Different degrees of wrist flexion and extension.
With thumb flexion was involved in all activities.

Arm Movements Used With Wii
(Laver et al. 2011)
Interestingly, when comparing traditional interventions such as:
Motor relearning conventional techniques
No one approach improves functional outcomes over another.

Constraint-induced motor therapy represents, thus far, the most promising intervention to date for improving upper limb function.

(Langhorne et al. 2009; Laver et al. 2011)
Comparison of Interventions
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