Stroke rehab has a pretty limited playbook. Keep in mind, by the time a therapist sees the client, the brain damage has been done and it’s during the window of rapid adaptation and new neural pattern formation that they try to maximize connections in neighboring brain regions to regain maximal function.
One of the new tools in the arsenal has been the Nintendo Wii (and more recently the Kinect and other tailored devices). Now, while this tool has been an easy way to encourage patients to repeat movements over and over (compared to constrained therapy or simply repetitive movement training) and patients report it is enjoyable, is it effective?
Mouawa et al 2011 compared 10 healthy post-stroke patients with 10 age matched healthy individual. They used the Wolf Motor Function Test and the Fugl-Meyer Assessment as their outcome measures. Active and passive range of motion were recorded and patient’s logged their activities. The healthy individuals showed no statistical improvement over the weeks of 1-3 hours/day every day therapy while the stroke patients showed improvement in time on task, ability, arom and prom and reported increased ability in daily tasks.
This would indicate that a 2 week out-patient intensive protocol can be used to increase function.
Yong Joo et al, 2010 used the Wii during in-patient rehab. Patients used the Wii for 6 sessions over 2 weeks along with standard treatment. This was compared to patients who only received standard treatment. Outcome measures included the Fugl-Meyer Assessment and the Limb Motor Function test. After the 6 sessions in 2 weeks, patients displayed a small but statistically significant improvement over their non-Wii compatriots. This would tend to indicate that even during in-patient therapy, the addition of a Wii rehab based program can benefit patients.
Saposnik et al, 2010 compared 11 patients who received Wii therapy with 11 patients who received recreational therapy (cards, bingo, jenga, blocks, etc.). The rec. therapy group totaled 388 minutes while the Wii group used 364 minutes- comparable total times over the 2 months of the intervention. The therapists testing the patients pre and post were blinded as to which treatment they had received during the 2 months, thus minimizing bias. The Wolf Motor Function test, Box and Block test and Stroke Impact Scale were used as outcome measures.
When the assessor was forced to categorize the patients into one of the two groups, he was correct 9 of 16 times or 56%- which is reasonable given that a rate of 8/16 was expected (the drop from 22 is due to drop-outs). The Wii group showed a non-significant improvement in grip strength. Both groups improved in all other domains but the Wii group demonstrated twice the improvement in speed and coordination of the rec. therapy group.
At this time, it is safe to say that including Wii therapy for upper-limb rehab in post-stroke is a safe and effective modality that will complement traditional means and help the patient improve strength, coordination and movement speed.