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  • Systematic Review: Commercial Video Games Likely a Good Option for Rehab

    While researchers and designers continue to work on advanced video games and hardware intended specifically for rehabilitation, a new systematic review says that there's sufficient research to support the idea that off-the-shelf games available on commercial gaming systems are useful as an adjunct to more traditional rehab approaches.

    Researchers writing in the International Journal of Rehabilitation Research (abstract only available for free) described findings from their analysis of 126 research articles published between 2008 and 2015, all of which focused on the use of commercially available gaming systems (VGs)—Nintendo Wii, Sony PlayStation, and Microsoft Xbox—as a component of rehabilitation. A total of 4,240 patients were included in the studies, which looked at VG use in connection with stroke recovery, cerebral palsy (CP), Parkinson disease (PD), balance training, problems associated with aging, and weight control.

    The most frequent use of VG in rehabilitation was for aging-related issues (28%), followed by weight control (25%), balance (22%), stroke (13%), CP (8%), and PD (4%). Patients participated in an average of 22 VG sessions, although variability was significant, ranging from an average of 16 sessions for stroke, to 94 sessions for weight control. With weight control excluded, the average dropped to 19 sessions, with a mean rate of 3 to 4 sessions per week. Studies of the Nintendo Wii system predominated at 79%, with 13% using PlayStation, and the remaining 8% focused on Xbox (and Kinect).

    Authors of the review then analyzed the studies according to each pathology. Here's what they found:

    Stroke. A total of 26 studies looked at VG and stroke. Authors write that because stroke rehabilitation requires significant amounts of repetition of movement, "VG is an interesting tool that enables patients to perform repetitive task-training," and "being immersed in games allows more motion repetitions without a decrease in motivation." Six studies found positive results for upper extremity gross motor function, 1 study found improvements in fine motor function, 3 studies cited improvements in balance, and 1 study each reported improvements in upper limb strength and grip strength.

    Cerebral palsy. Authors found that most research in the 16 studies addressing the use of VG for individuals with CP pointed to VG as a way to improve motivation and cooperation. Improvements in global gross motor function were noted in 4 studies; fine motor function was reported to improve in 2 studies; and 3 studies found positive effects associated with balance. No studies focused on strength.

    Parkinson disease. PD and VG was the subject of 10 studies, most of which focused on gait. Authors write that "significant" improvements gross motor performance—particularly gait parameters including freezing—were reported in 4 studies, with additional marked improvements in fine motor function noted in 3 studies. Five studies cited balance improvements, and 4 studies "indirectly" indicated improvements in strength.

    Aging. In the 37 studies on the use of VG for aging-related issues, the most prevalent issue reported was a higher reluctance among individuals 60 and older to use VGs, and a preference for traditional therapy exercises. Studies tended to find no significant differences between VG and control groups in improvements in gross and fine motor function, but several cited improvement in balance through VG that exceeded controls. Three studies reported improvements in strength in the VG group.

    Balance training. Results of the 25 studies related to balance control were mixed, with no clear advantage or disadvantage associated with VGs.

    Weight control. The 10 studies included in the review focused more on research related to level of physical activity associated with VGs (mostly moderate) and patient preference (balance games were preferred over aerobic games). Two studies focused on the type of game and device as it related to motivation, with patients demonstrating higher motivation (and expending more energy) while playing "cooperative" games, and lower motivation when playing "competitive" games.

    Authors of the study acknowledge that the research shows particular benefits for neurological rehabilitation, but add that "overall, results show that rehabilitation that includes VGs is at least as efficient as conventional therapy."

    "Because most patients, except some elderly patients, like VGs and prefer them to traditional exercises, VGs should be integrated into treatment for various pathologies," authors write. "The results of this review showed that integration of VGs in [physical rehabilitation] programs is efficient, despite the fact that none of these games were designed for clinical purposes."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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