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Background: Post spinal cord injury (SCI), sitting balance is considered a prerequisite for the effective performance of activities of daily living. Virtual Reality Training (VRT) may provide an interactive medium of rehabilitation, preventing a reduction in active participation of the patients while allowing for the training of sitting balance.Aim: The aim of this study was to evaluate the effect of the addition of VRT to conventional therapy in improving sitting balance in persons with SCI.Subjects and Methods: This was a single blinded randomized control trial conducted on 21 subjects with SCI (level of injury: D10 or below). They were randomly allocated into two groups; both groups received their routine exercise program. In addition, the intervention group, that is, Group B (n = 11) received 30 min of VRT in the seated position using Xbox-Kinect, while the conventional therapy group, that is, Group A (n = 10) received 30 min of additional conventional therapy to equalize the duration of the intervention (3 days/week, 4 weeks). The modified functional reach test and T-shirt test were measured at the beginning and at the end of 4 weeks.Results: MFRT changes for forward (Group A: 1.7 ± 1.09 cm; Group B: 4.83 ± 2.95 cm), right lateral (Group A: 2.43 ± 2.81 cm, Group B: 5.08 ± 1.85 cm), left lateral (Group A: 3.05 ± 4.65 cm, Group B: 6.19 ± 1.51 cm) were statistically significant for Group B (P < 0.05). No significant difference was observed between the two groups for T-shirt test (P > 0.05).Conclusion: VRT can be used as a part of a comprehensive rehabilitation program to improve sitting balance post-SCI. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Virtual reality programs, which have developed rapidly with the advancement of technology, have led to the development of alternative treatment methods preferred in rehabilitation. This study aimed to investigate the acute effects of a video game-based exercise program applied after breast cancer surgery on the upper extremity functionality, pain severity, and the level of fatigue. METHODS: Fifteen female patients aged between 30 and 60 years (50.13±8.79) who completed their 12th week after breast cancer surgery and were received adjuvant chemotherapy treatment were randomly included in this pre-test and post-test study. The patients were performed a 30-min video game-based exercise program. The muscle strength, range of motion (ROM), pain and fatigue level assessments were performed before and after the video game-based exercises. The level of exercise pleasure was determined with the modified visual analog scale. RESULTS: Shoulder flexion, abduction, and external rotation ROM significantly increased after video game-based exercise program. No difference was detected for shoulder abduction muscle strength (p>0.05) and pain level significantly increased (p<0.05). The average exercise pleasure level is 4.5/5 and the average fatigue level was 11.13/20. CONCLUSION: Video game-based exercises provided improvement in ROM of the shoulder joint without causing fatigue. Studies with different treatment durations are needed to minimize the increase in pain level. [ABSTRACT FROM AUTHOR]

Background/aims: Outpatient physical therapy is the mainstay of treatment in shoulder instability, but lack of motivation and intermittent monitoring of progress is associated with poor compliance. 'Exergames' (a combination of videogames and physical exercise) may provide an additional or alternative motivational factor. The aim of this study was to determine the applicability of the Medical Interactive Recovery Assistant Xbox Kinect gaming software in the management of adolescent atraumatic shoulder instability. Methods: Patients completed six 30-minute sessions playing games using the Medical Interactive Recovery Assistant while participating in a therapy programme. Pain and fatigue questionnaires, functional assessments and a framework analysis of free-text comments were used. Results: A total of 20 female patients (15 unilateral, five bilateral pathology, mean age 14.1 years) completed the sessions. An average session length was 10.8 mins (range 0–24 mins). After each session using the Medical Interactive Recovery Assistant, 80% were neither in pain, nor overly tired. At 2 weeks, the Stanmore Percentage of Normal Shoulder Assessment scores had improved by a mean 17.9% and 10 (50%) patients showed improvements in Oxford Shoulder Instability Scores. Overall, 15 participants (75%) liked the technology; however six (32%) preferred standard physiotherapy, because of software limitations and lack of personal interaction. Conclusions: Medical Interactive Recovery Assistant gamification is applicable for this patient cohort and could be integrated into adolescent atraumatic shoulder instability rehabilitation programmes; however, results emphasise the importance of personal contact. [ABSTRACT FROM AUTHOR]

