Virtual Reality Stroke Rehabilitation Health And Social Care Essay

In the last decennary there has been a turning involvement in the usage of Virtual Reality ( VR ) methods for the rehabilitation of cognitive and motor shortages after lesions to the encephalon. Stroke patients have become one of the chief mark populations for these new rehabilitative methods. This is due to stroke being one of the major causes of grownup disablement worldwide.

Harmonizing to the National Stroke Association “ Stroke is the 3rd prima cause of decease, killing 160,000 people each twelvemonth, and the taking cause of grownup disablement ” in the US. As is the instance with many signifiers of physical rehabilitation, the recovery of map following a shot can be backbreaking.

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Stroke is a sudden loss of neurological map, caused by vascular hurt to the encephalon ( Philadelphia: F. A. Davis, 2005 ) . Strokes are a heterogenous group of upsets affecting sudden, focal break of intellectual blood flow that causes neurologic shortage. The most common arterias that are affected in the encephalon are either the anterior circulation ( subdivisions of the internal carotid arteria ) or the posterior circulation ( subdivisions of the vertebral and basilar arterias ) ( MERCK, 2009 ) . Stroke is both common and deathly: approximately 795,000 shots occur in the United States each twelvemonth. The disease is the 3rd prima cause of decease in the U.S. and besides affects 15 million people worldwide each twelvemonth ( Internet Stroke Center, 2009 ) .

2. Types:

Stroke which is called encephalon onslaught has two types. The first type is ischaemic shot, a shot caused by lessened blood flow to a peculiar arteria in the encephalon as a consequence of a coagulum in the arteria or an embolus housing in the arteria, which is the most common type that accounts ( 80-85 % ) . The 2nd type is haemorrhagic shot ( 15-20 % ) , which is a rupture of diminished blood vas ( Philadelphia: F. A. Davis, 2005 ) ( MERCK, 2009 ) . This will take to accretion of blood causes a compaction to the environing encephalon tissue.

CT scan of a patient who has had a left in-between intellectual arteria shot. The pointer indicates the location of the shot.

Both types of shot lead to a lessening of O addendum to those countries ensuing in encephalon harm. The accomplishments or maps that are controlled by these parts are affected or lost. Patients may hold a failing of one side of the organic structure, loss of balance and coordination, esthesis jobs, address and vision problems, and memory jobs ( Philadelphia: F. A. Davis, 2005 ) . These effects can be divided into four classs, motor damage, centripetal damage, musculoskeletal damage and perceptual, cognitive, or communicating damage.

Post-stroke, a patient besides could hold some complications like depression, pressure sores, ictuss, and jobs with cardiorespiratory, GI, and urinary piece of land systems ( Washington Hospital Center, 2009 ) .

3. Hazard factors:

Hazard factors for shot include advanced age particularly older than 65 old ages, coronary artery disease of the aortal arch, carotid arteria disease, and coffin nail usage. Another hazard factor that may take to stroke is bosom failure. Other factors ensuing in shot are high blood pressure, lipemia, a history of myocardial infarction, physical inaction, or male gender ( Philadelphia: F. A. Davis, 2005 ) .

4. Complications:

As a consequence of shot, the patient will hold failing of one side of the organic structure, loss of balance and coordination, esthesis jobs, address and vision problems, and memory jobs ( Philadelphia: F. A. Davis, 2005 ) . Post-stroke patient besides, could hold some complications like depression, pressure sores, ictuss, and jobs with cardiorespiratory, GI, and urinary piece of land systems jobs.

5. Neuroplasticity:

New encephalon imagination techniques are doing it clear that the nervous system is continuously remodeled throughout life and after hurt by experience and acquisition in response to activity and behaviour. The term ‘plasticity ‘ refers to the capacity of the cardinal nervous system to accommodate to functional demands and hence to the system ‘s capacity to reorganise. There is grounds from old surveies that preparation is effectual for encephalon reorganisation, including functional alterations in cortical motor and centripetal nerve cells ( Philadelphia: F. A. Davis, 2005 ) . Motor damages, including hemiparesis, incoordination and spasticity, are the most common shortages after shot. Most patients recover at least some of their lost motor map over clip, though the grade of this recovery is variable. There is grounds that increasing the strength of post-stroke therapy can heighten motor recovery. Brain function surveies in patients have revealed that the encephalon reorganizes after shot in relation to recovery of motor map.

6. Management of complications:

There are many medical options to assist handle post-stroke complications. Often a combination of medical, physical and psychological interventions is prescribed. Medical intervention involves medical supervising, monitoring and drug therapies. Physical intervention includes: physical therapy, address therapy, and occupational therapy. Physical therapy provides activities that aid avoid complications such as: Range-of-motion exercisings that are effectual against limb contractures, shoulder hurting, and blood vas jobs. Frequent turning, good nutrition and tegument attention aid to avoid pressure sores. Bladder preparation plans help pull off incontinency like the Kegel exercisings. Speech, get downing and respiratory therapy lessening the hazard of developing pneumonia. Psychological intervention treats the depression ensuing from shot damages. Options include reding, supportive therapy, antidepressant medicine, psychotherapeutics and engagement in a shot support group.

