Bilateral priming before Wii-based movement therapy enhances upper limb rehabilitation and its retention after stroke: a case-controlled study

Hopefully you can figure out what bilateral priming is so you can ask your therapists and doctor for it.  They've only had 7 years to understand it.

Bilateral priming before Wii-based movement therapy enhances upper limb rehabilitation and its retention after stroke: a case-controlled study

Winston Byblow
2014, Neurorehabilitation and Neural Repair
29 Views
11 Pages
1 File ▾
Cognitive Science,
Video Games,
Exercise therapy,
Activities of Daily Living,
Stroke
 ...more ▾

 

Abstract

Background.
 Motor deficits after a stroke are thought to be compounded by the development of asymmetric interhemispheric inhibition. Bilateral priming was developed to rebalance this asymmetry and thus improve therapy efficacy.
Objective.
 This study investigated the effect of bilateral priming before Wii-based Movement Therapy to improve rehabilitation after stroke.
 Methods.
 Ten patients who had suffered a stroke (age, 23-77 years; 3-123 months after stroke) underwent a 14-day program of Wii-based Movement Therapy for upper limb rehabilitation. Formal Wii-based Movement Therapy sessions were immediately preceded by 15 minutes of bilateral priming, whereby active flexion-extension of the less affected wrist drove mirror-symmetric passive movements of the more affected wrist through a custom device. Functional movement was assessed at weeks 0 (before therapy), 3 (after therapy), and 28 (follow-up) using the Wolf Motor Function Test (WMFT), upper limb Fugl-Meyer Assessment (FMA), upper limb range of motion, and Motor Activity Log (MAL). Case-matched controls were patients who had suffered a stroke who received Wii-based Movement Therapy but not bilateral priming.
Results.
 Upper limb functional ability improved for both groups on all measures tested. Post therapy improvement on the FMA for primed patients was twice that of the unprimed patients (37.3% vs 14.6%, respectively) and was significantly better maintained at 28 weeks (P = .02). Improvements on the WMFT and MAL were similar for both groups, but the pattern of change in range of motion was strikingly different.
Conclusions.
 Bilateral priming before Wii-based Movement Therapy led to a greater magnitude and retention of improvement compared to control, especially measured with the FMA. These data suggest that bilateral priming can enhance the efficacy of Wii-based Movement Therapy, particularly for patients with low motor function after a stroke.

Playing Wii Is Helping Stroke Patients Move Again

Well, well, still no protocols on this and it has been known for years.

Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the first half decade of "Wii-search" Feb 2014.  

Feasibility and Efficacy of the Nintendo Wii Gaming System to Improve Balance Performance Post-Stroke: Protocol of a Phase II Randomized Controlled Trial in an Inpatient Rehabilitation Setting March, 2013

Clinical Feasibility of Interactive Commercial Nintendo Gaming for Chronic Stroke Rehabilitation Jan. 2013 

Suitability of Nintendo Wii Balance Board for rehabilitation of standing after stroke Aug. 2012

http://www.gizmodo.com.au/2016/12/playing-wii-is-helping-stroke-patients-move-again/

Two studies from Neuroscience Research Australia using "Wii-based Movement Therapy" on stroke patients have revealed extraordinary results.
Not only does playing Wii actually restore upper limb mobility, but it also improves lower limb movement and cardiovascular health.
Both studies compared Wii-based Movement Therapy (or WMT) with modified Constraint-induced Movement Therapy (mCMIT) and found that WMT is, well, better. CMIT is currently considered best-practice in stroke rehabilitation, but the results from these studies suggest that WMT is just as effective, and at six months into the treatment show better lifestyle outcomes.
Stroke is one of the leading causes of disability in Australia, with almost 440,000 people living with the after-effects. This is predicted to increase to 709,000 in 2032. Sixty-five per cent of those living with stroke also suffer a disability that means they can't carry out daily living activities without help.
Sedentary behaviour is common after a person has suffered a stroke, with cardiovascular fitness typically around half that of healthy people of a similar age. Poor cardiovascular fitness puts them at risk of another stroke. It's actually the reason for 19 per cent of stroke readmissions.
Most post-stroke therapies focus on regaining walking ability, which is important not only for mobility but to avoid social isolation and depression associated with the loss of mobility. While WMT is specifically targeted at rehabilitating upper-limb functionality, researchers found it also improved lower limb mobility.
"Our study shows us that Wii-based therapy provides three essential benefits to stroke survivors," says neurophysiologist Dr Penelope McNulty. "After receiving this treatment their stepping as well as arm and hand movements were improved and many enjoyed the additional benefit of increased cardiovascular fitness. We were pleasantly surprised with these results."

