Counting repetitions: an observational study of video game play in people with chronic poststroke hemiparesis.

BACKGROUND AND PURPOSE: The use of video gaming as a therapeutic intervention has increased in popularity; however, the number of repetitions in comparison with traditional therapy methods has yet to be investigated. The primary purpose of this study was to document and compare the number of repetitions performed while playing 1 of 2 video gaming systems for a time frame similar to that of a traditional therapy session in individuals with chronic stroke. METHODS: Twelve participants with chronic stroke (mean age, 66.8 ± 8.2 years; time poststroke, 19.2 ± 15.4 months) completed video game play sessions, using either the Nintendo Wii or the Playstation 2 EyeToy. A total of 203 sessions were captured on video record; of these, 50 sessions for each gaming system were randomly selected for analysis. For each selected record, active upper and lower extremity repetitions were counted for a 36-minute segment of the recorded session. RESULTS: The Playstation 2 EyeToy group produced an average of 302.5 (228.1) upper extremity active movements and 189.3 (98.3) weight shifts, significantly higher than the Nintendo Wii group, which produced an average of 61.9 (65.7) upper extremity active movements and 109.7 (78.5) weight shifts. No significant differences were found in steps and other lower extremity active movements between the 2 systems. DISCUSSION AND CONCLUSIONS: The Playstation 2 EyeToy group produced more upper extremity active movements and weight shifting movements than the Nintendo Wii group; the number and type of repetitions varied across games. Active gaming (specifically Playstation 2 EyeToy) provided more upper extremity repetitions than those reported in the literature by using traditional therapy, suggesting that it may be a modality to promote increased active movements in individuals poststroke.

Participants' perspectives on the feasibility of a novel, intensive, task-specific intervention for individuals with chronic stroke: a qualitative analysis.

BACKGROUND: Evidence-based practice promotes patient-centered care, yet the majority of rehabilitative research fails to take patient perspectives into consideration. Qualitative research provides a unique opportunity for patients to express opinions and provide valuable insight on intervention processes. OBJECTIVE: The purpose of this study was to assess the feasibility of a novel, intensive, task-specific intervention from the patient's perspective. DESIGN: A phenomenological approach to qualitative inquiry was used. METHODS: Eight individuals with chronic stroke participated in an intensive intervention, 3 hours per day for 10 consecutive days. Participants were interviewed twice regarding their impressions of the therapy, and a focus group was conducted with participants and family members. Data analysis included an analytical thematic approach. RESULTS: Five major themes arose related to the feasibility of the intervention: (1) a manageable amount of fatigue; (2) a difficult, yet doable, level of intensity; (3) a disappointingly short therapy duration; (4) enjoyment of the intervention; and (5) muscle soreness. CONCLUSIONS: The findings suggest that participants perceived this novel and intensive, task-specific intervention as a feasible therapeutic option for individuals with chronic stroke. Despite the fatigue and muscle soreness associated with intensive rehabilitation, participants frequently reported enjoying the therapy and stated disappointment with the short duration (10 days). Future research should include a feasibility trial of longer duration, as well as a qualitative analysis of the benefits associated with the intervention.

Feasibility of intensive mobility training to improve gait, balance, and mobility in persons with chronic neurological conditions: a case series.

BACKGROUND AND PURPOSE: Intensive mobility training (IMT) is a rehabilitative approach aimed at improving gait, balance, and mobility through the incorporation of task-specific, massed practice. The purpose of this case series was to examine the feasibility and benefits of the IMT protocol across a sample of 4 individuals with diverse chronic neurological diagnoses, including incomplete spinal cord injury, Parkinson's disease, stroke, and cerebral hemispherectomy. METHODS: The 4 participants enrolled in the IMT protocol and followed an intensive treatment schedule of 3 h/d sessions for 10 consecutive weekdays totaling 30 hours. Each session allocated 1 hour each to (1) body weight-supported treadmill-based locomotor training, (2) balance interventions, and (3) activities to improve coordination, strength, and range of motion. Interventions emphasized repetitive, task-specific training of lower-extremity movements in a massed practice schedule. Pain, fatigue, and time in activity were used to assess feasibility of the treatment. Temporal-spatial gait parameters, Berg Balance Scale, Dynamic Gait Index, Timed Up and Go test, and 6-Minute Walk test were used to assess changes in performance. RESULTS: Participants were able to complete an average of 144 of 180 minutes of activity per day for 10 days. Participants demonstrated modest improvements after the intervention on at least one outcome measure for each target area of gait, mobility, and balance. Some improvements were maintained for 1 to 6 months after participation. DISCUSSION: Despite differences in diagnosis among these participants with chronic neurological disorders, on average they were able to complete 80% of an intensive treatment schedule of 3 hours/day for 10 days with no adverse effects. It appears that some gains made during participation are maintained for a period of time after the end of training. IMT is a feasible intervention incorporating an intensive training approach to improve gait, balance, and mobility; however, a randomized trial is needed to further investigate the effects of the intervention.

