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Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis

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Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis

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https://bmcneurol.biomedcentral.com/track/pdf/10.1186/s12883-017-0888-0?site=bmcneurol.biomedcentral.com

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Two hundred twenty four adults with chronic hemiparesis post-stroke  will be recruited at four sites. Participants are randomized to one of four study groups。
(1) traditional clinic-based CI therapy
(2) therapist-as-consultant video game CI therapy
(3)  In-home gaming CI therapy + online therapist consultation
(4) standard upper extremity rehabilitation

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https://padlet.com/oranich_vim/y495ye2ebfn1

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A Single Bout of High-Intensity Interval Training Improves Motor Skill Retention in Individuals With Stroke

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A Single Bout of High-Intensity Interval Training Improves Motor Skill Retention in Individuals With Stroke

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https://www.ncbi.nlm.nih.gov/pubmed/28691645
http://journals.sagepub.com/doi/full/10.1177/1545968317718269

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Effects of exercise on brain activity during walking in older adults: a randomized controlled trial

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Effects of exercise on brain activity during walking in older adults: a randomized controlled trial

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450147/

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Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke.

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Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke.

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https://www.ncbi.nlm.nih.gov/pubmed/28784593

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24 elderly women (75–83 years old)

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1.Type of subject
2.Treatment(please specify intensity for the exercise)
3.Result of the treatment

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->  Twenty-two patients with chronic strokes who haven't upper limb musculoskeletal or neurological conditions (MoCA >= 20)

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Effect of Wii-Based Balance Training on Corticomotor Excitability Post Stroke

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Effect of Wii-Based Balance Training on Corticomotor Excitability Post Stroke

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https://www.ncbi.nlm.nih.gov/pubmed/25425118

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90-min sessions focused on aerobic exercise, muscle strength training, and postural balance retraining. Each supervised session involved six participants and began with 10 min of warm-up and stretching exercises followed by 20 min of strength training exercises. For the final 60 min, the subjects engaged in circuit training in which they completed individually prescribed muscle exercises, gait retraining, stair climbing and descending, postural control training, realignment of standing posture, and aerobic exercise using a bicycle ergometer.

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Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.

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Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.

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https://www.ncbi.nlm.nih.gov/pubmed/23589097/

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Patients with Alzheimer disease (AD).

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The 3 trial arms included
1. Group-based exercise
: Physical exercise for the GE group was provided during 4-hour visits to day care centers twice a week for 12 months.

2. Tailored home-based exercise
: The HE group performed physical exercise for 1 hour twice a week for 12 months.

3. Control group (CG)
: Receiving the usual community care.

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1.initial physical and cognitive evaluation
2.แบ่งTreatmentออกเป็น 3 sessions
- 1st session : all patients performed a maximal, symptom-limited GXT to assess their VO2peak
- 2nd session : they were randomly allocated (1:1) into either an exercise or nonexercise (control) group. The exercise group performed 15 minutes of HIIT and the control group simply rested for the same period. Twenty-four hours later
< HIIT = warmup2 min(25%GXT)
high int. 3 min(100%GXT)
cool down 2 min(25%GXT)
by 80 steps/min "bicycle" ทำ 2 set พัก 1 min>
- 3rd session : all patients underwent a test of the motor task to assess skill retention. Participants were instructed not to engage in moderate- or high-intensity physical activity during the 24 hours prior to the second and third sessions.

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1) The intervention group showed a significantly greater step length in the right foot after 3 months of physical activity , The FDG-PET assessment revealed a significant post-intervention increase in regional glucose metabolism in the left posterior entorhinal cortex, left superior temporal gyrus, and right superior temporopolar area
2)  The control group showed a relative increase in regional glucose metabolism in the left premotor and supplemental motor areas, left and right somatosensory association cortex, and right primary visual cortex

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Treatment(please specify intensity for the exercise)

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Treatment(please specify intensity for the exercise)

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1) traditional clinic-based CI therapy
：  Massed motor practice with shaping occurs for 3 h each treatment day on 10 treatment days within a 3- week period

2) therapist-as-consultant video game CI therapy
: Participants agree to play the game for 15 h over three weeks (ten treatment days; approximately 1.5 h of game play daily)

(3)  In-home gaming CI therapy + online therapist consultation
: treatment same the group2 with the addition of supplemental videoconferencing with therapists. Group 3 participants receive video consultation sessions on the 6 treatment days that in-person therapist consultation does not occur (to equate the number of therapist consultation sessions between Group 1 and Group 3). The first video consultation session (day 2) is 1 h in length and each subsequent video consultation session (days 4, 6, 7, 9, 10) is 20 min.
(4) standard upper extremity rehabilitation
:25 min of evaluation,50 min of neuromuscular reeducation, 100 min of functional training, 70 min of progressive strengthening,and 55 min of teaching/reviewing home programming over the course of 4 sessions

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participate
- intervention 20
- control group 19
(1) mild-to-moderate upper-limbs hemiparesis secondary to a first-ever stroke (>12 months post-stroke)
(2) age between 45 and 85 years old,
(3) absence of any major cognitive impairment (Mini-Mental State Evaluation, MMSE>22)
(4) previous experience with RGS in the clinic.

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divide in 2 group
1 control gr. do normal OT intervention
2 Experiment group. do the VR based therapy
Both group will evaluate with Navigated Brain Stimulation (NBS) before and after experiment.
-time of experiment :5 weekly days, for 3 consecutive weeks.

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10individuals (6 men and 4 women) who suffered ischemic stroke with residual hemiparetic gait. The subjects had to be at least 6 months poststroke

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Description of Training detail :

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60 minutes/day

3 times/week

3 weeks

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-  All patients participating in the study were able to put the gloves on with assistance, and autonomously set-up and use the system until finishing the game.

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7 people need aids, while 3 people able to manage themselves.

We present evidence that training with the Nintendo Wii Fit has the potential to modulate corticomotorexcitability post stroke, thereby enhancing motor learning as well as facilitating neural changes needed to achieve maximum functional recovery. In addition, the Wii Fit also positively inﬂuenced functional outcomes such as dynamic balance and balance conﬁdence. Because of its ability to modulate neural plasticity, we propose that Wii Fit training could serve as a movement priming adjuvant to rehabilitation.

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The predetermined exercise program consisted of endurance, balance, and strength training, as well as exercises for improving executive functioning.

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- The performance of a maximal graded exercise test triggers only modest neuroplastic changes in patients with chronic stroke. However, a single bout of high-intensity interval training performed immediately after motor practice improves skill retention, which could potentially accelerate motor recovery in these individuals.
- The results also indicate that one intense bout of cardiovascular exercise (GXT) reduces the interhemispheric imbalances in GABAA-mediated excitability which are common after stroke

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Hypotheses
We hypothesize that Groups 1–3 will not differ in response to treatment and that this response will be superior to that of Group 4 on both the MAL and the WMFT. We also anticipate that Groups 1–3 will show better retention of treatment gains than Group 4.

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1. Long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects.
2. All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group.

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Week 3 and 12