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Playing video games while recovering after a stroke appears to promote arm strength and function, Canadian researchers find.
"Stroke rehabilitation is rapidly evolving. Novel approaches - including the use of virtual reality [gaming] systems - may help improve motor impairment, activities and social participation," said lead researcher Dr Gustavo Saposnik, director of the Stroke Outcomes Research Unit at St. Michael's Hospital at the University of Toronto.
"Virtual reality may provide an affordable, enjoyable and effective alternative to intensify treatment and promote motor recovery after stroke," he added.
Up to 75% of stroke patients experience motor problems, including weakness, paralysis or difficulty with balance and coordination that can affect their quality of life. Conventional therapy provides only "modest and sometimes delayed effects" in treating these disorders, according to Saposnik.
The new study findings are published in the journal Stroke.
Stroke patients studied
To find out whether video games could play a role in stroke rehabilitation, Saposnik's team performed what is called a meta-analysis. In this type of study, investigators search the published literature to find studies related to the theory they are interested in testing. They then pull data from these studies and pool the results to come up with a conclusion.
In this case, they found 12 studies that included a total of 195 patients, aged 26 to 88 years, who had suffered a mild to moderate stroke. Each study reported the effects of electronic games on upper arm strength and function.
Of these studies, seven were observational and five were randomised trials. Observational studies are those in which researchers observe behaviour but without trying to influence behaviour or the outcome - such as comparing smokers with nonsmokers.
Randomised trials are ones where similar patients are randomly assigned to a certain treatment group - such as playing video games - while others are assigned to a different kind of group. These trials look for a specific outcome over a certain period of time.
Among stroke patients in observational studies, those playing virtual reality games improved their upper arm strength by 14.7% and motor function - or the ability to perform standard tasks - by 20%.
Those in the randomised trials who played virtual reality games had a 4.89 times greater chance of improving arm strength, compared with those did not play these games but had standard rehabilitation, the researchers found.
Stroke patients and video games
Treatment varied in each study, however, most patients played 20 to 30 hours over four to six weeks of therapy, the authors noted. The systems used included three traditional video game systems (Glasstron, IREX, PlayStation Eye Toy) and nine virtual reality systems (including Virtual Teacher, CyberGlove, VR Motion, PneuGlove and Wii).
Saposnik also noted that some studies looked at video gaming used in addition to standard therapy, something he said may have skewed the results somewhat in favour of the new therapy.
Video gaming may help stroke patients because of the brain's unusual potential for remodelling, in which it creates new nerve cell connections, some studies suggest. What is needed for such remodelling, recent research indicates, is training that is challenging, repetitive, task-specific, novel and motivating - all hallmarks of virtual reality games, which can also give immediate real-time feedback.
"Our study confirms the potential benefit of virtual reality in stroke rehabilitation identified in small studies," Saposnik said. "Further larger randomised trials are needed before changing practise. However, we are [going] in the right direction," he added.
Findings promising for further research
Commenting on the study, Dr Ralph L. Sacco, president of the American Heart Association and chair of neurology at the University of Miami Miller School of Medicine, said, "This is provocative information that should move us toward larger randomised trials to evaluate the impact of virtual reality in stroke rehab."
Sacco added that many stroke patients don't get into rehab programmes and might benefit from "innovative outpatient rehab approaches."
However, he is cautious about recommending virtual reality games as part of rehabilitation based on the meta-analysis.
"It's still premature today to have patients go out and buy virtual reality video games to improve motor function," Sacco said. "The message is still that continued rehabilitation exercises on your own still help months, even years, after a stroke."
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