Background and Objective: Postural defects are increased among students due to inactivity. Their unwillingness to perform traditional activities, requires finding appropriate ways to increase physical activity. This study was done to compare the effect of selected Xbox Kinect games and normal on the posture in low activity students. Methods: In this quasi-experimental study, 26 sedentary fourth and fifth grade students were non-randomly divided into two groups. During the 6-week period, one group engaged in 3 sessions per week of selected Xbox Kinect games and the other group engaged in routine school physical education activities during school hours. The photogrammetry and Kinovea software was used to study the posture of the joint angles. Results: In static posture, head position angle, thoracic arrow, horizontal scapula alignment, horizontal pelvic alignment, and body alignment were found positive effect in Xbox Kinect group in compared to normal physical activity (P<0.05). There was not any significant difference between the two groups in Lumbar Arrow, Lumbar Angle, pelvic Tilt Pelvis, Knee Position, Quadriceps Angle and Foot Pronation. Conclusion: Xbox Kinect games are a good way to correct postural deviations in sedentary students in low activity student. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement.Methods: Forty women with breast cancer who had undergone unilateral mastectomy with axillary lymph node dissection and who were receiving adjuvant therapy were included in the study and randomly assigned to two groups: the Kinect-based rehabilitation group (KBRG) and the standardized physical therapy group (SPTG). The KBRG (n = 20) received VR therapy using Xbox Kinect-based games and the SPTG (n = 20) received standard physiotherapy. Study subjects were assessed at baseline and after the 6-week treatment. Outcome measures were pain (visual analogue scale), grip strength (dynamometer), functionality (disabilities of the arm shoulder and hand questionnaire), muscle strength (handheld dynamometer), ROM (digital goniometer), and fear of movement (Tampa kinesiophobia scale (TKS)).Results: Both groups detected significant changes in pain, ROM, muscle strength, grip strength, functionality, and TKS scores after the treatment (p < 0.01). Fear of movement was significantly improved in the KBRG and the SPTG displayed more improvement in functionality (p < 0.05). There were no differences in ROM, muscle strength, grip strength, and pain between the groups after the treatment (p > 0.05).Conclusion: Kinect-based VR therapy resulted in significant outcomes that were comparable to those obtained under standard physiotherapy in the early postoperative phase in patients who had undergone breast cancer surgery.Trial Registration: This study is registered at ClinicalTrials.gov ( ClinicalTrials.gov identifier: NCT03618433). [ABSTRACT FROM AUTHOR]

Engaging in enjoyable activities is an essential part of well-being, but people with dementia can find participation increasingly difficult. Motion-based technologies can provide meaningful engagement in a wide range of activities, but for people with dementia to take advantage of these devices requires a good understanding of how best to select and present these activities to this population. The objective of this study was to explore the use of motion-based technology (Xbox Kinect) as a group activity for people with dementia who attend adult day programmes. This qualitative study took place in an adult day programme for older adults with age-related challenges. Participants (n = 23) were observed while playing a digital bowling game presented on Xbox Kinect one hour per week for a period of 20 weeks, to capture naturalistic data. Field notes generated through observations were transcribed and analysed to identify emerging themes. The findings revealed three predominant themes which illustrate the potential of motion-based technology as a group activity for people with dementia who attend adult day programmes: (a) the importance of having a trained trainer, (b) learning versus mastery and (c) playing 'independently together'. People with dementia can learn to play games presented on motion-based technology and enjoy doing so. Furthermore, using the technology in a group setting fostered an encouraging and supportive environment which further contributed to the leisure experience. However, to be used most effectively, staff must be trained to set-up and interact with the technology, as well as introduce, teach and support people with dementia to use it. [ABSTRACT FROM AUTHOR]

Various recreational activities have been identified as effective interventions to improve balance in individuals with compromised gait, balance, and a history of falls. This investigation explored the effectiveness of Tai chi, fitness boxing, and the Xbox Kinect on the balance of one participant with multiple sclerosis (MS). An 11-week program was implemented with each intervention scheduled for a 3-week duration. The participant's balance was assessed prior to and at the conclusion of each intervention using the Multidirectional Reach test, Vestibular subtest of the Fullerton, and the Sensory Interaction in Balance test. The participant began each session with a warm up involving stretching and ended with a cool down of lap walking. The 2-min step test was used to measure progress toward improving endurance. Results suggest that the greatest improvement in balance occurred following the implementation of the both Tai chi and Xbox Kinect. Some improvement with endurance was additionally noted in the results of the 2-min step test. As a case study, this investigation cannot provide conclusive results that one intervention is preferred over another. However, our findings provide emerging evidence that balance can potentially be improved through the use of Tai chi, the Xbox Kinect, and fitness boxing. [ABSTRACT FROM AUTHOR]

