Abstract
Rehabilitation therapy requires stroke patients to train muscles controlled by the brain that have been damaged. The challenge of the therapy is caused by improper and irregularly training from patients. An effective recovery process requires patients to cooperate in a training course designed by the medical team. The current practices of trainings are plain and might be discouraging resulting in a somewhat unsatisfied outcome. This research is to create an interdisciplinary intervention tool by integration of “Serious game” and rehabilitation body of knowledge. This proposed system is a 3D game having features to encourage the patient by immersing the patient in the Thai temple fair atmosphere games where they must make movements to complete the virtual reality games (VR). The games help patients to train in three patterns of movement required in daily living. The first pattern is focused on practicing a reaching out gesture, which involves practicing movement in the following muscles: Deltoid, Triceps, Biceps, Pectoralis and Serratus anterior muscles through selling ice-cream game. Second movement is to train arm-sweeping from left and right, which involves practicing the following muscles Deltoid, Pectoralis, Infraspinatus, Latissimus, Rhomboid and Trapezius through a shooting game. Third movement training is to train arm-lifting involved practicing the following muscles Deltoid, Triceps, Trapezius and Serratus anterior through the picking stars game. Moreover, in every game, players and patients will use their small muscles by stimulating picking up an object gesture. The game collects data from plays to formulate progression planning. Thirty eligible patients with stroke who were admitted to the Rehab ward, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University Medical School were randomly allocated into an intervention group (6 patients treated with conventional therapy and VR) and a control group (7 patients treated with conventional therapy only). Rehab outcome measurements including Fugl-Meyer Assessment of the arm (FMA), ArmA, Barthel index (BI) and Wolf Motor Function test (WMFT) were evaluated before, during and at the protocol completion. Our results revealed significant FMA score differences within group in both groups (p=0.039) implying that motor and sensory recovery was equivalent, however there was a trend toward better outcome in the intervention group. The ArmA, WMFT and BI scores showed no significant differences between groups on nonparametric analysis at any point of time. The FMA scores were moderately correlated with the “ice-cream selling” game scores (r = 0.57) which might be related to arm recovery. The “ice-cream selling” and “star picking” game scores were moderately to highly correlated with ArmA score (r = 0.65). The WMFT showed no significant correlation with all game scores which might be attributable to less hand and arm use in most of the WMFT items. The BI scores had significantly moderate to high correlation with “ice-cream selling” and “star picking” game scores as the game plays stimulated postural and balance training (r = 0.64 and 0.61, respectively). To sum up, combination of rehabilitation through virtual reality system and conventional therapy showed a trend toward better efficacy for stroke patients than the conventional therapy alone, especially arm and shoulder recovery.
