ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2019 October;55(5):542-50

DOI: 10.23736/S1973-9087.19.05598-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial

Jen-Wen HUNG ^{1, 2} ✉, Chiung-Xia CHOU ¹, Yao-Jen CHANG ³, Ching-Yi WU ^{4, 5, 6}, Ku-Chou CHANG ^{7, 8}, Wen-Chi WU ¹, Stephen HOWELL ⁹

¹ Department of Rehabilitation, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; ² School of Physical Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ³ Department of Electronic Engineering, Chung Yuan Christian University, Chung-Li, Taiwan; ⁴ Department of Occupational Therapy, Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ⁵ Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; ⁶ Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan; ⁷ Division of Cerebrovascular Diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; ⁸ Department of Neurology, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ⁹ SMARTlab, University College Dublin, Dublin, Ireland

BACKGROUND: Virtual reality and interactive video games could decrease the demands on the time of the therapists. However, the cost of a virtual reality system and the requirement for technical support limits the availability of these systems. Commercial exergames are not specifically designed for therapeutic use, most patients with hemiplegic stroke are either too weak to play the games or develop undesirable compensatory movements.
AIM: To develop Kinect2Scratch games and compare the effects of training with therapist-based training on upper extremity (UE) function of patients with chronic stroke.
DESIGN: A randomized controlled single-blinded trial.
SETTING: An outpatient rehabilitation clinic of a tertiary hospital.
POPULATION: Thirty-three patients with chronic hemiplegic stroke.
METHODS: We developed 8 Kinect2Scratch games. The participants were randomly assigned to either a Kinect2Scratch game group or a therapist-based training group. The training comprised 24 sessions of 30 minutes over 12 weeks. The primary outcome measure was the Fugl-Meyer UE scale and the secondary outcome measures were the Wolf Motor Function Test and Motor Activity Log. Patients were assessed at baseline, after intervention, and at the 3-month follow-up. We used the Pittsburgh participation scale (PPS) to assess the participation level of patients at each training session and an accelerometer to assess the activity counts of the affected UE of patients was used at the 12th and 24th training sessions.
RESULTS: Seventeen patients were assigned to the Kinect2Scratch group and 16 were assigned to the therapist-based training group. There were no differences between the two groups for any of the outcome measures postintervention and at the 3-month follow-up (all P>0.05). The level of participation was higher in the Kinect2Scratch group than in the therapist-based training group (PPS 5.25 vs. 5.00, P=0.112). The total activity counts of the affected UE was significantly higher in the Kinect2Scratch group than in the therapist-based training group (P<0.001).
CONCLUSIONS: Kinect2Scratch game training was feasible, with effects similar to those of therapist-based training on UE function of patients with chronic stroke.
CLINICAL REHABILITATION IMPACT: Kinect2Scratch games are low-cost and easily set-up games, which may serve as a complementary strategy to conventional therapy to decrease therapists’ work load.

KEY WORDS: Stroke; Upper extremity; Video games; Rehabilitation