Design considerations for a theory-driven exergame-based rehabilitation program to improve walking of persons with stroke

Abstract

Virtual rehabilitation approaches for promoting motor recovery has attracted considerable attention in recent years. It appears to be a useful tool to provide beneficial and motivational rehabilitation conditions. Following a stroke, hemiparesis is one of the most disabling impairments and, therefore, many affected people often show substantial deficits in walking abilities. Hence, one of the major goals of stroke rehabilitation is to improve patients' gait characteristics and hence to regain their highest possible level of walking ability. Because previous studies indicate a relationship between walking and balance ability, this article proposes a stroke rehabilitation program that targets balance impairments to improve walking in stroke survivors. Most currently, available stroke rehabilitation programs lack a theory-driven, feasible template consistent with widely accepted motor learning principles and theories in rehabilitation. To address this hiatus, we explore the potential of a set of virtual reality games specifically developed for stroke rehabilitation and ordered according to an established two-dimensional motor skill classification taxonomy. We argue that the ensuing “exergame”-based rehabilitation program warrants individually tailored balance progression in a learning environment that allows variable practice and hence optimizes the recovery of walking ability.

Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review

“…Studies performing VRBR of walking, balance and/or mobility were included in the review, assuming that a post-stroke physiotherapy program that targets deficits in balance may be also effective in restoring independent functional walking. 29 In fact, impaired balance seems to be related to a decreased locomotor function. 30,31 This review therefore sought to answer the following questions:…”

Reliability and validity of the inertial sensor-based Timed “Up and Go” test in individuals affected by stroke

“…Hemiparesis not only leads to gait impairments but may also affect balance and postural transfers (i.e., changing position from sitting to standing and vice versa), further impeding the patients' mobility and independence [6,[10][11][12]. It is therefore a central goal of stroke rehabilitation to improve the patient's independence and functional capacity by improving his or her mobility [13].…”

Usability and Effects of an Exergame-Based Balance Training Program

“…The process for game development within a theoretical framework has been described elsewhere. 23 The underlying exercisesspecifically targeting balance and walking recovery-were designed to be performed independently at home and remotely monitored by healthcare professionals. Moreover, the rehabilitation program explicitly considered variable practice and individually tailored progression, hence keeping participants engaged and appropriately challenged.…”

“…Moreover, the rehabilitation program explicitly considered variable practice and individually tailored progression, hence keeping participants engaged and appropriately challenged. 18,23,24 In accordance with the phased iterative approach suggested by Campbell et al, 25 this article aims to evaluate (1) the usability of the rehabilitation program in terms of acceptance, adherence, and attrition and (2) the effect of the program on measures of balance and gait in untrained healthy elderly.…”