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Improving upper-limb and trunk kinematics by interactive gaming in individuals with chronic stroke: A single-blinded RCT - 12/05/22

Doi : 10.1016/j.rehab.2021.101622 
Maxime Térémetz a, Alicia Garcia Alvarez b, c, 1, Sylvain Hanneton d, Agnès Roby-Brami e, Nicolas Roche c, f, Djamel Bensmail b, c, Påvel Lindberg a, Johanna V.G. Robertson b, c,
a Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France 
b Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Garches, AP-HP. Université Paris Saclay, France 
c Team INSERM 1179, UFR de Santé Simone Veil, Université de Versailles Saint-Quentin, France 
d Paris Institute of Sports and Health Science, URP 3625, UFR STAPS, Université de Paris, Paris, France 
e Institute of Intelligent Systems and Robotics, Sorbonne University, CNRS UMR 7222, AGATHE team, INSERM U 1150, France 
f Physiology and Functional Exploration Department, Raymond Poincaré Hospital, Garches, APHP. Université Paris-Saclay, France 

Corresponding author.

Highlights

Interactive gaming induced similar changes in elbow extension as conventional therapy.
Physiotherapist-supervised interactive gaming did not enhance forward trunk movement.
Arm but not trunk acceleration increased across gaming sessions.
The number of sessions may have been too low to induce clinically important changes.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Commercial gaming systems are increasingly being used for stroke rehabilitation; however, their effect on upper-limb recovery versus compensation is unknown.

Objectives

We aimed to compare the effect of upper-limb rehabilitation using interactive gaming (Nintendo Wii) with dose-matched conventional therapy on elbow extension (recovery) and forward trunk motion (compensation) in individuals with chronic stroke. Secondary aims were to compare the effect on (1) clinical tests of impairment and activity, pain and effort, and (2) trajectory kinematics. We also explored arm and trunk motion (acceleration) during Wii sessions to understand how participants performed movements during Wii gaming.

Methods

This single-centre, randomized controlled trial compared 12 hourly sessions over 4 weeks of upper-limb Wii therapy to conventional therapy. Outcomes were evaluated at baseline and 4 weeks. The change in elbow extension and trunk motion during a reaching task was evaluated by electromagnetic sensors. Secondary outcomes were change in Fugl-Meyer assessment, Box and Block test, Action Research Arm Test, Motor Activity Log, and Stroke Impact Scale scores. Arm and trunk acceleration during Wii therapy was evaluated by using inertial sensors. A healthy control group was included for reference data.

Results

Nineteen participants completed Wii therapy and 21 conventional therapy (mean [SD] time post-stroke 66.4 [57.2] months). The intervention and control groups did not differ in mean change in elbow extension angle (Wii: +4.5°, 95% confidence interval [CI] 0.1; 9.1; conventional therapy: +6.4°, 95%CI 0.6; 12.2) and forward trunk position (Wii: -3.3 cm, 95%CI -6.2;-0.4]; conventional therapy: -4.1 cm, 95%CI -6.6; -1.6) (effect size: elbow, d = 0.16, p = 0.61; trunk, d = 0.13, p = 0.65). Clinical scores improved similarly but to a small extent in both groups. The amount of arm but not trunk acceleration produced during Wii sessions increased with training.

Conclusions

Supervised upper-limb gaming therapy induced similar recovery of elbow extension as conventional therapy and did not enhance the development of compensatory forward trunk movement in individuals with chronic stroke. More sessions may be necessary to induce greater improvements.

ClinicalTrials.gov

NCT01806883

Le texte complet de cet article est disponible en PDF.

Keywords : Stroke, Compensatory strategies, Elbow extension, Trunk movement, Gaming, Wii-therapy


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Vol 65 - N° 3

Article 101622- mai 2022 Retour au numéro
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