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.
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.
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