Applying Game-Based Approaches for Physical Rehabilitation of Poststroke Patients: A Systematic Review

Objective. A large number of patients need critical physical rehabilitation after the stroke. This study aimed to review and report the result of published studies, in which newly emerged games were employed for physical rehabilitating in poststroke patients. Materials and Methods. This systematic review study was performed based on the PRISMA method. A comprehensive search of PubMed, Scopus, IEEE Xplore Digital Library, and ISI Web of Science was conducted from January 1, 2014, to November 9, 2020, to identify related articles. Studies have been entered in this review based on inclusion and exclusion criteria, in which new games have been used for physical rehabilitation. Results. Of the 1326 retrieved studies, 60 of them met our inclusion criteria. Virtual reality-oriented games were the most popular type of physical rehabilitation approach for poststroke patients. “The Nintendo Wii Fit” game was used more than other games. The reviewed games were mostly operated to balance training and limb mobilization. Based on the evaluation results of the utilized games, only in three studies, applied games were not effective. In other studies, games had effective outcomes for target body members. Conclusions. The results indicate that modern games are efficient in poststroke patients’ physical rehabilitation and can be used alongside conventional methods.

Inovação estratégica de valor: o caso Nintendo Wii / Value strategy innovation: the Nintendo Wii´s case

A inovação toma força como uma das soluções possíveis para que as organizações prosperem em um mercado turbulento e acirrado. O mercado de videogames, fortemente ligado às novidades tecnológicas, é altamente competitivo e movimenta bilhões de dólares a cada ano. A Nintendo liderou o mercado mundial de videogames, com os consoles NES e SuperNintendo. No entanto, seus lançamentos posteriores não foram suficientes para manter a liderança do passado frente a novos concorrentes como o Playstation (Sony) e o Xbox (Microsoft). A sua liderança de mercado só foi retomada após o lançamento do console Wii, com sua inovadora formar de jogar, que ocasionou recordes em vendas e o surgimento de um público consumidor nunca antes interessado neste tipo de produto. O objetivo deste artigo é estudar, sob o ponto de vista da inovação, quais elementos contribuíram para o sucesso do console Nintendo Wii e que devolveram a Nintendo ao posto de número 1 no mundo dos videogames.

Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial

Background: Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. Methods: Frail older adults (n = 37) were included in this study who were randomized and divided into a VR exercises group (VR group) or a control group using the Nintendo Wii system (CTRL group). Finally, 22 patients were included in the data treatment. APA were studied through muscular activation timings measured with electromyographic activities. The functional reach test, the gait speed, and the time up and go were also evaluated before and after a 3-week training phase. Results and discussion: As the main results, the training phase with VR improved the APA and the functional reach test score along the antero-posterior axis. Together, these results highlight the ability of a VR training phase to induce neuromuscular adaptations during the APA period in frail older adults. Then, it underlines the effective transfer from learning carried out during the VR training movements to control balance abilities in a more daily life context.

Exergames to Prevent the Secondary Functional Deterioration of Older Adults during Hospitalization and Isolation Periods during the COVID-19 Pandemic

The COVID-19 pandemic is having an intense impact on the functional capacity of older adults, making them more vulnerable to frailty and dependency. The development of preventive and rehabilitative measures which counteract the consequences of confinement or hospitalization is an urgent need. Exergaming can promote physical activity, prevent falls, and maintain functional and cognitive capacity. However, although the use of exergames in health programs for the elderly is promising, their widespread use should not be considered without the supervision of a social health professional. Therefore, the objective of this work was to evaluate and analyze three video game consoles (Nintendo Wii®, Xbox-Kinect® and Play Station 4®) and 26 commercial exergames with the aim of identifying their usefulness for the prevention of functional deterioration. Three occupational therapists analyzed the data independently, and subsequently agreed on the results. The examination of the commercial consoles met three criteria: components, interaction channels and the type of the exergame. Each exergame was analyzed taking into account its ability to train postural control, balance, upper limb functionality and cognitive function. The results of the evaluation showed that exergames contain game activities that can be part of the rehabilitative treatment aimed at the prevention of the functional impairment of older people affected by COVID.

Recurrence quantification analysis of motor learning and training

The goal of this study was to apply recurrence quantification analysis (RQA) to surface electromyographic (sEMG) signals during motor learning and training activities. It has been previously demonstrated that the RQA variable, percentage of determinism (�T), is related to the synchronization of motor units. It is suggested that �T will change throughout the motor learning and training process. As a result, the experiment consisted of two separate parts. The motor learning part required a male subject to train using the Nintendo Wii Fit® software, Wii Fit® balance board and the Nintendo Wii® gaming console. The myoelectric signals were acquired from the peroneus longus (PL) and soleusu (S) muscles. During the course of this experiment a soccor simulator and three in-game balance tests were used to evaluate motor learning. The second part of the experiment consisted of a chronic incomplete spinal cord injured patient from Toronto Rehabilitation Institute. The subject trained three times a week for fourteen days. Each training session consisted of the subject performing weighted dorsal and plantar flexion. Both parts of the experiments suggests that there is a decrease in synchronization of motor units after motor learning and training (decrease in �T). Additionally, the time course of �T displayed a convergence of levels between the right PL and right S during the virtual environment training. It is concluded that RQA demonstrates the ability to detect motor learning and training. Possible applications for the use of RQA on sEMG signal could be the evaluation of rehabilitation programs. By monitoring the �T, it may be possible to determine if a particular rehabilitation program is effective for a patient. This could lead to customizable programs, suited for a specific person, in order to increase the rate of recovery.

Recurrence quantification analysis of motor learning and training

The goal of this study was to apply recurrence quantification analysis (RQA) to surface electromyographic (sEMG) signals during motor learning and training activities. It has been previously demonstrated that the RQA variable, percentage of determinism (�T), is related to the synchronization of motor units. It is suggested that �T will change throughout the motor learning and training process. As a result, the experiment consisted of two separate parts. The motor learning part required a male subject to train using the Nintendo Wii Fit® software, Wii Fit® balance board and the Nintendo Wii® gaming console. The myoelectric signals were acquired from the peroneus longus (PL) and soleusu (S) muscles. During the course of this experiment a soccor simulator and three in-game balance tests were used to evaluate motor learning. The second part of the experiment consisted of a chronic incomplete spinal cord injured patient from Toronto Rehabilitation Institute. The subject trained three times a week for fourteen days. Each training session consisted of the subject performing weighted dorsal and plantar flexion. Both parts of the experiments suggests that there is a decrease in synchronization of motor units after motor learning and training (decrease in �T). Additionally, the time course of �T displayed a convergence of levels between the right PL and right S during the virtual environment training. It is concluded that RQA demonstrates the ability to detect motor learning and training. Possible applications for the use of RQA on sEMG signal could be the evaluation of rehabilitation programs. By monitoring the �T, it may be possible to determine if a particular rehabilitation program is effective for a patient. This could lead to customizable programs, suited for a specific person, in order to increase the rate of recovery.