The Wii-based therapy involved one hour sessions per day of an individually tailored program involving Wii-Sports (golf, bowling, baseball, tennis or boxing). Game activities were introduced and varied according to motor function and progress of each patient.
Participants in the mCMIT group wore a padded mitt on the less affected hand to encourage use of the more affected upper limb. Activities of mCIMT were tailored to individual deficits and were mostly performed seated.
"Our research emphasises the need to increase physical activity post-stroke. We have shown that WMT is as effective for upper limb rehabilitation as mCIMT and, crucially, it has the added benefit of having higher patient preference, so they're likely to adhere to their rehabilitation training for longer."
Researchers say that WMT can be tailored to address aerobic deconditioning that affects around 50 per cent of stroke survivors without compromising its focus on improving upper limb function. Dr McNulty believes that with few minor modifications, Wii-based Movement Therapy can be individualised to provide a carefully controlled cardiovascular rehabilitation option for stroke survivors.
"Our research highlights the importance of developing a therapy that focuses on enabling increased independence post-stroke, and that the Wii-based Movement Therapy can deliver benefits that have been overlooked by current standard therapies."

BDNF Genotype Interacts with Motor Function to Influence Rehabilitation Responsiveness Poststroke

And just when the hell is somebody going to write up a fucking stroke protocol on the use of BDNF for stroke recovery? Or is everyone in stroke a chickenshit? Not willing to publicly write up anything for survivors? This is why the complete stroke medical establishment needs to be destroyed.
http://journal.frontiersin.org/article/10.3389/fneur.2016.00069/full?utm_source=newsletter&

Christine T. Shiner^1,2, Kerrie D. Pierce¹, Angelica G. Thompson-Butel^1,2, Terry Trinh^1,2, Peter R. Schofield^1,2 and Penelope A. McNulty^1,2*

• ¹Neuroscience Research Australia, Sydney, NSW, Australia
• ²School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia

Background: Persistent motor impairment is common but highly heterogeneous poststroke. Genetic polymorphisms, including those identified on the brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) genes, may contribute to this variability by limiting the capacity for use-dependent neuroplasticity, and hence rehabilitation responsiveness.

Objective: To determine whether BDNF and APOE genotypes influence motor improvement facilitated by poststroke upper-limb rehabilitation.

Methods: BDNF-Val66Met and APOE isoform genotypes were determined using leukocyte DNA for 55 community-dwelling patients 2–123 months poststroke. All patients completed a dose-matched upper-limb rehabilitation program of either Wii-based Movement Therapy or Constraint-induced Movement Therapy. Upper-limb motor function was assessed pre- and post-therapy using a suite of functional measures.

Results: Motor function improved for all patients post-therapy, with no difference between therapy groups. In the pooled data, there was no significant effect of BDNF or APOE genotype on motor function at baseline, or following the intervention. However, a significant interaction between the level of residual motor function and BDNF genotype was identified (p = 0.029), whereby post-therapy improvement was significantly less for Met allele carriers with moderate and high, but not low motor function. There was no significant association between APOE genotype and therapy outcomes.

Conclusion: This study identified a novel interaction between the BDNF-Val66Met polymorphism, motor-function status, and the magnitude of improvement with rehabilitation in chronic stroke. This polymorphism does not preclude, but may reduce, the magnitude of motor improvement with therapy, particularly for patients with higher, but not lower residual motor function. BDNF genotype should be considered in the design and interpretation of clinical trials.

