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Virtual Rehabilitation International Conference, 2009

Date June 29 2009-July 2 2009

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Displaying Results 1 - 25 of 71
  • Virtual rehabilitation 2009 conference committee

    Page(s): i - ii
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    Freely Available from IEEE
  • Virtual rehabilitation 2009 international program committee

    Page(s): iii - iv
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    Freely Available from IEEE
  • Message from the General Co-Chairs

    Page(s): v
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    Freely Available from IEEE
  • Message from the Program Co-Chairs

    Page(s): vi
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    Freely Available from IEEE
  • Workshop A: Using low cost virtual reality systems in physical rehabilitation - A clinician's perspective

    Page(s): vii - ix
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    Freely Available from IEEE
  • Table of contents

    Page(s): x - xv
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    Freely Available from IEEE
  • The Impact of Personality Traits on the Experience of Presence

    Page(s): 1 - 7
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (328 KB) |  | HTML iconHTML  

    This study was designed to examine the correlation between five personality traits (empathy, imagination, immersive tendencies, dissociation tendencies and locus of control) and presence. Additionally, the study attempted to identify an optimal Virtual Reality user profile. Sixty one students (43 women & 18 men) completed personality questionnaires, experienced exposure in a virtual environment and completed a presence questionnaire. Although presence correlated with immersive tendencies and empathy, empathy and internal locus of control (and not immersive tendencies) were the best predictors for the sense of presence. Thus, this study revealed the importance of empathy and internal locus of control in sense of presence. View full abstract»

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  • Development and Clinical Results from the Virtual Iraq Exposure Therapy Application for PTSD

    Page(s): 8 - 15
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (725 KB) |  | HTML iconHTML  

    Post Traumatic Stress Disorder (PTSD) is reported to be caused by exposure to an extreme traumatic stressor involving direct personal experience of (or witnessing/learning about) an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Such incidents would be distressing to almost anyone, and are usually experienced with intense fear, horror, and helplessness. Initial data suggests that at least 1 out of 5 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. The current paper will present the rationale and description of a VR PTSD therapy application (Virtual Iraq/Afghanistan) and present initial findings from a number of early studies of its use with active duty service members. Virtual Iraq/Afghanistan consists of a series of customizable virtual scenarios designed to represent relevant Middle Eastern VR contexts for exposure therapy, including a city and desert road convoy environment. User-centered design feedback needed to iteratively evolve the system was gathered from returning Iraq War veterans in the USA and from a system deployed in Iraq and tested by an Army Combat Stress Control Team. Results from an open clinical trial using Virtual Iraq with 20 treatment completers indicated that 16 no longer met PTSD diagnostic criteria at post-treatment, with only one not maintaining treatment gains at 3 month follow-up. View full abstract»

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  • How do the properties of telerehabilitation technologies change clinical practice and interprofessional communication? A qualitative case-study

    Page(s): 16 - 22
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (278 KB) |  | HTML iconHTML  

    There has been a steady increase in the number of telerehabilitation programmes, as well as studies of telerehabilitation technology development, efficacy and effectiveness. However, few studies have examined the impact of telerehabilitation when it is actually implemented in a clinical setting. The objective of this study was therefore to explore how the properties of the technologies used for telerehabilitation affect clinical practice and interprofessional communication in a rehabilitation setting. A qualitative case study of an interorganisational telerehabilitation programme for traumatic brain injured and spinal cord injured patients was conducted, using data obtained from focus groups and interviews, along with observations of recordings of videoconference sessions. A conceptual framework based on technology adoption and organisational change theories was used to structure the data collection and thematic analysis. Several key characteristics of the telerehabilitation technologies were identified that impacted on interprofessional and interorganisational collaborations and patient participation, including the audio and video quality, the real-time communication capability, user-friendliness and time restrictions. The technology was used primarily for interdisciplinary care plan meetings, and occasionally for direct patient interventions in speech therapy and sexology, although additional uses had been identified in the planning stages. Implications for the development of future telerehabilitation programmes are discussed, in particular relating to sensitizing team members to each other's roles and organisational cultures. View full abstract»

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  • Eleven Months of home virtual reality telerehabilitation - Lessons learned