This study investigated changes in motor and cognitive skills, anxiety levels, and quality of life perception among patients with Parkinson's Disease (PD) following training with different commercial gaming devices—Nintendo Wii™ and Xbox Kinect™. We used a quasi-experimental, simple blinded clinical trial, dividing 27 patients with PD into three equal groups of nine members: (a) Nintendo Wii™, (b) Xbox Kinect™, and (c) control group. After pretests, experimental group participants spent 10 sessions playing four games of the selected gaming device, while control group participants received no intervention. Only those engaged with the Nintendo Wii™ significantly improved their performance on single and dual task gait tests, decreased anxiety levels, and improved memory, attention, and reversibility. The control group showed no changes on any measures. [ABSTRACT FROM AUTHOR]

PURPOSE: The present study investigated the effects of virtual reality (VR) training using the Xbox Kinect on motor function, balance, gait, and functional mobility in children with cerebral palsy (CP). METHOD: This was a case series. Four children with spastic diplegic cerebral palsy were provided VR training using the Xbox Kinect for 12 sessions (three sessions per week for 4 weeks). At baseline and follow-up, physical function was measured using the following: Selective Motor Control (SMC) for motor function, Pediatric Balance Scale (PBS) for balance, Timed Up and Go (TUG) test and Functional Mobility Scale (FMS) for functional mobility, and 6-meter walk test (6WT) for gait. RESULTS: As compared with the baseline scores, SMC, PBS, TUG, FMS, and 6MWT scores after training showed improvements. In participant 1, PBS and TUG scores improved after VR training. In participant 2, SMC (left ankle dorsiflexor, left knee extensor), PBS, TUG, and FMS scores improved after training. In participant 3, SMC (left hip flexor), TUG, FMS, and 6MWT scores improved after training. In participant 4, SMC (right ankle dorsiflexor), PBS, TUG, FMS, and 6MWT scores improved after training. CONCLUSION: The results show that VR training using the Xbox Kinect may improve physical functioning in children with spastic diplegic cerebral palsy. However, its utility in the rehabilitation of children with CP requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Parkinson’s disease (PD) commonly impairs posture, gait, and cognition. Exercise in the form of aerobic activity as well as exergaming may improve motor ability and cognition in persons with PD. Exergaming and treadmill training can be a practical form of exercise within the home; however, there is minimal research on this combined multimodal intervention for persons with PD.Objective: We investigated the effects of this combined intervention on cognition, balance, and gait in a person with PD through supervised lab sessions augmented by home-based sessions. Methods: This case study utilized an ABA single subject experimental design with 4 weeks of pre-intervention, followed by 8 weeks of intervention, and 4 weeks of post-intervention. The intervention consisted of treadmill walking and Xbox Kinect exergaming, 30 minutes each, performed unsupervised at home and at supervised lab sessions. The two standard deviation band method was used to determine significance.Results: MiniBEST test, 2-minute walk distance, sway area, endurance test, and a few parameters of gait initiation and gait improved significantly throughout the intervention period. Only a few measures sustained the improvement 4 weeks after completion of intervention.Conclusion: Eight weeks of treadmill and exergaming intervention with a person with PD improved static and dynamic postural control measures, but not gait, cognition, endurance, and clinical measures of balance. Longer and more intense multimodal intervention may be warranted. [ABSTRACT FROM PUBLISHER]

Background: Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. Methods: A single system experimental design (n = 1) was utilized, which included baseline, intervention and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT) and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE) and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT) and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. Results: Dynamic balance, characterized by the DGI, increased during the intervention phase x2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction x2 (1, N = 12) = 5.6, p = .02 and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = < .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. Conclusions: Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this report is to describe an intervention using the Xbox Kinect virtual gaming system to improve gait, postural control and cognitive awareness in order to reduce falls and improve the quality of life for an individual with Progressive Supranuclear Palsy. Methods: A 65-year-old woman with a five-year history of PSP and frequent falls presented for physical therapy. Her case was complicated by poor ability to visually track objects, axial rigidity, retropulsion, poor postural control with reaching and declines in cognitive awareness. Intervention was provided using the Xbox Kinect for 12 one-hour sessions over six weeks in an outpatient setting. Games were selected to challenge functional motor and cognitive tasks based on patient enjoyment. Results: The Xbox Kinect intervention may have contributed to a decline in falls and maintenance of scores on the BBS, TUG and 10 Meter Walk Tests above fall risk values. A decline in quality of life measures, PDQ-39 and FFABQ, may be attributed to an increase in cognitive awareness of deficits promoted by the intervention structure. Conclusion: Implementation of a gaming intervention using the Xbox Kinect is feasible for reducing fall risk, maintaining function and improving cognitive awareness when used in an outpatient setting. Implications for Rehabilitation: Progressive Supranuclear Palsy is a rare and rapidly progressive neurodegenerative disease wherethere is a lack of long-term rehabilitation options to help slow their rapid progressions. Our case demonstrates the feasibility of an intervention using a virtual gaming system to helpmaintain functional mobility, balance and independence for an individual with PSP. Collaborative interactions between game companies and physical therapists will improve theability of virtual games to address rehabilitation goals within neurodegenerative populations. [ABSTRACT FROM AUTHOR]

