Background: Stroke is one of the largest causes of disability worldwide usually resulting in hemiplegia; however, there is no defined post-stroke protocol. Many stroke patients continue to experience motor deficits of the upper and lower extremity after discharge from hospital care and therapy which can affect the quality of life. Current literature and clinical guidelines suggest the patient should undergo intensive, repetitive, task-specific activities within the first 6 months of discharge to regain motor function. Current therapeutic resources are inadequate worldwide. Recent studies have demonstrated off the shelf virtual reality interventions, such as the Nintendo Wii, may be an effective alternative to conventional therapy. The primary aim of this literature review addresses whether virtual reality therapy using the Nintendo Wii post-stroke could effectively improve static balance, functional balance, walking mobility, body symmetry, walking speed, and independence in activities of daily in conjunction with conventional therapy in patients post-stroke with lower extremity hemiparesis. The secondary aim was to evaluate the feasibility and safety of Nintendo Wii therapy.
Methods: An exhaustive literature search of available medical literature was performed using MEDLINE-Ovid, MEDLINE- PubMed, Cochrane, EMBASE, EBSCO Host, Web of Science, CINAHL, and EBM Review Multifile. Keywords used included: Wii, Nintendo Wii, stroke, post-stroke, lower extremity, balance training, and virtual reality. Relevant articles were assessed for quality using GRADE.
Results: Twenty-four articles were found and reviewed for relevancy. Three studies fit the inclusion criteria and were included in this systematic review. All studies were randomized, single blind, controlled trials. Two studies were performed in an inpatient setting examining 30 and 50 subacute stroke patients, respectively. Both studies demonstrated a statistically significant improvement in functional balance and motor outcomes when using Wii therapy in addition to conventional therapy than that of conventional therapy alone. The third study was performed in an outpatient setting examining 20 chronic stroke patients. There was no intergroup statistically significant differences; however, the Wii therapy in addition to conventional therapy had greater outcomes than that of conventional therapy alone. Patients enjoyed the experience with preference for Nintendo Wii therapy over conventional therapy. They demonstrated greater motivation, learning, and interest in comparison with the control group.
Conclusion: Virtual Reality Nintendo Wii therapy is an efficacious adjunct to conventional therapy for patients post-stoke for increasing motor function and activities of daily living. Greatest benefits have been demonstrated in patients in the subacute phase. It should be strongly considered in clinical practice due to efficacy, feasibility, safety, and affordability as shown in small studies. It is imperative that more research be performed with a larger sample size to determine if these effects can be generalized. Longer study periods and follow-up are also needed to evaluate long-term efficacy and acceptability.
Keywords: Wii, Nintendo Wii, stroke, post-stroke, lower extremity, balance training, virtual reality
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