    Page(s): 23 - 28
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    Indiana University School of Medicine and the Rutgers Tele-rehabilitation Institute have collaborated for over a year on a clinical pilot study of in-home hand telerehabiltation. Virtual reality videogames were used to train three adolescents with hemiplegic cerebral palsy. Training duration varied between 6 and 11 months. The investigators summarize medical, technological, legal, safety, social, and economic issues that arose during this lengthy study. Solutions to deal with these multitude of issues are proposed. The authors stress the importance of choosing multiple outcome measures to detect clinically meaningful change. The authors believe that in-home telerehabilitation is the future of rehabilitation. View full abstract»

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  • Blind children navigation through gaming and associated brain plasticity

    Page(s): 29 - 36
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    Blind people have difficulty navigating and traveling autonomously and efficiently mainly because they cannot access information about their environment in a quick and efficient manner. We present the design, development and the evaluation of usability of Audio-Based Environments Simulator (AbES) software that enables a blind user to navigate through a virtual representation of a real space in order to train his/her orientation and mobility skills. Our findings indicate that users feel satisfied with the proposed interface, are sure of themselves when interacting with the software, and the incorporated sounds allow them to become correctly oriented within the virtual world that they navigate. AbES is also being used to study changes and adaptations at the level of the brain related to navigation by incorporating the software within a neuroimaging environment. Our results suggest that this kind of virtual environment is highly efficient as a testing, training and rehabilitation platform for learning and navigation. View full abstract»

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  • Integrate the BlindAid system in a traditional orientation and mobility rehabilitation program

    Page(s): 37 - 41
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    In the process of becoming blind, newly- blinded people participate in a rehabilitation program, which includes different skills that a newly- blinded person needs to adapt as a result of his or her lost of vision. The virtual system, the BlindAid, involves active collaboration between orientation and mobility instructors from the Carroll Center for the Blind in Newton, Massachusetts and engineers and cognitive scientists at the MIT Touch Lab in Cambridge, Massachusetts. The two teams collaborated in the integration of the BlindAid system in the traditional orientation and mobility rehabilitation program. In this study we will describe the model of the integration. The three main goals of this model were to study: (1) cognitive mapping process of newly-blinded when using the virtual environment; (2) mental support of the BlindAid system to the newly- blinded; and (3) enhancement of the BlindAid system for the orientation and mobility instructors. The findings supply strong evidence that interaction with the BlindAid system by people who are newly-blinded provides a robust foundation for the participants' development of comprehensive cognitive maps of actual unknown spaces during their rehabilitation program. View full abstract»

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  • PlayCubes: Monitoring constructional ability in children using a tangible user interface and a playful virtual environment

    Page(s): 42 - 49
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    Constructional ability is a necessary part of everyday functioning for adults and children alike. In children, the need for adequate levels of constructional ability is evident during both recreational and school activities. PlayCubes is a dynamic tool that supports monitoring a variety of the perceptual-motor processes needed while children perform constructional tasks. PlayCubes is based on ActiveCube (AC), an electronic, Lego-like tangible user interface (TUI) designed to construct three-dimensional (3D) objects in both the physical and virtual realms simultaneously. In this paper we explore PlayCubes' use as a concrete, ecologically valid tool which reveals the dynamic functional processes underlying constructional ability among typically developed children. Our paper describes the PlayCubes interface including its interactive playground virtual setting, the motivation for the study, the experimental design and results to date. We conclude that, despite several technical limitations, the PlayCubes system and playground apparatus tasks appear to be sensitive to differences in children constructional abilities while presenting an engaging and enjoyable assessment tool. View full abstract»

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  • Rubber ball to cloud rehabilitation musing on the future of therapy