Microsoft Xbox Kinect is a soft device applied into a video game: a sensor attached to a video camera detects body movement and helps to control video games through gestures, movements and voice commands. It is useful in medical and therapeutic practice developing a virtual reality custom and based on a video game, allowing the user to perform physical and cognitive rehabilitation therapies, using virtual rehabilitation exercises. Used in several Rehabilitation centres around the world, Microsoft Xbox Kinect is exploited in Romania as MIRA - “Medical Interactive Recovery Assistant”, platform for medical rehabilitation addressed to disabled children and their physiotherapists and rehabilitation physicians. The system might be also used in high-tech medical rehabilitation using virtual rehabilitation and research, with modern equipment, but and not extravagant costs. [ABSTRACT FROM AUTHOR]

Gaming technology – exergaming – is a novel tool to facilitate exercise, improve balance, and encourage rehabilitation training. This review will describe some of the key exergame research to promote physical activity and its use in rehabilitation in other diseases or clinical populations. We will then describe the current state of research in exergaming in people with multiple sclerosis and describe the theories for the mechanism behind some of the improvements in outcomes seen after using exergaming. Lastly, we will identify gaps in the literature and provide directions for future work in this growing area. The current work is contradictory and there is no consensus with regards to training duration/intensity and the outcomes used to assess the clinical effectiveness. This in part is due to the off-the-shelf nature of the games used. A more satisfactory approach would be the development of bespoke games which match a clinical need. Exergames are seen as enjoyable and could be effective in enhancing adherence to rehabilitation. However, the definitive RCT has yet to be carried out comparing exergaming to traditional exercise. [ABSTRACT FROM AUTHOR]

Purpose: Little is known of Motion-Controlled Video Games (MCVGs) as an intervention for people with chronic pain. The aim of this study was to explore the experience women with fibromyalgia syndrome (FMS) had, using commercially available MCVGs; and to investigate indicators of symptom severity and performance of activities of daily living (ADL). Method: Of 15 female participants diagnosed with FMS, 7 completed a program of five sessions with Nintendo Wii (Wii), five sessions with PlayStation 3 Move (PS3 Move) and five sessions with Microsoft Xbox Kinect (Xbox Kinect). Interviews were conducted at baseline and post-intervention and were supported by data from observation and self-reported assessment. Results: Participants experienced play with MCVGs as a way to get distraction from pain symptoms while doing fun and manageable exercise. They enjoyed the slow pace and familiarity of Wii, while some considered PS3 Move to be too fast paced. Xbox Kinect was reported as the best console for exercise. There were no indication of general improvement in symptom severity or performance of ADL. Conclusion: This study demonstrated MCVG as an effective healthcare intervention for the women with FMS who completed the program, with regards to temporary pain relief and enjoyable low impact exercise. [ABSTRACT FROM AUTHOR]

BACKGROUND: Balance impairments are common in children with acquired brain injury (ABI) and a need exists to explore motivating interventions with this population. Xbox Kinect is a gaming system that might assist therapists in providing meaningful rehabilitation. OBJECTIVE: To explore the effect of Kinect on improving balance and motivation in one child with ABI. METHODS: Using an A-B design, the participant received traditional balance therapy for five days, followed by 15 days of Kinect rehabilitation. Balance and motivation were measured daily; function measured weekly. Baseline and intervention trend lines were visually analyzed to assess changes in balance and motivation. RESULTS: Participant was unable to follow protocol; intervention was modified to use Nintendo Wii at day 14. While Kinect data showed greater improvement in balance when compared to traditional and Wii rehabilitation, Wii showed greater improvement in dynamic balance involving the body's affected side. Motivation remained high between baseline and intervention. CONCLUSIONS: Kinect may be challenging to use therapeutically early in rehabilitation for improving balance in children with ABI. However, Kinect might improve balance more than traditional or Wii rehabilitation when used with the appropriate child at the right stage of rehabilitation. Motivation results remain inconclusive. Further research is warranted. [ABSTRACT FROM AUTHOR]