Serious game for balance rehabilitation of hemiparetic stroke patients
DOI:
https://doi.org/10.33448/rsd-v11i14.33600Keywords:
Stroke; Video games; Paresis; Postural balance.Abstract
Introduction: The development of specific software with Serious Games (SG) is promising for use in physiotherapy. Objective: To develop and test the applicability of an SG for the balance training of hemiparetic patients after stroke. Methods: Hemiparetic stroke patients have evaluated pre and post-training in terms of functional mobility (Timed Up and Go Test), gait speed (10 meters), bilateral femoral quadriceps muscle strength (Hand-held Dynamometry), balance (Berg Balance Scale), and perception of self-efficacy (Self-efficacy questionnaire after stroke). For training, a system was developed consisting of a balance board with inertial sensors, a microcontroller system, and a computer system that executes a JS. Descriptive statistics were performed to characterize the individuals. After verifying the normality of the data, the differences between the pre-test and the post-test were verified using the paired Student's t-test and the Wilcoxon test using a significance level of p <0.05. Results: Seven individuals completed the training. All variables showed statistically significant differences (p <0.05), except for the strength of the quadriceps muscle on the non-paretic side. Conclusion: The development of GS represents a viable and very promising possibility in this field. Studies with a larger number of individuals, comparing this approach with conventional ones, as well as the involvement of a control group will expand the understanding of the therapeutic potentials of this resource.
References
Alghadir, A. H., Al-Eisa, E. S., Anwer, S., & Sarkar, B. (2018). Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurology, 18(1). https://doi.org/10.1186/s12883-018-1146-9
Araújo F, Oliveira F, Carvalho D, et al. (2019). Evaluation instruments for physical therapy using virtual reality in stroke patients : a systematic review. Epub ahead of print. DOI: 10.1016/j.physio.2019.05.005.
Araújo, M., Postól, M., Diogo Bruckheimer, A., Da, M., Hounsell, S., Woelner, S., & Soares, A. (2014). Realidade virtual: efeitos na recuperação do membro superior de pacientes he- miparéticos por acidente vascular cerebral Virtual reality: effects on upper limb recovery in hemiparetic patients after stroke. http://www.acm.org.br/revista/pdf/artigos/1267.pdf
Barcala L, Colella F, Araujo MC, et al. (2011). Análise do equilíbrio em pacientes hemiparéticos após o treino com o programa Wii Fit. Fisioter em Mov ; 24: 337–343.
Bertemes-Filho, P. (2018). Biomedical Serious Game System for Balance Rehabilitation of Hemiparetic Stroke Patients. IEEE Transactions on Neural Systems and Rehabilitation Engineering: A Publication of the IEEE Engineering in Medicine and Biology Society, 26(11), 2179–2188. https://doi.org/10.1109/TNSRE.2018.2876670
Bohannon, R. W., & Andrews, A. W. (1998). Relationships between Impairments in Strength of Limb Muscle Actions following Stroke. Perceptual and Motor Skills, 87(3_suppl), 1327–1330. https://doi.org/10.2466/pms.1998.87.3f.1327
Bohannon, R. W., & Smith, M. B. (1987). Assessment of Strength Deficits in Eight Paretic Upper Extremity Muscle Groups of Stroke Patients with Hemiplegia. Physical Therapy, 67(4), 522–525. https://doi.org/10.1093/ptj/67.4.522
Bohannon RW. Dynamometer measurements of grip and knee extension strength: are they indicative of overall limb and trunk muscle strength? Percept Mot Skills 2009; 108: 339–42.
Bowden, M. G., Balasubramanian, C. K., Behrman, A. L., & Kautz, S. A. (2008). Validation of a Speed-Based Classification System Using Quantitative Measures of Walking Performance Poststroke. Neurorehabilitation and Neural Repair, 22(6), 672–675. https://doi.org/10.1177/1545968308318837
Bosse, R., Soares, A. V., & da Silva Hounsell, M. (2016). Serious Games for Balance Improvement: A Systematic Literature Mapping. New Advances in Information Systems and Technologies, 73–82. https://doi.org/10.1007/978-3-319-31307-8_8
Cho, K. H., & Lee, W. H. (2013). Virtual walking training program using a real-world video recording for patients with chronic stroke: a pilot study. American Journal of Physical Medicine & Rehabilitation, 92(5), 371–380; quiz 380-382, 458. https://doi.org/10.1097/PHM.0b013e31828cd5d3
Costa MCF, Bezerra PP, de Oliveira APR. Impacto da hemiparesia na simetria e na transferência de peso : repercussões no desempenho funcional. Rev Neurociência 2006; 14: 10–13.
