The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Feasibility of delivering a trunk exercise programme post stroke using a virtual reality video game-based system: a mixed methods case series

Feasibility of delivering a trunk exercise programme post stroke using a virtual reality video game-based system: a mixed methods case series
Feasibility of delivering a trunk exercise programme post stroke using a virtual reality video game-based system: a mixed methods case series
Background: trunk control post-stroke can be affected by muscle weakness, reduced position sense and poor coordination leading to decreases in balance and functional ability ( Bohannon et al. 1995; Fujiwara et al. 2001, Langhorne et al. 2009). Virtual reality (VR) technology in stroke rehabilitation has been demonstrated to improve function and activity. The Valedo® system (Hocoma, Switzerland) comprises three lightweight sensors worn on the sternum, lumbar and sacral spine and a series of VR games. However, the feasibility of using VR to deliver post-stroke trunk exercises is unknown.

Purpose: to explore the feasibility of conducting trunk rehabilitation post-stroke using a virtual reality (VR) video game-based system (Valedo® system) by investigating adherence, safety, acceptability and participation. In addition, changes in pre-post measures of trunk impairment, balance and upper and lower limb motor function were assessed.

Methods: the intervention consisted of 18 sessions of VR video games trunk training program (three days/week, 45 minutes a day) over six weeks. The exercises consisted of specific upper and lower trunk exercises including lateral flexion, rotation, flexion and extension. During each session, participants practiced playing five videogames (nine minutes/game) with rest periods upon request.
The feasibility of using the Valedo® system was measured by means of adherence (sessions missed/drop outs), safety (adverse events), acceptability (post intervention semi structure interview) and participation in each session (Pittsburgh Rehabilitation Participation Scale (PRPS)).
Pre- and post-intervention testing included the Trunk Impairment Scale (TIS), Streamlined Wolf Motor Function Test (SWMFT), Fugl-Meyer Assessment Motor Function (FMA), Berg Balance Scale (BBS).
To ensure safety, a BBS score of 45+ was required to practice exercises in a standing position. Initial TIS scores were used to tailor the exercises practiced including trunk mobilization, movement awareness and isolation.

Results: two people with chronic stroke (SA and JT) participated in the intervention; SA practiced the exercises in standing (initial Berg 54/56), while JT practiced in sitting (initial Berg 44/56).
Post intervention results showed adherence was excellent, no adverse events occurred, acceptability was high and the PRPS revealed very good to excellent participation; participants actively participated in all exercises with maximal effort, were excited and looked forward to subsequent therapy sessions. Both participants were positive about the intervention and would recommend it to others. Participants suggested changes to the system including changing the distracting music (SA) and increasing the challenge of the game focussed on trunk lateral flexion (JT).
The clinical outcome measures for SA and JT respectively demonstrated the following improvements: TIS (7 and 6 points), SWMFT (4 and 4 points), BBS (4 and 9 points), FMA upper limb (1 and 1 point) and FMA lower limb (SA had maximal score at baseline, 5 points for JT participant).

Conclusion(s): results suggest that it is feasible to utilise VR video game-based system for trunk rehabilitation post-stroke.
Implications: A wider scale study is warranted, to determine feasibility and sample size for a randomised controlled trial investigating the effectiveness of trunk exercises using VR video games for improving trunk and balance ability in people with stroke.
Alhwoaimel, Norah
2bbf3fd2-1b5b-4f87-b357-47a182893249
Hughes, Ann-Marie
11239f51-de47-4445-9a0d-5b82ddc11dea
Warner, Martin
0d9ce533-67ba-4b3f-b798-53ab1a4f4ca7
Brown, Simon
81f6a7a5-379f-4b86-8b55-39f9799c23c8
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Verhyden, Geert
da5e731e-fb41-494a-8b4f-c44570059992
Thijs, Liselot
7e98df02-b544-47aa-8511-b407dfc3bc51
Wee, Seng Kwee
876fdc2f-4b84-4aba-bf50-f3417ae532c2
Turk, Ruth
9bb21965-6f9f-4c9c-8505-94df8e168f52
Alhwoaimel, Norah
2bbf3fd2-1b5b-4f87-b357-47a182893249
Hughes, Ann-Marie
11239f51-de47-4445-9a0d-5b82ddc11dea
Warner, Martin
0d9ce533-67ba-4b3f-b798-53ab1a4f4ca7
Brown, Simon
81f6a7a5-379f-4b86-8b55-39f9799c23c8
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Verhyden, Geert
da5e731e-fb41-494a-8b4f-c44570059992
Thijs, Liselot
7e98df02-b544-47aa-8511-b407dfc3bc51
Wee, Seng Kwee
876fdc2f-4b84-4aba-bf50-f3417ae532c2
Turk, Ruth
9bb21965-6f9f-4c9c-8505-94df8e168f52

Alhwoaimel, Norah, Hughes, Ann-Marie, Warner, Martin, Brown, Simon, Burridge, Jane, Verhyden, Geert, Thijs, Liselot, Wee, Seng Kwee and Turk, Ruth (2019) Feasibility of delivering a trunk exercise programme post stroke using a virtual reality video game-based system: a mixed methods case series. In World Confederation for Physical Therapy (WCPT) congress.