Introduction

Motor impairment is a common, disabling, and inherently heterogeneous outcome of stroke (1, 2). Patients typically present across a broad clinical continuum and undergo variable and often incomplete recovery of motor function over time and in response to targeted rehabilitation (3). Predicting poststroke prognosis and recovery potential has gained a prominent research focus, with the most common predictive factors being measures of lesion size (4, 5), location (6, 7), corticospinal tract integrity (8, 9), and initial impairment severity (10, 11). While more extensive corticospinal tract damage and more severe baseline impairment are generally associated with poorer prognosis poststroke (10–12), these factors alone cannot fully explain the degree of variability in poststroke motor outcomes and patients’ response to motor therapies (3, 13). In order to optimize rehabilitation and thus maximize poststroke recovery, a deeper understanding of the factors that mediate this residual variability is necessary.

Genetic variation may account for some of the unexplained variance in stroke recovery. In particular, single-nucleotide polymorphisms (SNPs) in genes related to cortical plasticity and neural repair could influence an individual’s capacity for use-dependent plasticity, and hence their responsiveness to poststroke rehabilitation [for review, see Ref. (14)]. Numerous genes of interest continue to emerge in the growing field of stroke genetics (14, 15). Here, we have adopted a candidate gene approach based on two genetic factors with the strongest evidence in subacute stroke and extended this investigation into the chronic setting. The candidate genes are the brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) genes (16).

The BDNF gene encodes for the neurotrophin most abundantly expressed in the brain and involved in neuronal differentiation, survival, and synaptic plasticity (17–19). Approximately 30% of the Caucasian population and a higher percentage of the Asian population possess an SNP (rs6265) in the BDNF gene, resulting in a valine to methionine substitution at codon 66, the Val66Met polymorphism (20). This polymorphism alters the intracellular trafficking and activity-dependent release of BDNF (21, 22), and in healthy cohorts has been associated with a reduced capacity for use-dependent plasticity in the motor cortex (23–26) and impaired motor learning (26).

The BDNF-66Met allele may be detrimental to recovery following stroke (14), but the evidence to date remains contentious (27). Studies have primarily focused on subacute outcomes following spontaneous recovery, where both a significant negative association between Val66Met and stroke outcome (28–31) and a modest or negligible effect have been reported (16, 32–34). There is scant evidence of whether the Val66Met polymorphism influences long-term stroke recovery or responsiveness to targeted therapies. There is some suggestion that it may alter patient responsiveness to non-invasive brain stimulation (35, 36), but to date, no significant effect of this genotype on motor therapy has been identified (13).

Single-nucleotide polymorphisms within the APOE gene are less prevalent but potentially stronger genetic mediators of poststroke recovery (16). This gene encodes for a glycoprotein primarily involved in lipid transport and metabolism, but it also plays an important role in neuronal repair and synaptic remodeling (37, 38). Two SNPs (rs429358 and rs7412) in the APOE gene give rise to three distinct APOE isoforms, ε2 (Cys¹¹²/Arg¹⁵⁸Cys), ε3 (Cys¹¹²/Arg¹⁵⁸), and ε4 (Cys¹¹²Arg/Arg¹⁵⁸) (39). The ε4 isoform is present in only 10–20% of the population (40) but has been strongly implicated in the risk for Alzheimer’s disease (41, 42) and cardiovascular pathology (40, 43). Studies of APOE ε4 in stroke have mainly focused on stroke incidence rather than outcome (43), although emerging evidence suggests that the ε4 allele may have a detrimental effect on poststroke recovery (16, 44–46). Like BDNF, it remains uncertain whether APOE genotype can influence motor function and rehabilitation outcomes more chronically poststroke (13).

Here, we investigated whether BDNF and APOE genotype influence how stroke patients with stable motor function respond to a targeted protocol of upper-limb motor therapy poststroke. Data were collected from a pooled cohort of patients who received a dose-matched protocol of either Constraint-induced Movement Therapy, the current gold standard in upper-limb stroke rehabilitation, or Wii-based Movement Therapy, recently shown to be an engaging and equally efficacious therapy alternative (47). Given that no differences were demonstrated in any measure of upper-limb motor function between these two therapies (47), we did not expect to see differences according to therapy type, but rather according to genotype. We hypothesized that all patients would make some degree of motor improvement post-therapy, although those who possessed the BDNF-66Met or APOE-ε4 alleles would have less improvement with a standardized dose of therapy.

More at link

Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the first half decade of "Wii-search"

Its been 5 years, has your therapy department done anything with the Wii yet?
http://www.jneuroengrehab.com/content/11/1/12/abstract

Daniel J Goble, Brian L Cone and Brett W Fling

Author Affiliations

For all author emails, please log on.

