Serious Game for rehabilitation of Hemiparetic Stroke patients: impact on quality of life
DOI:
https://doi.org/10.33448/rsd-v11i14.35976Keywords:
Video games; Exercise therapy; Quality of life; Hemiparesis; Stroke.Abstract
Hemiparesis is the typical clinical picture of stroke, resulting in important functional losses that compromise the quality of life (QOL) of patients. Although conventional physiotherapy is beneficial in rehabilitation, there are some limitations. Serious Games (SG) correspond to a viable alternative in rehabilitation because they make the process more motivating. The objective was to verify the therapeutic effects of an exercise program using a SG on the motor functions of the lower limbs, functional mobility and QOL of post-stroke hemiparetic patients. This is a non-randomized controlled clinical trial involving 24 patients in the subacute or chronic phase of the disease. The experimental group (EG n=16) received treatment for the paretic lower limb using SG mim-Pong. The control group (CG n=8) received treatment with conventional kinesiotherapy. Twenty sessions were held (twice a week), lasting 30 minutes. The following were evaluated: motor impairment (Fugl-Meyer-FMAS), cognitive level (Mini Mental State Examination), functional mobility (Timed Up and Go Test), QOL perception (Nottingham-PSN Health Profile) and perception of improvement (Likert Scale). Significant improvements were observed only in the GE. We highlight the large effect size (ES) obtained in the variables evaluated with the PSN (ES=0.5) and the FMAS (ES=0.6). There was also superiority of the GE in the perception of improvement. It is concluded that the SG mim-Pong can be considered as a valuable resource in the rehabilitation of hemiparetic stroke patients, as it provided motor and functional improvements, which directly impacted on the quality of life, and these improvements were superior to those obtained with conventional physiotherapy.
References
Ahmad, M. A., Singh, D. K. A., Nordin, N. A. M., Nee, K. H. & Ibrahim, N. (2019). Virtual reality games as an adjunct in improving upper limb function and general health among stroke survivors. International Journal of Environmental Research and Public Health, 16(24), 5144. https://doi.org/10.3390/ijerph16245144
Amadeu, J. R. & Justi, M. M. (2017). Qualidade de vida de estudantes de graduação e pós-graduação em odontologia. Archives of Health Investigation, 6(11), 540-544. https://doi.org/10.21270/archi.v6i11.2275
Baluz, R. A. R. S., Fontenele, J. E. S., Teles, A. S., Nascimento, R. F., Santos, R. P. M., Bastos, V. H. V. et al. (2020). Um Jogo Sério baseado em gestos para a reabilitação motora de membros superiores. Research, Society and Development, 9(11), e2569119896. https://doi.org/10.33448/rsd-v9i11.9896
Bertolucci, P. H. F., Brucki, S. M. D., Campacci, S. R. & Juliano, Y. (1994). O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arquivos de Neuro-Psiquiatria, 52(1), 1-7. https://doi.org/10.1590/S0004-282X1994000100001
Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M. et al. (2014). Physical activity and exercise recommendations for stroke survivors. Stroke, 45(8), 2532-2553. https://doi.org/10.1161/STR.0000000000000022
Bitencourt, T. C., Santos, F. M. K. & Soares, A. V. (2020). Relação entre a funcionalidade e a capacidade motora de pacientes pós-AVC na fase aguda. Revista Neurociências, 28(1), 1-18. https://doi.org/10.34024/rnc.2020.v28.10241
Bunketorp Käll, L., Pekna, M., Pekny, M., Samuelsson, H., Blomstrand, C. & Nilsson, M. (2020). Motor function in the late phase after stroke: stroke survivors perspective. Annals of Rehabilitation Medicine, 44(5), 362-369. https://doi.org/10.5535/arm.20060
Chan, P. P., Si Tou, J. I., Tse, M. M. & Ng, S. S. (2017). Reliability and validity of the timed up and go test with a motor task in people with chronic stroke.
Archives of Physical Medicine and Rehabilitation, 98(11), 2213-2220. https://doi.org/10.1016/j.apmr.2017.03.008
Cohen, J. (1988). Statistical Power analysis for the behavioral sciences. 2 ed. Hillsdale, NJ: Erlbaum, 474 p.