Record type: Conference or Workshop Item (Paper)

Abstract

Background: trunk control post-stroke can be affected by muscle weakness, reduced position sense and poor coordination leading to decreases in balance and functional ability ( Bohannon et al. 1995; Fujiwara et al. 2001, Langhorne et al. 2009). Virtual reality (VR) technology in stroke rehabilitation has been demonstrated to improve function and activity. The Valedo® system (Hocoma, Switzerland) comprises three lightweight sensors worn on the sternum, lumbar and sacral spine and a series of VR games. However, the feasibility of using VR to deliver post-stroke trunk exercises is unknown.

Purpose: to explore the feasibility of conducting trunk rehabilitation post-stroke using a virtual reality (VR) video game-based system (Valedo® system) by investigating adherence, safety, acceptability and participation. In addition, changes in pre-post measures of trunk impairment, balance and upper and lower limb motor function were assessed.

Methods: the intervention consisted of 18 sessions of VR video games trunk training program (three days/week, 45 minutes a day) over six weeks. The exercises consisted of specific upper and lower trunk exercises including lateral flexion, rotation, flexion and extension. During each session, participants practiced playing five videogames (nine minutes/game) with rest periods upon request.
The feasibility of using the Valedo® system was measured by means of adherence (sessions missed/drop outs), safety (adverse events), acceptability (post intervention semi structure interview) and participation in each session (Pittsburgh Rehabilitation Participation Scale (PRPS)).
Pre- and post-intervention testing included the Trunk Impairment Scale (TIS), Streamlined Wolf Motor Function Test (SWMFT), Fugl-Meyer Assessment Motor Function (FMA), Berg Balance Scale (BBS).
To ensure safety, a BBS score of 45+ was required to practice exercises in a standing position. Initial TIS scores were used to tailor the exercises practiced including trunk mobilization, movement awareness and isolation.

Results: two people with chronic stroke (SA and JT) participated in the intervention; SA practiced the exercises in standing (initial Berg 54/56), while JT practiced in sitting (initial Berg 44/56).
Post intervention results showed adherence was excellent, no adverse events occurred, acceptability was high and the PRPS revealed very good to excellent participation; participants actively participated in all exercises with maximal effort, were excited and looked forward to subsequent therapy sessions. Both participants were positive about the intervention and would recommend it to others. Participants suggested changes to the system including changing the distracting music (SA) and increasing the challenge of the game focussed on trunk lateral flexion (JT).
The clinical outcome measures for SA and JT respectively demonstrated the following improvements: TIS (7 and 6 points), SWMFT (4 and 4 points), BBS (4 and 9 points), FMA upper limb (1 and 1 point) and FMA lower limb (SA had maximal score at baseline, 5 points for JT participant).

Conclusion(s): results suggest that it is feasible to utilise VR video game-based system for trunk rehabilitation post-stroke.
Implications: A wider scale study is warranted, to determine feasibility and sample size for a randomised controlled trial investigating the effectiveness of trunk exercises using VR video games for improving trunk and balance ability in people with stroke.

This record has no associated files available for download.

More information

Published date: 12 May 2019
Venue - Dates: World Confederation for Physical Therapy (WCPT) congress, Switzerland, 2019-05-10 - 2019-05-13

Identifiers

Local EPrints ID: 438264
URI: http://eprints.soton.ac.uk/id/eprint/438264
PURE UUID: db339721-363f-40b4-a7d7-aaeda6776c69
ORCID for Ann-Marie Hughes: ORCID iD orcid.org/0000-0002-3958-8206
ORCID for Simon Brown: ORCID iD orcid.org/0000-0001-9646-3285
ORCID for Jane Burridge: ORCID iD orcid.org/0000-0003-3497-6725
ORCID for Ruth Turk: ORCID iD orcid.org/0000-0001-6332-5353

Catalogue record

Date deposited: 04 Mar 2020 17:32
Last modified: 18 Feb 2021 17:09

Export record

Contributors

Author: Norah Alhwoaimel
Author: Martin Warner
Author: Simon Brown ORCID iD
Author: Jane Burridge ORCID iD
Author: Geert Verhyden
Author: Liselot Thijs
Author: Seng Kwee Wee
Author: Ruth Turk ORCID iD

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×