Journal of NeuroEngineering and Rehabilitation 2014, 11:12  doi:10.1186/1743-0003-11-12
Published: 8 February 2014

Abstract (provisional)

The Nintendo Wii Fit was released just over five years ago as a means of improving basic fitness and overall well-being. Despite this broad mission, the Wii Fit has generated specific interest in the domain of neurorehabilitation as a biobehavioral measurement and training device for balance ability. Growing interest in Wii Fit technology is likely due to the ubiquitous nature of poor balance and catastrophic falls, which are commonly seen in older adults and various disability conditions. The present review provides the first comprehensive summary of Wii Fit balance research, giving specific insight into the system's use for the assessment and training of balance. Overall, at the time of the fifth anniversary, work in the field showed that custom applications using the Wii Balance Board as a proxy for a force platform have great promise as a low cost and portable way to assess balance. On the other hand, use of Wii Fit software-based balance metrics has been far less effective in determining balance status. As an intervention tool, positive balance outcomes have typically been obtained using Wii Fit balance games, advocating their use for neurorehabilitative training. Despite this, limited sample sizes and few randomized control designs indicate that research regarding use of the Wii Fit system for balance intervention remains subject to improvement. Future work aimed at conducting studies with larger scale randomized control designs and a greater mechanistic focus is recommended to further advance the efficacy of this impactful neurorehabilitation tool.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Low-cost evaluation and real-time feedback of static and dynamic weight bearing asymmetry in patients undergoing in-patient physiotherapy rehabilitation for neurological conditions

More therapist possibilities for you to ask about.
http://www.jneuroengrehab.com/content/10/1/74/abstract

Abstract (provisional)

Background

Weight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting. The aim of this research is to determine whether commercially-available Wii Balance Boards with customized software providing real-time feedback could be used in a clinical setting to evaluate and improve weight-bearing asymmetry in people with various neurological conditions.

Methods

Twenty participants (age = 43.25 +/- 19.37 years) receiving physiotherapy as a result of a neurological condition performed three trials each of two tasks (static standing and sit-to-stand) with and without visual feedback. Vertical forces were measured using available Wii Balance Boards coupled with customized software that displayed visual feedback in real-time. Primary outcome measures included weight-bearing asymmetry as a percentage of body mass, peak force symmetry index, and a visual analogue scale score rating self-perceived level of asymmetry.

Results

Weight-bearing asymmetry during the static balance task was significantly reduced (Z = -2.912, p = 0.004, ES = 0.65) with visual feedback. There was no significant difference (Z = -0.336, p = 0.737) with visual feedback for the dynamic task, however subgroup analysis indicated that those with higher weight-bearing asymmetry responded the most to feedback. Correlation analysis revealed little or no relationship between participant perception of weight-bearing asymmetry and the results for the static or dynamic balance task (Spearman's rho: rho = 0.138, p = 0.561 and rho = 0.018, rho =0.940 respectively).

Conclusions

These findings suggest that weight-bearing asymmetry can be reduced during static tasks in patients with neurological conditions using inexpensive commercially-available Wii Balance Boards coupled with customized visual feedback software. Further research is needed to determine whether real-time visual feedback is appropriate for reducing dynamic weight-bearing asymmetry, whether improvements result in improved physical function, and how cognitive and physical impairments influence the patient's ability to respond to treatment.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Feasibility and Efficacy of the Nintendo Wii Gaming System to Improve Balance Performance Post-Stroke: Protocol of a Phase II Randomized Controlled Trial in an Inpatient Rehabilitation Setting

You have to get your doctor/therapist to get the protocol associated with this device. If they were any good they would already be following this clinical trial and be in contact with the researchers.
http://online.liebertpub.com/doi/abs/10.1089/g4h.2012.0069

