More hospitals are making use of virtual reality games to complement conventional therapy for patients
Many helping hands are needed to get stroke patients on the road to recovery. And some of them are coming from tertiary students or engineers working with hospitals to design computer games that patients can practise on to regain their movement. A handful of projects are on the boil to cook up solutions for rehabilitation that are inexpensive, useful and fun. For instance, stroke patients often have upper arm weakness that can be strengthened by exercise that moves the arms sideways. So some Temasek Polytechnic information technology students wrote a program for the Kinect, that requires patients to move a spaceship from side to side on a screen to avoid being hit by asteroids.
The Kinect is a motion-sensing device for the Microsoft Xbox 360 video game console. The students approached five rehabilitation centres earlier this year to see if they could design software to help patients with similar needs. They even tweaked the game so the spaceship would not respond if patients moved their bodies or legs instead of their arms to manoeuvre it. The project took top prize in a competition and the students plan to hold clinical trials with hospitals this year to test the program out. It is just the beginning but rehab doctors and therapists see potential in harnessing the technology of user-controlled consoles for therapeutic purposes.
Singapore Polytechnic students have also worked with hospitals such as the National University Hospital (NUH) and KK Women’s and Children’s Hospital (KKH) to develop therapeutic game software. With NUH, the poly students customised a Nintendo Wii game to incorporate useful arm movements for stroke patients – such as flipping burger patties on a barbecue grill – to improve their hand and wrist movements. The Wii is a motion-sensing device which comes with a controller. The Singapore General Hospital (SGH) is also working with an engineering company to develop a software which will train stroke patients to use their affected arm to pick up fruit in a virtual supermarket. They do this while they are standing, to also train their balance and endurance.
To a layman, using computer games for rehab might sound frivolous, but therapists say there are many advantages in using them for therapy. Unlike traditional computer games played with a mouse, these motion-sensing consoles require players to move their bodies to mimic real-life movements. There are few side effects to playing the games and they bring an element of entertainment, which has an impact on compliance and recovery rates. Indeed, the fun and appeal of such games in rehabilitation cannot be ignored, said the authors of a study by Tan Tock Seng Hospital (TTSH) published in the Journal Of Rehabilitation Medicine last year. The study found that patients who used a combination of the Wii and conventional therapy appeared to recover faster, but the finding was limited in that the authors were not able to compare these patients with those on conventional therapy alone. What was significant was how stroke patients had an “overwhelming positive” experience from the use of the Wii, with about 75 per cent, or 12 out of 16, finding the Wii to be subjectively as useful as, if not better, than conventional rehabilitation. Almost 88 per cent wanted to continue using the Wii as part of their rehabilitation.
These findings were all the more impressive as most of the patients had never played a computer game before, said the authors. The main side effect of the virtual games? Temporary muscle soreness – no worse than that from conventional therapy, said Mr Donald Xu Tong, one of the study authors and a senior occupational therapist from TTSH. Even before the software could be customised, hospitals had been using commercial games to help patients with stroke or other neurological movement disorders. SGH uses a webcam-based program called Ovogame, while Changi General Hospital and TTSH use the Wii or Kinect. As the games are fun and interactive, patients find it easy to concentrate on them, said Dr Karen Chua, a senior consultant from TTSH rehabilitation centre. They can also receive immediate feedback on their progress. The consoles are also relatively cheap, with the Wii costing about $200 and the Kinect about $229.
The Ovogame is just $20. The hospitals stressed that such games complement, and do not replace, conventional therapy. There are certain movements that cannot be translated completely from the virtual world to the real one, said Ms Natalie Chew, a senior principal occupational therapist from SGH. For example, a patient who has used virtual games to practise finger movements may not necessarily know how to do up buttons. To learn that, he needs to practise on real buttons, she said. Studies on the use of virtual games for physiotherapy so far have been small and lack long-term follow-up, according to a review of 19 trials involving 565 stroke patients published by the non-profit Cochrane Collaboration. But therapists believe it is only a matter of time before it is accepted.
Ms Ong Ghim Hui, a senior physiotherapist from KKH, feels the limited evidence on the efficacy of virtual games in rehabilitation so far could be due to their recent introduction. The hospital has been using Wii for its paediatric patients with balance and body awareness problems only since 2009. Said Ms Ong: “Wii adds variety to the children’s therapy sessions. It encourages them to pay attention and comply with therapy.” The only thing that one needs to be aware of is the fact that frequent and intensive gaming can lead to repetitive strain-induced injuries such as “Wii-shoulder or Wii-elbow”. However, for one 44-year-old patient who is recovering from a brain haemorrhage, these concerns are far from her mind. She said: “I have never liked to exercise. Without these games, I wouldn’t have found my therapy sessions so positive.”