Video games in stroke rehabilitation
Published in February 2010 issue of "Stroke Matters" (Stroke Association)

James Burke, PhD Candidate in Game Development for Post-stroke Rehabilitation, University of Ulster.

In recent years, researchers have started looking at the potential benefits of using video games in stroke rehabilitation.

Technology and games can offer a novel, safe and customisable training environment which can maintain engagement levels and boost patient motivation. Systems typically comprise rehabilitation gaming software with an input device (e.g. joystick, motion-sensing camera, data-gloves, electromagnetic sensors), an output device (e.g. monitor, projector, head-mounted display) and a computer. In addition to custom-built systems, commercial gaming consoles such as the Nintendo Wii have also been used in stroke rehabilitation studies.

The games used in these systems emphasise repetitive movements similar to those performed in traditional therapy, such as reach, grasp, manipulation and release for upper-limb rehabilitation. These games are often simple and easy to play. This is important since a person with stroke may not have played a video game before or may have cognitive impairments. Well-designed games are also easily configured, allowing people with varying degrees of impaired movements to engage effectively in the rehabilitation process.

Good game design allows repetitive movements to be presented in a more challenging and rewarding way than is possible with traditional therapy. For example, reach actions could translate to a game where players are required to touch one target object (of many objects) on the screen. To introduce an aspect of challenge the target object could be 'active' for only a few seconds before a new target is selected. One of the advantages of this approach is that all the game elements can be programmed to change. For example, the size of the objects and the length of time they stay 'active' can be changed to accommodate a variety of player abilities.

These systems are not designed with the intention of replacing traditional therapy; rather they are designed to be used in addition to therapy. Therapists will still be required to assess patients and perhaps recommend particular games. Therapist involvement to monitor progress and set new challenges will also be necessary. Should such systems be available in hospital stroke units, for example, It might be possible that newly diagnosed stroke patients can engage in useful and stimulating therapy when their therapists are working with other patients. There is also great interest in evaluating the technology for home use as this could lead to patients being able to play rehabilitation games outside of their therapy sessions.

The cost of systems varies depending on the technology used. Expensive systems such as those which use virtual reality technology can cost over £10,000 and may only be suitable in a clinical setting. However, emphasis is increasingly being placed on creating viable home rehabilitation by using off-the-shelf technology such as low-cost webcams or haptic joysticks.

Although large studies looking at the effectiveness of such technology solutions have yet to be carried out in the UK, it is likely that we will see projects coming forward for health technology assessment by UK agencies in the near future.

There have been many studies investigating the use of technology in stroke rehabilitation therapy. A review of the field by Cameirao et al¹ confirms that technology can have a positive effect on stroke rehabilitation, with many studies showing improved motor function recovery. There have been few studies investigating the use of video games in stroke rehabilitation; however, feedback from initial studies has been positive – people with stroke do find these rehabilitation games enjoyable and motivational.²

References

¹ Mónica S. Cameirão, Sergi Bermúdez i Badia; Paul F. M. J. Verschure, “Virtual Reality Based Upper Extremity Rehabilitation following Stroke: a Review”, Journal of CyberTherapy & Rehabilitation, Vol 1 Issue 1, Spring 2008.

² James W. Burke, Michael D. J. McNeill, Darryl K. Charles, P. J. Morrow, Jacqui H. Crosbie, Suzanne M. McDonough, “Optimising engagement for stroke rehabilitation using serious games”, The Visual Computer, Vol 25, Issue 12, p1085-1099, December 2009.