ABSTRACT

Objective: Balance deficits following stroke are common and debilitating. Commercially available gaming systems, such as the Nintendo^® (Kyoto, Japan) Wii™, have been widely adopted clinically; however, there is limited evidence supporting their feasibility and efficacy for improving balance performance following stroke. The aim of this trial is to investigate the clinical feasibility and efficacy of using the Nintendo Wii gaming system as an adjunct to standard care to improve balance performance following stroke in an inpatient rehabilitation setting.
Subjects and Methods: Thirty participants undergoing inpatient stroke rehabilitation will be recruited into this Phase II, single-blind, randomized controlled trial. Participants will be allocated into a Balance or Upper Limb Group, and both groups will perform activities using the Nintendo Wii in addition to their standard care. Participants will attend three 45-minute sessions per week, for a minimum of 2 and a maximum of 4 weeks.
Results: The main focus of the study is to investigate the feasibility of the intervention protocol. This will be evaluated through recruitment, retention, adherence, acceptability, and safety. The Step Test and Functional Reach Test will be the primary efficacy outcomes. Secondary outcomes will include force platform, mobility, and upper limb measures. Assessments will occur at baseline, 2 weeks, and 4 weeks after study entry.

Discussion: To the authors' knowledge, this will be the largest randomized clinical trial to investigate the feasibility and efficacy of the Nintendo Wii gaming system for improving balance performance in a stroke population. The results will inform the design of a Phase III multicenter trial.

Clinical Feasibility of Interactive Commercial Nintendo Gaming for Chronic Stroke Rehabilitation

No self-prescribing, you know your doctor needs to ok all your therapy.
https://www.jstage.jst.go.jp/article/jpts/24/9/24_901/_article
The purpose of this study was to investigate the effect of interactive games played on a Nintendo Wii on postural control, motor function and functional independence of chronic stroke patients. [Subjects and Methods] Twenty chronic stroke patients were recruited for this study. The subjects were randomly divided into experimental and control groups. The experimental group played interactive games using the Nintendo Wii for 30 minutes a day, 3 times a week, for 3 weeks, whereas the control group did not play interactive games. Result measures included the postural assessment scale, the modified motor assessment scale and the functional independence measure. [Results] There were significant differences in the postural assessment scale and modified motor assessment scale scores of both groups after the intervention, and between the control group and the experimental group after the intervention. However, there were no significant differences in functional independence measure scores. [Conclusion] An interactive game played on a Nintendo Wii appears to be an effective intervention for improvement of chronic stroke patients’ functional results. Therefore, research into the most effective type of Wii game and the clinical significance should continue.

Full PDF here;
https://www.jstage.jst.go.jp/article/jpts/24/9/24_901/_pdf

Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: implications for stroke rehabilitation

Ask your doctor /therapist which one is better for your rehab,
These two
http://www.ncbi.nlm.nih.gov/pubmed/23172403
 or 
1. the xBox Kinect
2. Limbs Alive
3.  KineLabs making egg tart, cleaning the window panes of a tram, and even killing cockroaches
4. Rejoyce Workstation
5. Spatial Augmented Reality system
6. Augmented Reflection Technology
7. interactive game
8. REO Therapy and an Auditory Sensor Feedback
9. Haptic-Rehab
10. a virtual system that incorporates music with visuals
11. Nintendo Wii Fit Plus
12. Neurorehabilitation Training Toolkit (NTT)
13. distributed Virtual Reality
14. 3D immersive videogame
15. Open-source version of Curictus VRS commercial stroke rehabilitation product
Your doctor should know about every one of these.

Abstract

BACKGROUND:Virtual reality (VR) is an emerging trend in stroke rehabilitation. VR gaming consoles in stroke intervention have been shown to increase motivation and enjoyment during exercise. The amount and intensity of movements elicited using these consoles are unknown. Aims. The aims of this study were: 1) to quantify the amount and intensity of movement elicited from both hands of two groups of individuals ([chronic stroke and without a disability [healthy]); 2) to determine the effect of console (Wii/EyeToy) and group (stroke/healthy) on the amount and intensity of upper extremity movement; 3) to determine the effect of console (Wii/EyeToy) and group (stroke/healthy) on the usability and VR experience. DESIGN:A cross-sectional design was taken.

SETTING:

Outpatient rehabilitation setting and healthy participant's homes.

POPULATION:

Participants included ten adults with stroke and ten adults without a disability. Methods. Participants experienced two games from each console. Amount and intensity of movement was measured using accelerometers on both wrists, while the virtual experience and usability was determined with questionnaires.