Cooper, A., Alghamdi, G. A., Alghamdi, M. A., Altowaikri, A. & Richardson, R. (2011). The relationship of lower limb muscle strength and knee joint hyperextension during the stance phase of gait in hemiparetic stroke patients. Physiotherapy Research International, 17(3), 150-156. https://doi.org/10.1002/pri.528
Correa, C. S., Silva, B. G. C., Alberton, C. L., Wilhelm, E. N., Moraes, A. C., Lima, C. S. et al. (2011). Analysis of maximal isometric force and EMG signal in lower limb exercise. Rev Brasileira de Cineantropometria e Desempenho Humano, 13(6), 429-435. https://doi.org/10.5+007/1980-0037.2011v13n6p429
Cunha, B. P., Freita, S. M. S. F., Menezes, V. V. D. B. & Freitas, P. B. (2016). Ipsilesional upper limb performance in stroke individuals: relationship among outcomes of different tests used to assess hand function. Fisioterapia em Movimento, 29(3), 561-568. https://doi.org/10.1590/0103-5150.029.003.AO14
Demetrios, M., Khan, F., Stokes, L. T., Brand, C. & McSweeney, S. (2013). Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity. Cochrane Database of Systematic Reviews, (6), CD009689. https://doi.org/10.1002/14651858.CD009689.pub2
Dewilde, S., Annemans, L., Pincé, H. & Thijs, V. (2018). Hospital financing of ischaemic stroke: determinants of funding and usefulness of DRG subcategories based on severity of illness. BMC Health Services Research, 18(1), 356. https://doi.org/10.1186/s12913-018-3134-6
Domínguz Téllez, P., Moral Muñoz, J. A., Salazar, A., Casado Fernández, E. & Lucena Antón, D. (2020). Game-based virtual reality interventions to improve upper limb motor function and quality of life after stroke: systematic review and meta-analysis. Games Health Journal, 9(1), 1-10. https://doi.org/10.1089/g4h.2019.0043
Eichinger, F. L. F., Soares, A. V., Noveletto, F., Sagawa Júnior, Y., Bertemes Filho, P. & Domenech, S. C. (2020). Serious game for locomotor rehabilitation of hemiparetic stroke patients. Fisioterapia em Movimento, 33, e003316. https://doi.org/10.1590/1980-5918.033.AO16
Fekadu, G., Chelkeba, L. & Kebede, A. (2019). Burden clinical outcomes and predictors of time to in hospital mortality among adult patients admitted to stroke unit of Jimma university medical center: a prospective cohort study. BMC Neurology, 19(1), 213. https://doi.org/10.1186/s12883-019-1439-7
Gandhi, D. B., Sterba, A., Khatter, H. & Pandian, J. D. (2020). Mirror therapy in stroke rehabilitation: current perspectives. Therapeutics and Clinical Risk Management, 7(16), 75-85. https://doi.org/10.2147/TCRM.S206883
Khiabani, R. R., Mochizuki, G., Ismail, F., Boulias, C., Phadke, C. P. & Gageimpact, W. H. (2017). Impact of spasticity on balance control during quiet standing in persons after stroke. Stroke Research and Treatment, 2017, 6153714. https://doi.org/10.1155/2017/6153714
Lee, H. C., Huang, C. L., Ho, S. H. & Sung, W. H. (2017). The effect of a virtual reality game intervention on balance for patients with stroke: a randomized controlled trial. Games Health Journal, 6(5), 303-311. https://doi.org/10.1089/g4h.2016.0109
Li, L., Scott, C. A. & Rothwell, P. M. (2020). Trends in stroke incidence in high-income countries in the 21st century: population-based study and systematic review. Stroke, 51(5), 1372-1380. https://doi.org/10.1161/STROKEAHA.119.028484
Lin, R. C., Chiang, S. L., Heitkemper, M. M., Weng, S. M., Lin, C. F., Yang, F. C. et al. (2020). Effectiveness of early rehabilitation combined with virtual reality training on muscle strength, mood state, and functional status in patients with acute stroke: a randomized controlled trial. Worldviews on Evidence-Based Nursing, 17, 158-167. https://doi.org/10.1111/wvn.12429
Medeiros, C. S. P., Fernandes, S. G. G., Souza, D. E., Guedes, D. T., Cacho, E. W. A. & Cacho, R. O. (2019). Comprometimento motor e risco de quedas em pacientes pós-acidente vascular encefálico. Revista Brasileira de Ciência e Movimento, 27(1), 42-49. https://dx.doi.org/10.31501/rbcm.v27i1.7940
Miclaus, R. S., Roman, N., Henter, R. & Caloian, S. (2021). Lower extremity rehabilitation in patients with post-stroke sequelae through virtual reality associated with mirror therapy. International Journal of Environmental Research and Public Health, 18(5), 2654. https://doi.org/10.3390/ijerph18052654
Moreira, N. R. T., Andrade, A. S., Ribeiro, K. S. Q. S., Nascimento, J. A. & Brito, G. E. G. (2015). Qualidade de vida em indivíduos acometidos por acidente vascular cerebral. Revista Neurociências, 23(4), 530-537. https://doi.org/10.4181/RNC.2015.23.04.1036.08p
Mubin, O., Alnajjar, F., Al Mahmud, A., Jishtu, N. & Alsinglawi, B. (2022). Exploring serious games for stroke rehabilitation: a scoping review. Disability and Rehabilitation: Assistive Technology, 17(2), 159-165. https://doi.org/10.1080/1748310+7.2020.1768309