    Page(s): 50
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    We can trace the origins of virtual rehabilitation to the late 80s when sensing gloves were used to determine the degree of hand tremor in patients with Parkinson, and virtual environments were investigated as a medium to train wheelchair navigation. At the first Medicine Meets Virtual Reality conference in San Diego in 1992, we proposed a unified system where sensing gloves were used to diagnose and train patients post hand surgery. Other researchers pioneered the use of virtual environments in phobias, attention deficit, post-traumatic stress and other conditions. In 1996 researchers interested primarily in VR phobia treatment started the CyberTherapy conference series, and VR-based physical therapy, occupational therapy, therapy for learning deficits, and amnesia were reported at the first International Conference on Disability, Virtual Reality and Associated Technologies. By 1997 the National Science Foundation funded a study of rehabilitation at a distance between Rutgers and Stanford universities, located on either side of the United States. These beginnings used color-coded virtual rubber balls and haptic gloves to program the mechanical work done by the patient's affected hand. An artificial separation existed in the clinical practice between physical or occupational rehabilitation and cognitive therapy, due in part to separate education tracks. Nonetheless virtual reality researchers realized that the same hardware could be used in either physical or cognitive rehabilitation, and all that needed changing was the simulation software used. We thus coined the term “virtual rehabilitation” to encompass the continuum of therapy. In 2002 the associated conference started in Switzerland as the International Workshop on Virtual Rehabilitation. This later became the Virtual Rehabilitation International Conference series which you are attending today. While “virtual rehabilitation” was initially met with some skepticism by therapists - who were concerned patients will misunderstand it, nowadays the term is better understood. To help further recognition for this emerging field, a new society was formed in 2008, the International Society for Virtual Rehabilitation (www.isvr.org), which is a co-sponsor of this conference. The merging of physical/occupational therapy and cognitive therapy is not due solely to the modularity offered by the hardware and software used in virtual environments. Another cause is the fact that patients affected by certain neurologic and motor deficits often have psychological and other cognitive co-morbidities. A well known example is depression associated with some types of stroke or with societal isolation that often follows the inability to have regular employment. The same tele-rehabilitation systems that are projected for large scale use to train patients in their home, may also be used to reduce the sense of isolation. Video games that are now being investigated as a way to reinvigorate therapeutic interventions could also be used in future game “tournaments” among teams of people with disabilities, or among people with disabilities and their families and friends. Virtual environments could then be used to customize the games and allow a patient to succeed, greatly boosting morale. An extreme example is the use of virtual hand avatars controlled by people with amputated arms, an application which we pioneered back in 2003. Popular awareness of and demand for virtual rehabilitation is expected to grow, which in turn will trigger changes in the way therapists are educated and accredited. A new field of study will emerge, as will the way therapists and psychologists will be recertified. Certainly the way licensing, insurance, even liability clauses follow local geography is archaic, and a more global certification program is expected to emerge. The one-to-one paradigm of therapy will also change, with one therapist performing “multiplexed” View full abstract»

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  • A new virtual environment paradigm for high functioning autism intended to help attentional disengagement in a social context Bridging the gap between relevance theory and executive dysfunction

    Page(s): 51 - 58
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    This article presents a review of the question regarding the link between social communication difficulties and altered executive functions (which are cognitive functions involved in the control of behavior, such as planning, inhibition, working memory etc) in high functioning autism. We first analyze the difficulties experienced by people with high functioning autism in processing contextual cues during social conversations. We extend this approach to a broader scope including verbal and non-verbal communication. Indeed, understanding social interactions requires integrating and connecting transient multimodal social cues. The article then focuses on the alterations reported in high functioning autism concerning the ability to process facial expressions during an ongoing conversation. This ability involves attentional resources that are discussed in light of the executive dysfunction attributed to autism. On this basis, we hypothesize that the difficulties in appreciating the synergy between facial expressions and speech could be linked to impairments in shifting attention from one to the other. A new experimental paradigm designed for testing this hypothesis is presented. It relies on a virtual environment system based on eye- tracking technology enabling users to control the visual display via their gaze. The intent behind this apparatus is to compensate for the deficits in shifting attention attributed to autism. We finally describe the procedure devised for testing this new virtual environment paradigm and conclude on its potential therapeutic use. View full abstract»

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  • Virtual reality in rehabilitation of attention deficit / hyperactivity disorder The instrument construction principles

    Page(s): 59 - 64
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    Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric childhood disorders. Good clinical practices are therefore needed regarding both assessment and therapy. In which assessment is concerned, valid instruments are available, one of the last developments in the field being the virtual reality guided assessment (VirtualClassroom). Regarding intervention, the multimodal, cognitive behavioral therapy (CBT) oriented approach is the most frequently employed. However, this approach has some limitations, one of them concerning ecological validity. Our VR-based intervention addresses this issue, by providing a high ecological validity therapeutic tool. We do not propose a new therapeutic paradigm. We instead move the intervention from the clinician's office into the virtual classroom, where we still use cognitive restructuring and the behavioral techniques of the classic intervention. This paper highlights the implementation of the psychotherapeutic principles involved in ADHD therapy in the VR environment. The different features of this instrument are designed to address specific cognitive-behavioral modifications involved in the therapeutic process. View full abstract»

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  • e-Empowerment of young adults with special needs Behind the computer screen I am not disabled

