Virtual Environment Rehabilitation for Chronic Stroke
Virtual Environment Rehabilitation for Chronic Stroke
More than half of individuals post-stroke have residual movement disabilities, including
 reduced mobility, balance, and increased risk of falling. There is a need for innovative,
 long-term and economically-feasible interventions for those with chronic stroke. Recently, a
 focus has been placed on the use of virtual reality and interactive gaming as a low cost and
 effective manner of treating movement disorders. Yet few studies have investigated
 interactive gaming platforms effect on balance following stroke. The proposed study is a
 randomized, single-blind, control group cross-over study for individuals with chronic stroke
 designed to examine an innovative therapeutic approach by investigating the effects of
 commercially-available gaming systems on balance, mobility and fear of falling in a sample of
 individuals with chronic motor deficits following 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