Designing a Double-Blind Clinical Trial to Compare the Effects of Nintendo Wii on Ankle Spasticity in Subjects with Stroke

Document Type : Original Articles

Authors
Ehsan Ghasemi 1
Narges Yousefi 2
1 Assistant Professor, Musculoskeletal Research Center AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 MSc Student, Musculoskeletal Research Center AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jrrs.v15i4.3432
Abstract
Introduction: Spasticity is one of the well-known consequences of stroke. Todays, virtual reality systems are known as a standard therapy method in neurologic disorders such as stroke. Nintendo Wii is a motion-controlled game system which provides an alternative form of repetitive task training in an interactive enriched environment. Despite the direct relationship between the motor pattern and spasticity, former studies have not considered the effect of spasticity on balance and movement of patients experiencing a stroke. Given the above-mentioned issues, this study seeks to evaluate the effect of Nintendo Wii on ankle spasticity in patients with a stroke.Materials and Methods: This study was a double-blind randomized controlled trial. Based on the inclusion and exclusion criteria, the subjects selected were randomly divided into the two standard therapy and standard therapy plus Nintento Wii groups. Modified Ashworth scale (MAS), H-Reflex latency, Hmax/Mmax Ratio, Timed Up and Go (TUG) test, and 36-Item Short Form Health Survey questionnaire (SF-36) as outcome measures were assessed by a blinded physiotherapist and a neurologist at the beginning of the first session and at the end of the last session. Standard therapy included weight bearing, stretching, and active exercises. In addition to the standard therapy, the trial group received 30 minutes of Nintendo Wii game. the data analysis was conducted by SPSS software. T-test and paired t-test were used for the normal data distribution and Mann-Whitney U test and Wilcoxon test for the abnormal data distribution.Conclusion: This study sought to introduce a new and cost-effective treatment tools which can be used at home to improve function among the stroke survivors.

Keywords

  1. Sommerfeld DK, Eek EUB, Svensson A, Holmqvist LW, von Arbin MH. Spasticity after stroke. Stroke 2004; 35(1): 134-9.
  2. Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke 2016; 11(4): 459-84.
  3. Kuo CL, Hu GC. Post-stroke spasticity: A Review of epidemiology, pathophysiology, and treatments. Int J Gerontol 2018; 12(4): 280-4.
  4. Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Baghban AA, et al. The effect of functional stretching exercises on functional outcomes in spastic stroke patients: A randomized controlled clinical trial. J Bodyw Mov Ther 2018; 22(4): 1004-12.
  5. Cheok G, Tan D, Low A, Hewitt J. Is Nintendo Wii an effective intervention for individuals with stroke? A systematic review and meta-analysis. J Am Med Dir Assoc 2015; 16(11): 923-32.
  6. Ghotbi N, Nakhostin AN, Naghdi S, Hasson S. Measurement of lower-limb muscle spasticity: Intrarater reliability of Modified Modified Ashworth Scale. J Rehabil Res Dev 2011; 48(1): 83-8.
  7. Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: A pilot study. Appl Neuropsychol 2010; 17(3): 190-5.
  8. Chung EJ, Kim JH, Lee BH. The effects of core stabilization exercise on dynamic balance and gait function in stroke patients. J Phys Ther Sci 2013; 25(7): 803-6.
  9. Shin JW, Don KK. The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position. J Phys Ther Sci 2016; 28(1): 194-7.
  10. Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Akbarzadeh BA, et al. The effect of functional stretching exercises on neural and mechanical properties of the spastic medial gastrocnemius muscle in patients with chronic stroke: A randomized controlled trial. J Stroke Cerebrovasc Dis 2018; 27(7): 1733-42.
  11. Salter K, Campbell N, Richardson M, Mehta S, Jutai J, Zettler L, et al. Outcome measures in stroke rehabilitation. Evidence Reviews. 2013.
  12. Bakheit AM, Maynard V, Shaw S. The effects of isotonic and isokinetic muscle stretch on the excitability of the spinal alpha motor neurones in patients with muscle spasticity. Eur J Neurol 2005; 12(9): 719-24.
  13. Faria CD, Teixeira-Salmela LF, Silva EB, Nadeau S. Expanded timed up and go test with subjects with stroke: Reliability and comparisons with matched healthy controls. Arch Phys Med Rehabil 2012; 93(6): 1034-8.
  14. McDowell I, Newell C. Measuring Health: A guide to rating scales and questionnaires. 2nd ed. Oxford, UK: Oxford University Press; 1996.
  15. Zheng H, Cao N, Yin Y, Feng W. Stroke recovery and rehabilitation in 2016: A year in review of basic science and clinical science. Stroke Vasc Neurol 2017; 2(4): 222-9.
Journal of Research in Rehabilitation Sciences
Volume 15, Issue 4 - Serial Number 4
September 2019
Pages 184-189