title: Clinical feasibility of interactive motion-controlled games for stroke rehabilitation.
abstract: BACKGROUND
  Active gaming technologies, including the Nintendo Wii and Xbox Kinect, have become increasingly popular for use in stroke rehabilitation. However, these systems are not specifically designed for this purpose and have limitations. The aim of this study was to investigate the feasibility of using a suite of motion-controlled games in individuals with stroke undergoing rehabilitation.
  
  
  METHODS
  Four games, which utilised a depth-sensing camera (PrimeSense), were developed and tested. The games could be played in a seated or standing position. Three games were controlled by movement of the torso and one by upper limb movement. Phase 1 involved consecutive recruitment of 40 individuals with stroke who were able to sit unsupported. Participants were randomly assigned to trial one game during a single session. Sixteen individuals from Phase 1 were recruited to Phase 2. These participants were randomly assigned to an intervention or control group. Intervention participants performed an additional eight sessions over four weeks using all four game activities. Feasibility was assessed by examining recruitment, adherence, acceptability and safety in both phases of the study.
  
  
  RESULTS
  Forty individuals (mean age 63 years) completed Phase 1, with an average session time of 34 min. The majority of Phase 1 participants reported the session to be enjoyable (93 %), helpful (80 %) and something they would like to include in their therapy (88 %). Sixteen individuals (mean age 61 years) took part in Phase 2, with an average of seven 26-min sessions over four weeks. Reported acceptability was high for the intervention group and improvements over time were seen in several functional outcome measures. There were no serious adverse safety events reported in either phase of the study; however, a number of participants reported minor increases in pain.
  
  
  CONCLUSIONS
  A post-stroke intervention using interactive motion-controlled games shows promise as a feasible and potentially effective treatment approach. This paper presents important recommendations for future game development and research to further explore long-term adherence, acceptability, safety and efficacy.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ( ACTRN12613000220763 ).
authors.affiliation: Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia. kelly.bower@acu.edu.au.|The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia. kelly.bower@acu.edu.au.|Australian Catholic University, School of Exercise Science, Melbourne, VIC, Australia. kelly.bower@acu.edu.au.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Bower
authors.affiliation: Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia. julie.louie@mh.org.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Louie
authors.affiliation: Current Circus, Melbourne, VIC, Australia. yossi@currentcircus.com.
authors.forename: Yoseph
authors.initials: Y
authors.lastname: Landesrocha
authors.affiliation: Current Circus, Melbourne, VIC, Australia. paul@currentcircus.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Seedy
authors.affiliation: Royal Melbourne Hospital, Melbourne Epicentre, Melbourne, VIC, Australia. alexandra.gorelik@mh.org.au.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gorelik
authors.affiliation: The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia. julie.bernhardt@florey.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Bernhardt
mesh_terms: D000368:Aged; D005221:Fatigue / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D010146:Pain / Q000209:etiology; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D061214:Patient Safety; D004856:Postural Balance; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D060726:Torso / Q000503:physiopathology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology; D018910:Video Games