Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle.
OBJECTIVE
Hemiparesis resulting in functional limitation of an upper extremity is common among stroke survivors. Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for stroke rehabilitation.


METHODS
In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or "Jenga") among those receiving standard rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at 4 weeks after intervention.


RESULTS
Overall, 22 of 110 (20%) of screened patients were randomized. The mean age (range) was 61.3 (41 to 83) years. Two participants dropped out after a training session. The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm. The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group (P=0.75). There were no serious adverse events in any group. Relative to the recreational therapy group, participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds (Wolf Motor Function Test, 7.4 seconds; 95% CI, -14.5, -0.2) after adjustment for age, baseline functional status (Wolf Motor Function Test), and stroke severity.


CONCLUSIONS
VRWii gaming technology represents a safe, feasible, and potentially effective alternative to facilitate rehabilitation therapy and promote motor recovery after stroke.
Division of Neurology, Departments of Medicine and Health Policy Management and Evaluation and Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Dalla Lana, School of Public Health, University of Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Gustavo
G
Saposnik
Robert
R
Teasell
Muhammad
M
Mamdani
Judith
J
Hall
William
W
McIlroy
Donna
D
Cheung
Kevin E
KE
Thorpe
Leonardo G
LG
Cohen
Mark
M
Bayley
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D010865:Pilot Projects; D020127:Recovery of Function / Q000502:physiology*; D057173:Recreation Therapy / Q000295:instrumentation* / Q000379:methods; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014584:User-Computer Interface; D018910:Video Games / Q000523:psychology