Dewilde, S., Annemans, L., Peeters, A., Hemelsoet, D., Vandermeeren, Y., Desfontaines, P., Brouns, R., Vanhooren, G., Cras, P., Michielsens, B., Redondo, P., & Thijs, V. (2017). Modified Rankin scale as a determinant of direct medical costs after stroke. International Journal of Stroke, 12(4), 392–400. https://doi.org/10.1177/1747493017691984
De, R., Dias, S., Levy, I., Sampaio, A., Da, L., & Taddeo, S. (2009). Fisioterapia x wii: a introdução do lúdico no processo de reabilitação de pacientes em tratamento fisioterápico. http://www.sbgames.org/papers/sbgames09/culture/short/cults8_09.pdf
Eichinger FLF, Soares AV, Noveletto F, et al. Serious game for locomotor rehabilitation of hemiparetic stroke patients. Fisioter em Mov 2020; 33: 15–25.
Ibrahim, A., Singh, D. K. A., & Shahar, S. (2017). “Timed Up and Go” test: Age, gender and cognitive impairment stratified normative values of older adults. PLOS ONE, 12(10), e0185641. https://doi.org/10.1371/journal.pone.0185641
Jones, F., Partridge, C., & Reid, F. (2008). The Stroke Self-Efficacy Questionnaire: measuring individual confidence in functional performance after stroke. Journal of Clinical Nursing, 17(7b), 244–252. https://doi.org/10.1111/j.1365-2702.2008.02333.x
Lee, H. S., Park, Y. J., & Park, S. W. (2019, June 18). The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis. BioMed Research International. https://www.hindawi.com/journals/bmri/2019/7595639/
Lexell, J., Flansbjer, U.-B., Holmbäck, A. M., Downham, D., & Patten, C. (2005). Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine, 37(2), 75–82. https://doi.org/10.1080/16501970410017215
Makhoul, M. P., Pinto, E. B., Mazzini, N. A., Winstein, C., & Torriani-Pasin, C. (2020). Translation and validation of the stroke self-efficacy questionnaire to a Portuguese version in stroke survivors. Topics in Stroke Rehabilitation, 1–11. https://doi.org/10.1080/10749357.2020.1713555
Masson, E. (2018, July 15). Serious game for rehabilitation of the lower limb of hemiparetics patients after stroke. EM-Consulte. https://www.em-consulte.com/article/1227857/article/serious-game-for-rehabilitation-of-the-lower-limb-
Memon MQ, Macdonald IA. (2012). Assessment of diurnal and ethnic influences on the systemic cardiovascular response to forearm occlusion in healthy white European and Pakistani male. Pakistan J Med Sci ; 28: 149–153.
Mirvis PH. (1990). Flow: The Psychology of Optimal ExperienceFlow: The Psychology of Optimal Experience, by Csikszentmihalyi Michael. New York: Harper & Row,, 303 pp., cloth. Acad Manag Rev 1991; 16: 636–640.
Miyamoto, S. T., Lombardi Junior, I., Berg, K. O., Ramos, L. R., & Natour, J. (2004). Brazilian version of the Berg balance scale. Brazilian Journal of Medical and Biological Research, 37(9), 1411–1421. https://doi.org/10.1590/s0100-879x2004000900017
Mittmann, N., Seung, S. J., Hill, M. D., Phillips, S. J., Hachinski, V., Coté, R., Buck, B. H., Mackey, A., Gladstone, D. J., Howse, D. C., Shuaib, A., & Sharma, M. (2012). Impact of disability status on ischemic stroke costs in Canada in the first year. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 39(6), 793–800. https://doi.org/10.1017/s0317167100015638
Mubin, O., Alnajjar, F., Al Mahmud, A., Jishtu, N., & Alsinglawi, B. (2020). Exploring serious games for stroke rehabilitation: a scoping review. Disability and Rehabilitation: Assistive Technology, 1–7. https://doi.org/10.1080/17483107.2020.1768309
Noveletto, F., Soares, A. V., Eichinger, F. L. F., Domenech, S. C., Hounsell, M. da S., & Filho, P. B. (2020). Biomedical Serious Game System for Lower Limb Motor Rehabilitation of Hemiparetic Stroke Patients. IEEE Transactions on Neural Systems and Rehabilitation Engineering: A Publication of the IEEE Engineering in Medicine and Biology Society, 28(6), 1481–1487. https://doi.org/10.1109/TNSRE.2020.2988362
