Gaming Technology in Neurological Rehabilitation

Introduction

This wiki will look at the use of consoles and other technological formats in physiotherapy for the rehabilitation in neurological patients.

Audience
The resource was produced for use by Band 6 physiotherapists may be of benefit to other health professionals seeking background knowledge.

Learning Outcomes

1. Provide the therapist with information that explains the rationale behind game based rehabilitation (Explain why gaming therapy is good)
2. Introduction and integration of technology into neurological rehabilitation to enhance self management and enable patients to independently continue home based therapy (Explain how games enhance rehab)
3. Provide analysis and critically evaluate the evidence available for current technology currently available
4. Provide an evaluation of the robustness of current research and technology within the realm of gaming therapy
5. The learner will have available to them the real world availability and application of current technology
6. Professionals making an informed decision on what console/games to use

Introduction to Neurological Rehabilitation

This section will give a brief outline of a number of neurological disorders that will be mentioned in this wiki.

Stroke

Definition/Description
“A clinical syndrome characterised by a rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that is vascular origin” (Hatano 1976, p. 541)
There are two types of stroke; ischemic and hemorrhagic stroke. The most common type of stroke is an ischemic stroke. It is caused by a blockage of a blood vessel in the brain. In hemorrhagic strokes, a burst blood vessel causes the stroke.

Signs and Symptoms
Symptoms associated with stroke differentiate based on where the hemorrhage or block has occurred in the brain. A stroke on the left side of the brain affects the right side of the body and vice versa for a right sided stroke.
Some of the most common symptoms are hemiparesis/hemiplegia (body part depends on where the stroke is in the brain), altered sensations, slurred speech, aphasia, dysphagia, ataxia, visual field defects, neglect, dyspraxia, memory and personality issues, altered tone, pain (neuro lecture reference).

Table 3.1: Perceptual deficits in CNS dysfunction

Left hemiparesis: right hemisphere—general spatial-global deficits Visual-perceptual deficits Hand-eye coordination Figure-ground discrimination Spatial relationships Position in space Form constancy Behavioural and intellectual deficits Poor judgement, unrealistic behaviour Denial of disability Inability to abstract Rigidity of thought Disturbances in body image and body scheme Impairment of ability to self-correct Difficulty retaining information Distortion of time concepts Tendency to see the whole and not individual steps Affect lability Feelings of persecution Irritability, confusion Distraction by verbalization Short attention span Appearance of lethargy Fluctuation in performance disturbances in relative size and distance of objects

Right hemiparesis: left hemisphere—general language and temporal ordering deficits Apraxia Motor Ideational Behavioural and intellectual deficits Difficulty initiating tasks Sequencing deficits Processing delays Directionality deficits Low frustration levels Verbal and manual perseveration Rapid performance of movement or activity Compulsive behaviour Extreme distractibility

(Umphred pp. 870)

Rehabilitation

The majority of the recovery occurs in the first 3 months and tends to decrease significantly after 6 months post-stroke. Repetition and specificity of exercises has been shown to be the most effective for recovery. The aim of physiotherapy is to restore function and re-educate the body to move in a functional manner. For the rehabilitation of a stroke patient; “more is better” therefore it’s up to the patient to do their exercises as time with a physiotherapist is limited. Most stroke rehabilitation interventions involve an impairment-based strategy to re-educate movement and allow appropriate compensatory actions. These interventions may include strengthening of the muscles that link movements between the trunk and the extremities as well as promotion of functional movements in relation to the link between the trunk and extremities.