    Page(s): 65 - 69
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    The Internet has opened up a range of new communication opportunities for people with special needs since it is an accessible communication medium that provides an opportunity to exchange practical information and support and to experience an accepting relationship with less prejudice. To date, few computer-mediated support intervention programs have been designed especially to support the socio-emotional needs of people with special needs. This paper presents the results of a study that evaluated an electronic mentoring intervention program designed to provide socio-emotional support for proteges with disabilities by mentors who also have disabilities. Using a qualitative research design, the study characterized the electronic mentoring process and its contributions from the mentors' point of view. The findings provided support for the potential of electronic mentoring for personal development and empowerment of young adults with special needs. View full abstract»

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  • Lessons learned towards a best practices model of virtual reality intervention for individuals with intellectual and developmental disability

    Page(s): 70 - 77
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    Individuals with intellectual and developmental disabilities (IDD) are in need of effective physical fitness training programs, leisure time opportunities and strategies to improve their participation. The overall objective was to gather ldquolessons learnedrdquo towards the formulation of a best practices model for the application of VR intervention for adults with IDD. During study 1 a group of 33 participants (mean age = 28.1 plusmn 5.3 years; moderate IDD level) underwent a 12 week program of 2-3 30 minute sessions per week consisting of game-like exercises provided by the GestureTek's IREX VR operated by an occupational therapist. During study 2 a research group (N=30; mean age = 52.3 plusmn 5.8 years; moderate IDD level) participated in a 6 week fitness program of three 30 minute sessions per week consisting of game-like exercises provided by the Sony PlayStation II EyeToy VR system. Changes in physical fitness were monitored by the Energy Expenditure Index (EEI), the modified 12 min walkrun and the Total Heart Beat Index (THBI). Results were compared to a control group (N=30, mean age = 54.3 plusmn 5.4 years). During study 3, 24 participants with severe levels of IDD (N=30; mean age = 52.3 plusmn 5.8 years; moderate IDD level) were matched for age, IDD level and functional abilities with a control group (N=30, mean age = 54.3 plusmn 5.4 years). The research group participated in an 8 week VR program (3 times per week) using GestureTek's IREX video capture technology operated by the local caregiver staff. The VR programs were found to attract full participation by the participants at moderate levels of IDD but some difficulties were found in fully engaging all individuals at severe levels of IDD. Different commercial VR systems were used and were found to be usable by health-profession students and local caregiver staff. Significant (P<0.05) improvements in physical fitness were demonstrated for the research group in comparison to the control group. VR - technology is an effective tool to engage individuals with IDD in a variety of activities by operators of different educational background and professions. VR technology could be successfully operated for adults at mild, moderate and severe levels of IDD and VR technology resulted in significant improvements in the physical fitness levels of the participants. Further research is needed to complete the construction of a ldquobest practicerdquo model. View full abstract»

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  • Ethnicity and sense of presence in a virtual environment: Arab women - A case in point

    Page(s): 78 - 82
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    Participants (99) experienced Virtual Reality Environment (VRE) exposure in a virtual airplane, and completed a presence questionnaire. Twenty seven participants avoided viewing the virtual window, and reported lower levels of presence. Significantly more window avoiders were Arab females than any other group. Thus Arab women behaved differently in the VRE, which in turn influenced their ability to experience the VRE as real and vivid. View full abstract»

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  • VirHab - A virtual reality system for treatment of chronic pain and disability

    Page(s): 83 - 86
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (576 KB) |  | HTML iconHTML  

    In recent years several lines of research have provided scientific evidence for the therapeutic value of non-invasive methods based on visual feedback and motor imagery. Clinical studies have demonstrated their potential to benefit some patient populations such as cerebrovascular accident (CVA) and complex regional pain syndrome (CRPS). This type of intervention appears appropriate for implementation using virtual reality (VR) technology which can provide the required stimuli. The present study proposes a new VR system based on a motion capture platform, and is currently targeted at treating pain and impairment of upper extremities. The system employs image processing algorithms so the patient sees himself on a screen within a virtual environment. His impaired arm, however, is replaced by a virtual arm. Thus upon making small movements of his paretic arm, he can view his image performing healthy full-range movements with the virtual arm. We hypothesize that this would facilitate plastic changes in the brain, leading to reduced pain and improved function of the impaired limb. View full abstract»

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  • PREVIRNEC: A cognitive telerehabilitation system based on Virtual Environments