Noveletto, F., Soares, A. V., Mello, B. A., Sevegnani, C. N., Eichinger, F. L. F., Hounsell, M. D. S., & Pereira, V. A., Eldebrando, L., Silva, H. E. da, Eichinger, F. L. F., Noveletto, F., & Soares, A. V. (2020). Biomedical system to evaluate pulmonary function in patients with post-stroke hemiparesis. Fisioterapia Em Movimento, 33(1). https://doi.org/10.1590/1980-5918.033.AO38
Noveletto, F., Hounsell, M. D. S., Soares, A. V., Eichinger, F. L. F., Sagawa, Y., & Bertemes Filho, P. (2018). Stronger: A serious game framework for post-stroke rehabilitation. Annals of Physical and Rehabilitation Medicine, 61, e487. https://doi.org/10.1016/j.rehab.2018.05.1135
Noveletto, F., Filho, P. B., & Hounsell, M. da S. (2019, June 11). Sistema Biomédico para Avaliação e Reabilitação Motora em Hemiparéticos por AVC. Sol.sbc.org.br; SBC. https://doi.org/10.5753/sbcas.2019.6286
Santos, F. M. K. dos, Mendes, F. V., Woellner, S. S., Borges Júnior, N. G., & Soares, A. V. (2015). Use of visual feedback for balance training in hemiparetic Stroke patients. Fisioterapia Em Movimento, 28(2), 241–249. https://doi.org/10.1590/0103-5150.028.002.ao04
Schmid, A. A., Van Puymbroeck, M., Altenburger, P. A., Miller, K. K., Combs, S. A., & Page, S. J. (2013). Balance Is Associated with Quality of Life in Chronic Stroke. Topics in Stroke Rehabilitation, 20(4), 340–346. https://doi.org/10.1310/tsr2004-340
Schmid, A., Duncan, P. W., Studenski, S., Lai, S. M., Richards, L., Perera, S., & Wu, S. S. (2007). Improvements in Speed-Based Gait Classifications Are Meaningful. Stroke, 38(7), 2096–2100. https://doi.org/10.1161/strokeaha.106.475921
Soares, A. V., Woellner, S. S., Andrade, C. dos S., Mesadri, T. J., Bruckheimer, A. D., & Hounsell, M. da S. (2014). The use of Virtual Reality for upper limb rehabilitation of hemiparetic Stroke patients. Fisioterapia Em Movimento, 27(3), 309–317. https://doi.org/10.1590/0103-5150.027.003.ao01
Soares, A. V., Hochmüller, A. C. O. de L., Silva, P. da, Fronza, D., Woellner, S. S., & Noveletto, F. (2009). Biorretroalimentação para treinamento do equilíbrio em hemiparéticos por acidente vascular encefálico: estudo preliminar. Fisioterapia E Pesquisa, 16(2), 132–136. https://doi.org/10.1590/s1809-29502009000200007
Tay, E. L., Lee, S. W. H., Yong, G. H., & Wong, C. P. (2018). A systematic review and meta-analysis of the efficacy of custom game based virtual rehabilitation in improving physical functioning of patients with acquired brain injury. Technology and Disability, 30(1-2), 1–23. https://doi.org/10.3233/tad-170184
Tăut, D., Pintea, S., Roovers, J.-P. W. R., Mañanas, M.-A., & Băban, A. (2017). Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis. NeuroRehabilitation, 41(1), 105–118. https://doi.org/10.3233/nre-171462
Vinicius-Soares, A., Juvêncio-de-Oliveira, C. T., Fischer-Eichinger, F. L., & Noveletto, F. (2020). Factors influencing locomotor capacity of hemiparetic post-stroke patients. Revista Mexicana de Neurociencia, 21(4), 135–142. https://doi.org/10.24875/rmn.20000118
Wüest, S., van de Langenberg, R., & de Bruin, E. D. (2013). Design considerations for a theory-driven exergame-based rehabilitation program to improve walking of persons with stroke. European Review of Aging and Physical Activity, 11(2), 119–129. https://doi.org/10.1007/s11556-013-0136-6
Wüest, S., Borghese, N. A., Pirovano, M., Mainetti, R., van de Langenberg, R., & de Bruin, E. D. (2014). Usability and Effects of an Exergame-Based Balance Training Program. Games for Health Journal, 3(2), 106–114. https://doi.org/10.1089/g4h.2013.0093
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Fabiane Maria Klitzke dos Santos; Fernando Luiz Fischer Eichinger; Susana Cristina Domenech; Fabrício Noveletto; Maria Paula Engster; Ana Paula Marcelino de Aquino; Felipe Neumann; Guilherme Tobias Andrioni Faccin; Antonio Vinicius Soares
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
