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Rehab reprieve: games add a little fun to recovery Add to ...

While Jean-Guy Thibault was in a Montreal rehabilitation hospital in 2008 after a massive stroke, he made a promise to his occupational therapist: "One day, I'm going to have a beer on Saint Catherine Street and watch the girls go by."

It seemed like a long shot at the time: He couldn't walk, sit or even hold a pint.

The 66-year-old underwent intensive rehab for eight months, but his left arm was still paralyzed by the time he was sent home to continue his recovery on his own.

Then, about two months ago, he participated in a clinical trial for an emerging field of therapy: video-game rehab.

In recent years, researchers around the world have been investigating the potential of virtual reality to help victims of stroke and other brain injuries. While it can't replace work with a physical therapist, it is still effective and far cheaper. But most importantly, because it's entertaining, patients are more likely to do the same exercises over and over again, which is crucial for recovery.

The trial Mr. Thibault participated in - which included 60 patients in Montreal and Ottawa - was led by Mindy Levin, a professor in the School of Physical and Occupational Therapy at McGill University. Last week, she told the Canadian Stroke Congress about the potential for 3-D video games (as opposed to traditional exercises) to help stroke victims regain the use of their arms and legs.

"In order to change the brain, in order to drive the best kind of plasticity in the brain, you need to do a lot of repetition," Dr. Levin says.

Many patients lose the use of one arm after a stroke and, instead of doing exercises to regain the use of it, simply switch to using their other arm, she says.

During the five-week intervention, Mr. Thibault spent three to five hours each week playing games that helped him practise everyday activities. One simulated a trip to the supermarket; with probes attached to his arm, he would reach for a bottle of pop or water on a store shelf. In another, the avid cook relearned some of the fine motor skills required to open containers, measure ingredients and chop vegetables in the kitchen.

A bonus of the program, he says, was the feedback; it was similar to having a therapist with him, correcting his form.

"If you do it yourself, you develop some bad habits and you don't even realize it," he says.

Mark Bayley, a doctor in the Toronto Rehabilitation Institute's Neuro Rehabilitation program and moderator at the neuro-rehabilitation session at the Canadian Stroke Congress, says the process of relearning to point, reach or grasp something can be tedious for stroke patients. Making the process as fun as possible reaps huge benefits.

In a study published in the July issue of Stroke: The Journal of the American Heart Association, Dr. Bayley and a team of researchers report the results of a head-to-head test of video-game therapy and traditional therapy.

Rather than using a system developed specifically for rehab (such as the one Dr. Levin used), which can cost several thousand dollars, the team used the relatively inexpensive Nintendo Wii gaming system.

Ten stroke patients used the Wii for a few weeks to improve their upper-arm function, while another 10 did traditional recreational therapy (games such as bingo or Jenga). After the intervention, patients who used the Wii were able to perform tasks that used their arms seven seconds faster than the other group.

"Just having that variety of different tools you can use again that are adapted to the level of the individual and to their own personal interest is where the field needs to go," Dr. Bayley says.

The Wii has shortcomings, however. A patient must already have the use of his thumbs to use the controller. Arthur Prochazka, a neuroscience professor at the University of Alberta in Edmonton who has researched video-game therapy for stroke patients for about six years, says the Wii also isn't great for mimicking real-life activities because there's little weight and resistance in the wand.

A better model, Dr. Prochazka says, is his ReJoyce, a joystick with various attachments to be used with gaming software. He and his research partner Jan Kowalczewski developed it specifically for stroke patients, and it has been used by hundreds of patients at rehab hospitals in North America, Australia and New Zealand.

In a matching game, the player assumes the role of cupid and pairs up woodland creatures. In a bartending game, players refine their motor skills by repeatedly reaching for bottles off a shelf, opening them, pouring drinks and releasing glasses.

"They're specifically geared to trick the individual into having a fun experience while performing the repetitive tasks of daily life," Dr. Kowalczewski says.

Like the program Dr. Levin used, the ReJoyce system also offers feedback that is cheaper - and potentially more accurate - than a therapist's.

"Clinical assessments ... are quite qualitative. Here, the device is measuring what the people can do," Dr. Prochazka says.

Mr. Thibault says he was impressed by how quickly his skills improved after the gaming treatment. In his first run of 72 exercises, he had a total score of 2 per cent accuracy. By the end of the therapy, his score was 80 per cent.

"[Before] I used to drop everything. I didn't have a sense of where my arm was," he says. "Now I can hold the [beer bottle]and use my right hand to open and unscrew the top."

 

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