    Page(s): 87 - 93
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    In this paper, we describe PREVIRNEC, a distributed system for cognitive telerehabilitation based on virtual environments. Our system allows personalized treatments by means of 2D and 3D exercises that can be built according to single patient's characteristics. Patients realize their exercises remotely. Depending on their obtained results, the system readjusts automatically the levels of difficulty of the tasks, and switches from one task to the other. The paper focuses on technological issues of the system design. We analyze its structure, components, and we discuss the decisions adopted in the interaction mode design as well as in the tasks layout. View full abstract»

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  • Breath: A game to motivate the compliance of postoperative breathing exercises

    Page(s): 94 - 97
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (416 KB) |  | HTML iconHTML  

    The use of breathing exercises post surgery can reduce pulmonary complications. Incentive spirometry is a widely used device that provides visual feedback for patients during breathing exercises. This paper describes the initial development of an interaction device, game design and initial playtesting and usability of a game to motivate patients to perform post operative breathing exercises. View full abstract»

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  • Modeling the dynamics of the recovery process in robot therapy

    Page(s): 98 - 104
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (323 KB) |  | HTML iconHTML  

    The mechanisms of action of physical assistance in promoting motor recovery after stroke are poorly understood. To explicitly model this process might help understanding what determines recovery, and how to make it faster and more effective. Linear dynamical models are used to describe the dynamics of sensorimotor adaptation, and could be extended to characterize the process of recovery of motor functions in impaired subjects while they move with the assistance of a therapist, or a robot. To test the feasibility of this approach, here we focus on a robot therapy experiment which involves a hitting task. Nine chronic stroke survivors underwent 8 to 10 rehabilitation sessions. We used a linear dynamical model to describe the trial-by-trial dynamics of the recovery process, with robot-generated assistance as input and subject's motor performance as output. In all subjects, the model correctly reproduced the overall evolution of performance over sessions. A comparison of the estimated model parameters with the clinical scales (Fugl-Meyer arm portion and Ashworth) and their modifications indicated that the time constant of the recovery process is predictive of the retention of the recovery (assessed after three months from completion of the protocol). Moreover, we found that in subjects with little or no spasticity, recovery is mediated by motor error. In contrast, in subjects with high spasticity, recovery is more influenced by performance. Although preliminary, these results suggest that modeling the recovery process with dynamical models is feasible, and could serve as basis to devise dasiaoptimalpsila strategies for regulating assistance with the aim of maximizing recovery. View full abstract»

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  • Proximodistal gradient in the perception of delayed stiffness

    Page(s): 105 - 110
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (420 KB) |  | HTML iconHTML  

    Introduction of successful telerehabilitation into the variety of techniques that are available to the therapist will forever change the field of rehabilitation. Accurate perception of the remote environment's mechanical properties and of stiffness in particular is extremely important for successful telerehabilitation. In the current study we present the framework for exploring perception of delayed stiffness when probing is executed using movement with different joints, and provide experimental results supporting the existence of proximodistal gradient in the perception of delayed stiffness. We found that delayed stiffness was underestimated to a larger extent after probing with wrist than with elbow. We suggest that the observed gradient in perception reveals a proximodistal gradient in control: proximal joints are dominated by force control, whereas distal joints are dominated by position control. View full abstract»

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  • Use of the Wii Fit system for the treatment of balance problems in the elderly: A feasibility study

    Page(s): 111 - 116
    Save to Project icon | Request Permissions | Click to expandQuick Abstract | PDF file iconPDF (291 KB) |  | HTML iconHTML  

    This paper is a report of the feasibility and outcome of using a low-cost, commercially available gaming system - Wii Fit - for balance training after stroke. The patient was an 86 year-old woman five weeks after stroke, who was unable to walk without close supervision, even with a walker, due to poor balance and a tendency to fall. In addition to standard physical therapy, the patient participated in four training sessions with the Wii Fit system; each training session included four different games. The outcome measures were Berg Balance Scale (BBS), the Functional Reach and Lateral Reach tests, Timed Up & Go test (TUG), computerized posturography, and the Short Feedback Questionnaire (SFQ). The tests were done before the intervention and on the last day of training. The SFQ was done during the third training session. The patient greatly enjoyed the training sessions and felt that she was receiving very dasiaup-to-datepsila treatment. She did not experience any discomfort such as nausea or dizziness while using the system. Following combined Wii and standard treatment, the patient demonstrated improved antero-posterior symmetry of stance, and there was a 10 second improvement in her TUG score. When released from hospital, she was able to walk with a walker with minimal supervision. This initial pilot study indicates that the Wii Fit gaming system has the potential to be used in clinical settings in order to improve balance. A full clinical trial is necessary in order to examine this premise. View full abstract»

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