Name: mobile game-based virtual reality program for upper extremity stroke rehabilitation
Uploaded: 2018-03-08T14:00:00
Description: Watch this Scientific Journal Video about Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation at JoVE.com

This research was supported by grant no. 06-2013-105 from the SK Telecom Research Fund. This work was supported by the Soonchunhyang University Research Fund.

The study was approved by the Seoul National University Bundang Hospital Institutional Review Board, and all participants gave written informed consent before screening.
1. Game Contents Development
NOTE: The mobile game-based upper extremity virtual reality program for patients with stroke (MoU-Rehab) consists of mobile game applications.
<ol>
	<li>Install the studio and environment for development using a programing language.</li>
	<li>Collect data on x, y and z...

<ol>
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Patients with stroke usually have disabilities related to motor impairments due to incomplete motor recovery. Such disabilities, lengthy travel time to a clinic, or socioeconomic difficulties can hinder patients&#39; access to adequate rehabilitation therapy. A ubiquitous healthcare (u-Health) program can be a good option for removing those barriers. As a part of such a u-Health program, a mobile game-based VR rehabilitation program was developed for upper limb recovery after ischemic stroke in the present study. Our fin...

Stroke is one of the most common causes of neurological impairment in adults. Recovery from impairment after a stroke is usually incomplete, and approximately 50% of patients are left with disabilities, making them dependent on others1. In particular, upper limb dysfunction makes stroke survivors dependent on others for assistance with activities of daily living (ADL)2. Regaining the lost function in the upper extremities may be more difficult to achieve than returning the normal function of ambulation to the lower extremities. Although bilateral lower extremity movement is indispensable for locomotion, patients can perform ADL with unilateral upper extremity movement. This leads to a learned non-use phenomenon of the affected limb3. This phenomenon is an obstacle to the rehabilitation of the upper extremity in stroke survivors. Therefore, a tremendous amount of research is focused on the upper limb function recovery. Studies have highlighted the importance of extensive practice and repetitive task-specific training4,5,6.
Virtual reality (VR) technology has recently been introduced into the field of rehabilitation7. VR allows users to interact with a simulated environment and receive continuous, immediate feedback related to performance. VR has the potential to apply basic concepts of neurorehabilitation in stroke patients, such as intensive, repetitive, and task-oriented training8. Specifically, non-immersive VR does not require high-level graphics performance or special hardware. Therefore, non-immersive VR is a good candidate for providing a low-cost, ubiquitous, and interesting treatment program. Previous studies used computers, monitors, and special devices, such as consoles, sensor gloves, joy-sticks, and commercial gaming systems for non-immersive VR9. Higher start-up costs and sufficient space were mandatory for using such systems. Recently, low-cost tools, such as commercial gaming devices, have been utilized to develop new rehabilitation systems10,11. However, the consoles with sensors in those devicesare not sufficiently small and lightweight for carrying. Nevertheless, to improve the popularity of non-immersive VR as a post-stroke upper extremity treatment method and to create a ubiquitous rehabilitation environment for stroke survivors, portable and inexpensive tools are needed.
Furthermore, game-based therapy can be a good option for stroke rehabilitation. Many patients complain that conventional occupational therapy (OT) for upper limb function recovery is boring and monotonous12,13. A more interesting and motivating tool for the therapy is, therefore, necessary to promote patients&#39; engagement in rehabilitation training. Many studies that involve the use of commercial games have been conducted14,15,16. However, the games used do not target the desired movement of the upper extremity in patients with stroke, and they lack special consideration for the spasticity that may be present after a stroke.
This paper describes the development of a mobile game-based VR program and its use for patients who have experienced a stroke and suffer from upper limb dysfunction (Figure 1).

<table>
	<tbody>
		<tr>
			<td>Galaxy Note 10.0</td>
			<td>Samsung</td>
			<td>Galaxy Note 10.0</td>
			<td>Tablet PC</td>
		</tr>
		<tr>
			<td>Galaxy S2</td>
			<td>Samsung</td>
			<td>Galaxy S2</td>
			<td>Smartphone</td>
		</tr>
		<tr>
			<td>Bluetooth</td>
			<td>Bluetooth SIG</td>
			<td>Bluetooth</td>
			<td>short-distance wireless connection&#160;</td>
		</tr>
		<tr>
			<td>Java</td>
			<td>Oracle</td>
			<td>Java</td>
			<td>programming language</td>
		</tr>
	</tbody>
</table>

mobile game-based virtual reality program for upper extremity stroke rehabilitation

Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. Virtual reality (VR) has the potential to satisfy these requirements. Game-based therapy can promote patients&#39; engagement in rehabilitation therapy as a more interesting and a motivating tool. Mobile devices such as smartphones and tablet PCs can provide personalized home-based therapy with interactive communication between patients and clinicians. In this study, a mobile VR upper extremity rehabilitation program using game applications was developed. The findings from the study show that the mobile game-based VR program effectively promotes upper extremity recovery in patients with stroke. In addition, patients completed two weeks of treatment using the program without adverse effects and were generally satisfied with the program. This mobile game-based VR upper extremity rehabilitation program can substitute for some parts of the conventional therapy that are delivered one-on-one by an occupational therapist. This time-efficient, easy to implement, and clinically effective program would be a good candidate tool for tele-rehabilitation for upper extremity recovery in patients with stroke. Patients and therapists can collaborate remotely through these e-health rehabilitation programs while reducing economic and social costs.

A total of 24 patients were enrolled and assigned to either the control or the experimental group (Table 1). A greater improvement in the FMA-UE, B-stage, and manual muscle testing was found after treatment with the mobile game-based VR upper extremity rehabilitation program than with conventional therapy (Figure 3). The effect was maintained until the one-month follow-up. This means MoU-Rehab was not inferior to the conventional therapy that...

Watch this Scientific Journal Video about Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation at JoVE.com

Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation

Here, we present a protocol to develop and apply a mobile game-based virtual reality program for the recovery of upper limb dysfunction in patients with stroke. The present study shows that the mobile program is feasible and effectively promotes upper limb recovery in stroke patients.

Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. Virtual reality (VR) has the potential to satisfy these requirements. ...

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