An intensive intervention for improving gait, balance, and mobility in individuals with chronic incomplete spinal cord injury: a pilot study of activity tolerance and benefits.

OBJECTIVE: To determine the tolerance to and benefits of an intensive mobility training (IMT) approach for individuals with incomplete spinal cord injury (ISCI). DESIGN: Prospective pretest-posttest study with 6-month follow-up. SETTING: University research laboratory. PARTICIPANTS: A volunteer sample of individuals with ISCI (N=15; >6 mo postinjury and able to walk at least 3.05 m with or without assistance). Follow-up data were collected for 10 of the participants. INTERVENTIONS: Participants received IMT for 3h/d for 10 weekdays, participating in activities that encouraged repetitive, task-specific training of their lower extremities in a massed practice schedule. MAIN OUTCOME MEASURES: Amount of time spent in therapeutic activities and rest was used to assess participants' tolerance to the intervention. Treatment outcomes were assessed pretest, posttest, and 6 months after the intervention and included the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), 6-minute walk test, gait speed, and Spinal Cord Injury Functional Ambulation Inventory. RESULTS: Individuals in the higher functioning ISCI group (BBS score ≥45 and gait speed ≥0.6 m/s) spent more time in the intensive therapy on average than individuals in the lower functioning ISCI group. Effect sizes were comparable for changes in balance and mobility assessments between the lower and higher functioning groups, with the largest effect sizes observed for the DGI. CONCLUSIONS: This dosage of IMT may be a more appropriate treatment approach for higher functioning ISCI individuals, as they were better able to tolerate the length of the session and demonstrated higher effect sizes postintervention.

Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older.

BACKGROUND: Falls and fall-related injuries are a major public health concern, a financial challenge for health care providers, and critical issues for older adults. Poor balance and limited mobility are major risk factors for falls. OBJECTIVE: The purpose of this study was to examine effects of Feldenkrais exercises in improving balance, mobility, and balance confidence in older adults. METHODS: Participants (N = 47, mean age 75.6) were randomly assigned to a Feldenkrais group (FG, n = 25) or to a control group (CG, n = 22). The FG group attended a 5-week Feldenkrais program, 60 minutes three times per week, while the CG group was a waitlist control. The outcome measures were balance (tandem stance), mobility (Timed Up and Go), gait characteristics (GAITRite Walkway System), balance confidence (Balance Confidence Scale; ABC), and fear of falling (Falls Efficacy Scale). Pre- and post-tests were conducted. RESULTS: After completion of the program, balance (p = 0.030) and mobility (p = 0.042) increased while fear of falling (p = 0.042) decreased significantly for the FG group. No other significant changes were observed. However, participants of the FG group showed improvements in balance confidence (p = 0.054) and mobility while performing concurrently a cognitive task (p = 0.067). CONCLUSIONS: These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility, and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults. A long-term follow-up study of balance and mobility is warranted. Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes.

Are measures employed in the assessment of balance useful for detecting differences among groups that vary by age and disease state?

PURPOSE: This study explored the usefulness of measures commonly employed in the examination of persons with balance impairment to discriminate between performances of young and older adults and older adults with and without neurological disease. METHODS: Eighteen young adults, 22 healthy older adults, 12 individuals with Parkinson disease, and 20 older adults with peripheral neuropathy were recruited from the community.Performances on the following measures were compared: Mini Mental State Exam, grip strength, timed chair rise, semitandem and tandem stance, Timed Up and Go (TUG), and Berg Balance Scale (BBS). Survival analysis was used to analyze semitandem and tandem stance. Grip strength and other tests were analyzed using analysis of variance. Tukey multiple comparison procedure was employed to assess differences in performance among groups. RESULTS: Significant differences in performance were found for all measures. Grip and timed chair rise discriminated young and older adult groups. Timed chair rise, tandem stance, TUG, and BBS detected differences between healthy individuals and those with disease. Semitandem stance and BBS discriminated between individuals with disease conditions. CONCLUSIONS: When examining individuals with balance difficulty, combinations of measures are needed to discriminate between clinically distinct groups.