RESULTS:

No significant differences were found between the consoles usability and experience. EyeToy elicited significantly greater activity count than Wii among the healthy participants (P=0.028) and significantly greater movement intensity in both the stroke (P=0.005) and healthy (P=0.005) groups.

CONCLUSION:

Both consoles rated high for usability, enjoyment and satisfaction highlighting their suitability for a range of individuals in stroke rehabilitation. EyeToy provides increased movement and movement intensity.

CLINICAL REHABILITATION IMPACT:

Both consoles are suitable for use in stroke rehabilitation however this information can be helpful to clinicians while selecting a gaming console according to the type and intensity of movements that he/she aims to encourage during therapy.

Suitability of Nintendo Wii Balance Board for rehabilitation of standing after stroke

Or you could get a 16.95 balance board from Amazon. But that would have no scientific trials proving it worked so if a clinical trial has not been run then it can't work.  A tree falls in the forest, etc.
http://www.ingentaconnect.com/content/maney/ptr/2012/00000017/00000005/art00006
Abstract:
Background: Normal standing requires ongoing postural adjustments while performing a variety of everyday tasks. Reduced muscle strength and dexterity affect the ability to stand after stroke. Biofeedback has been shown to be effective in training lower limb activities in people with stroke. Nintendo Wii, Nintendo Wii Balance Board, and Nintendo Wii Fit Plus are potentially useful devices for providing feedback to train standing after stroke.

Objectives: What specific Nintendo Wii Fit Plus games are suitable for rehabilitation of standing in patients with stroke?

Method: A criteria-based review of the Nintendo Wii Fit Plus was carried out to determine the movements required, feedback provided, demands upon the patient, difficulty of and instruction provided by the Nintendo Wii Fit Plus games in the context of stroke rehabilitation. Seventy-five Nintendo Wii Fit Plus games were reviewed and 20 were included for in-depth review.

Major findings: The games require movements of the centre of mass in different directions, provide feedback in different ways and place additional physical and cognitive demands upon the patient. Only five games are suitable for people who have severely impaired ability to stand. Six games are suitable for people with moderately impaired standing and nine games are suitable only for people with mildly impaired standing ability. Game goals and the position of the patient can be modified to make the games target physiotherapy goals.

Conclusions: Enough suitable games exist to make the Nintendo Wii and Nintendo Wii Fit Plus an appropriate biofeedback device for rehabilitation of standing after stroke.

Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

This may not have been for stroke but it sure is applicable.
http://www.biomedcentral.com/1472-6815/12/3/abstract

Abstract (provisional)

Background

Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unkown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus (R) (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy.

Methods

In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months.

Discussion

Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated. Trial registration Clinical trials.gov identifier: NCT01442623

The ReWiiRe Project - Research for Wii Rehabilitation

Sounds cool but why can't the US have some innovative people working in stroke research? Do we need the UK to prove how its done?
http://www.rewiire.org.uk/

Motivation & Project Overview

Wii technology is recreational software and readily available on the market. The Wii technology has proved to be a great motivation tool for doing exercises at home. Currently there is some adoption of the Wii into physical rehabilitation practice with anecdotal evidence but little systematic evaluation. Therefore it is important to carry out this work to provide a solid evidence base for practice and commissioning.
In this project we would be also employing the Nintendo Wii remote technology that users are familiar with as a motivation tool and adapt it so that it can be used within healthcare for physiotherapy based rehabilitation.

ReWiiRe stand for Research for Wii technology in Rehabilitation. The project aim is twofold. Firstly to investigate therapist use and the patient experience of using the Nintendo Wii console technology in physical rehabilitation programmes in four NHS Trusts across hospital and community settings. We will be seeking to work with people with stroke, musculoskeletal conditions and amputation. Secondly to develop a customised rehabilitation platform that employs the Nintendo Wii remote technology and open source 3D software for the delivery of motivating rehabilitation sessions.

Furthermore we wish to investigate how this can be taken forward with a view to using it as part of physical rehabilitation and examining how game console technology may be adopted for personalised home rehabilitation that can be remotely monitored and adapted by the therapist.
This research is carried out by a multi-disciplinary team that includes Central London Community Healthcare NHS and Brunel University's School of Health Sciences and Social Care and School of Engineering and Design.