Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study
Articolo
Data di Pubblicazione:
2017
Citazione:
Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study / B.C. Tobler-Ammann, E. Surer, E.D. de Bruin, M. Rabuffetti, N.A. Borghese, R. Mainetti, M. Pirovano, L. Wittwer, R.H. Knols. - In: JMIR SERIOUS GAMES. - ISSN 2291-9279. - 5:3(2017 Sep).
Abstract:
Background: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial
neglect (VSN) training. A series of 9 exergames—games based on therapeutic principles—aimed at improving exploration of
the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility.
Objectives: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation
of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects
on VSN symptoms in a case series of patients early poststroke.
Methods: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was
documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse
events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills
were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker
Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention.
Results: The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions
was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial
exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92)
in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group
improvement from 15 to 16 total located targets (+6%).
Conclusions: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for
the participants. The results of the amount of exergames use is promising for future applications and warrants further
investigations—for example, in the home setting of patients to augment training frequency and intensity. The preliminary results
indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of
training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations
are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
exergames; eye tracking; feasibility; virtual reality; visuospatial neglect
Elenco autori:
B.C. Tobler-Ammann, E. Surer, E.D. de Bruin, M. Rabuffetti, N.A. Borghese, R. Mainetti, M. Pirovano, L. Wittwer, R.H. Knols
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