Virtual Environment Rehabilitation for Chronic Stroke

Objective: To determine if playing active video games results in improved balance and motor performance.

Design: Randomized-matched, single-blind, control group cross-over study Setting: Laboratory Patients: Participants with chronic hemiparesis post-stroke were randomly assigned to a gaming group or normal activity control group.

Interventions: Gaming systems provided an interactive interface of real-time movement of either themselves or an avatar on the screen. Participants played games 1 hour/day, 4 days/week, for 5 weeks, totaling 20 hours of game-play. The intervention was strictly game-play without physical therapy. All games were played in standing position and trainers supervised to protect against loss of balance.

Measurements: Both groups were tested prior to and following the 5 weeks (post-test) and 3 months following the completion of the intervention/control. Outcome measures included: Fugl-Meyer Motor Exam, Single Leg Stance time, symmetrical weight bearing, Berg Balance Scale, Dynamic Gait Index, Timed Up and Go, Six Minute Walk, 3 Meter Walk, step length differential, and perception of recovery.

Inclusion criteria

• Greater than 6 months following stroke
• Ability to walk 10 feet with or without assistance
• 18 years of age or older
• Clinical presentation of unilateral hemiplegia post-stroke
• Ability to follow simple two-step instructions

Exclusion criteria

• Unable to ambulate 150 feet prior to stroke
• History of serious chronic obstructive pulmonary disease or oxygen dependence
• Severe weight bearing pain
• Lower-extremity amputation
• Non-healing ulcers on the lower extremity
• Renal dialysis or end stage liver disease
• Legal blindness or deafness or severe visual or hearing impairment
• A history of significant psychiatric illness defined by diagnosis of bipolar affective disorder, psychosis, or schizophrenia
• Life expectancy less than one year
• Severe arthritis or orthopaedic problems that limit passive ranges of motion of lower extremity: Knee flexion contracture of -10 degrees, Knee flexion ROM < 90 degrees, hip flexion contracture > 25 degrees, ankle plantar flexion contracture > 15 degrees
• History of deep venous thrombosis or pulmonary embolism within 6 months
• Uncontrollable diabetes: diabetic coma, frequent insulin reactions
• Severe hypertension with systolic > 200mmHg and diastolic > 110mmHg at rest
• Intracranial hemorrhage related to aneurysm rupture or an arteriovenous malformation (hemorrhagic infarctions will not be excluded)
• History of severe seizure disorder; other neurological conditions such as multiple sclerosis or Parkinson's Disease
• Pain that is scored greater than 5 out of 10 on a visual analog scale and limits daily activity
• Any health problems judged by their screening physician to put the client at significant risk of harm during the study