Najafi, Z., Rezaeitalab, F., Yaghubi, M. & Manzari, Z. S. (2018). The effect of biofeedback on the motor-muscular situation in rehabilitation of stroke patients: a randomized controlled trial. Journal of Caring Sciences, 7, 89-93. https://doi.org/10.15171/jcs.2018.014
Neves, M. M. F. & Guimarães, L. H. C. T. (2016). Qualidade de vida e grau de independência funcional em pacientes com acidente vascular cerebral. Revista Neurociências, 24, 1-17. https://doi.org/10.34024/rnc.2016.v24.9940
Noveletto, F., Soares, A. V., Eichinger, F. L. F., Domenech, S. C., Hounsell, M. S. & Bertemes Filho, P. (2020). Biomedical serious game system for lower limb motor rehabilitation of hemiparetic stroke patients. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 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. S. & Bertemes Filho, P. (2018). Biomedical serious game system for balance rehabilitation of hemiparetic stroke patients. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 26(11), 2179-2188. https://doi.org/10.1109/TNSRE.2018.2876670
Oliveira, M. P. B., Ferreira, D. M., Silva, J. R. T., Silva, A. M., Lobato, D. F. M., Kosour, C. et al. (2016). Realidade virtual na função motora de membros inferiores pós-acidente vascular encefálico. Acta Fisiátrica, 23(3), 135-139. https://doi.org/10.5935/0104-7795.20160026
Rech, K. D., Salazar, A. P., Marchese, R. R., Schifino, G., Cimolin, V. & Paghussat, A. S. (2019). Fugl-Meyer assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke. Journal of Stroke and Cerebrovascular Diseases, 29(1), 1-8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104463
Reis, M. F., Chaoubah, A., Mármora, C. H. C. & Liebel, G. (2018). Análise do gasto ambulatorial do acidente vascular cerebral na perspectiva do sistema público. Jornal Brasileiro de Economia da Saúde, 10(3), 219-225. https://doi.org/10.21115/JBES.v10.n3.p219-25
Rodríguez Hernández, M., Criado Álvarez, J. J., Corregidor Sánchez, A. I., Martín Conty, J. L., Mohedano Moriano, A. & Polonio López, B. (2021). Effects of virtual reality-based therapy on quality of life of patients with subacute stroke: a three-month follow-up randomized controlled trial. International Journal of Environmental Research and Public Health, 18(6), 2810. https://doi.org/10.3390/ijerph18062810
Rodríguez Hernández, M., Polonio López, B., Corregidor Sánchez, A. I., Martín Conty, J. L., Mohedano Moriano, A. & Criado Álvarez, J. J. (2021). Effects of specific virtual reality-based therapy for the rehabilitation of the upper limb motor function post-ictus: randomized controlled trial. Brain Sciences, 11(5), 555. https://doi.org/10.3390/brainsci1105055
Sanchez Bezanilla, S., Åberg, N. D., Crock, P., Walker, F. R., Nilsson, M., Isgaard, J. et al. (2020). Growth hormone promotes motor function after experimental stroke and enhances recovery-promoting mechanisms within the peri-infarct area. International Journal of Molecular Sciences, 21(2), 606-626. https://doi.org/10.3390/ijms21+020606
Sardi, M. D., Schuster, R. C. & Alvarenga, L. F. C. (2012). Efeitos da realidade virtual em hemiparéticos crônicos pós-acidente vascular encefálico. Revista Brasileira de Ciências da Saúde, 10(32), 29-35. https://doi.org/10.13037+/rbcs.vol10n32.1584
Soares, A. V., Korn, R., Pertile, T., Domenico, B., Eichinger, F. L. F. & Noveletto, F. (2020). Cicloergometria adaptada para membros superiores de pacientes hemiparéticos por acidente vascular: uma série de casos. Revista Neurociências, 28, 1-12. https://doi.org/10.34024/rnc.2020.v28.10826
Soares, A. V., Woellner, S. S., Andrade, C. S., Mesadri, T. J., Bruckheimer, A. D. & Hounsell, M. S. (2014). A utilização da realidade virtual para recuperação do membro superior de pacientes hemiparéticos por acidente vascular cerebral. Fisioterapia em Movimento, 27(3), 309-317. https://doi.org/10.1590/0103-5150.027.003.AO01
Souza, L. A., Martins, J. C., Teixeira Salmela, L. F., Lara, E. M., Moura, J. B., Aguiar, L. T. et al. (2014). Validity and reliability of the modified sphygmomanometer test to assess strength of the lower limbs and trunk muscles after stroke. Journal of Rehabilitation Medicine, 46(7), 620-628. https://doi.org/10.2340/16501977-1823
Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C. et al. (2016). Guidelines for adult stroke rehabilitation and recovery. Stroke, 47(6), 98-169. https://doi.org/10.1161/STR.0000000000000098
Xu, Y., Tong, M., Ming, W. K., Lin, Y., Mai, W., Huang, W. et al. (2021).A depth camera–based, task-specific virtual reality rehabilitation game for patients with stroke: pilot usability study. JMIR Serious Games, 9(1), e20916. https://doi.org/10.2196/20916
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Copyright (c) 2022 Fernanda Lenkulkul; Gabriele Franco; Antonio Vinicius Soares; Fabrício Noveletto; Susana Cristina Domenech; Fernando Luís Fischer Eichinger
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