The purpose of physical therapy in neurorehabilitation is to enable persons with ague or chronic encephalon lesion, such as shot, to work every bit efficaciously as possible in mundane life. Patients with motor damage must try to recover optimum ( effectual ) motor public presentation with the proviso of an expert and the chance for intensive pattern and exercising.

Loss and damage of walking ability is one of the major lay waste toing results of post-stroke complications. Gait Restoration has been recognized as a primary end in shot rehabilitation. In recent old ages, the accent has been extended to concentrate on the ability of community ambulation. It has been reported that merely a little proportion can walk with sufficient ability to map efficaciously within the community. In this paper I will concentrate on the consequence of Virtual world therapy particularly Wii game therapy on bettering damages in station shot patients such as: motor and balance.

Virtual World:

Virtual world ( VR ) , a non-pharmacological intervention technique, is a computing machine simulated technique that allows persons who wear a head-mounted device to be immersed in scenarios through ocular and audile stimulations that they manipulate. It is an effectual and synergistic distraction intercession used therapeutically to pull patients ‘ attending off from unpleasant stimulations ( Schneider SM, 2008 ) . The practical world equipment consists of headset ( head-mounted show ) , mouse, control stick, and laptop with the game package ( Das DA, 2008 ) . 3-D computer- generated images are displayed in the headset which blocks ocular and audile signals from the environing environment. Patients are engaged in the game and seek to interact with the events happening in that game environment by utilizing a 3-D mouse or a joy stick for their uses. The practical world plan distracts the patient ‘s attending from hurting or other unpleasant stimulations, hence less hurting is experienced. Virtual environments may offer a method of practising mundane activities during which advancement through the activity can be monitored objectively and physical danger is removed from the scenario. One of the compelling attributes of a practical world environment is that the activities may be meaningful and set in the context of pragmatism, or ecological cogency. Virtual environments have been demonstrated to be dependable in the appraisal and rehabilitation of cognitive operation ( Pugnetti et al, 1995 ; Rose et al. , 1996 ; Rizzo and Buckwalter, 1997 ; Riva, 1998 ) . VR has besides been shown to be capable of bettering spacial accomplishments ( Stanton et al. , 1998 ) and acquisition and pattern of mundane life accomplishments ( Christiansen et al. , 1998 ; Brown et al. , 1999 ) .

Virtual Reality is frequently cited as a method of retroflexing activities in a simulation of 3-dimensional physical infinite. In the context of rehabilitation, commanding the clip taken to finish a subtask may besides be an of import factor and it has been suggested that a practical environment may promote the patient to finish the action by cut downing the chance for distraction or discontinuance of the activity. In many rehabilitation centres, practical world therapy is provided through the Nintendo ( Wii game ) .

Clinical usage of VR:

Virtual world therapy combined with traditional physical therapy is provided to stroke patients around the universe. Many surveies were conducted to look into whether practical world therapy is effectual in the rehabilitation of shot patients.

A foundational survey was performed to find whether VR entirely could be used as a curative intercession mode to better the manus map of chronic station shot patients ( Boian R, 2002 ) . The survey included four station shot hemiplegic patients with left manus damage between the ages of 58 to 72. Scientists used cyber baseball mitt and Rutgers Master II tactile baseball mitt ( RM11-ND ) in the survey to rehabilitate these patients. The rehabilitation exercises mark 4 manus damages: finger scope of gesture, finger velocity of gesture, finger fractional process, and finger strength. These exercisings provide public presentation feedback. One exercising consists of a practical butterfly winging above the practical manus controlled by the patient ; in other exercising the patient plays a practical piano. In add-on to computerized trials, the patient ‘s public presentation was evaluated utilizing the Jebsen Taylor manus map trial. The consequences showed assorted grades of betterment in manus damage. The maps of the manus were improved for each patient.

Another survey was done subsequently by Merians, Boian, Jack, Tremaine, Burdea, Adamoveich, Recce and Poizner in order to bespeak that VR has the capableness of making synergistic and actuating environment to augment rehabilitation of patients with lessened upper – appendage map ( Merians Al, 2002 ) . Three patients in the chronic stage following shot were utilizing VR exercising system in their rehabilitation. Two manus input devices were used, a Cyber Glove and ( RM11 ) force feedback baseball mitt. The exercising package provides ocular, audile, and tactile feedback. Patient ‘s consequences were obtained utilizing computing machine steps and clinical steps such as the Jebsen and Taylor Test of Hand Function and The Fugl-Meyer Assessment of Sensorimotor recovery after shot. All patients showed betterment in the motor recovery, and cortical reorganisation in 10 patients with hemiparetic shot. The patients were assigned to either the VR group or the control group. In the VR group patients used VR exercises which provide synergistic real-life pattern environment that optimize motor larning. Patient ‘s motive power map was measured by ( FAC ) and ( MMAS ) . The cortical activation was monitored utilizing functional MRI ( functional magnetic resonance imaging ) . VR-trained group performed better than the control group, and the cortical activation by affected motions was reorganized from ipsilateral to contralateral activation ( You SH et Al, 2005 ) .

Another survey was performed late to prove the efficaciousness of VR cognitive therapy system on acute shot patients and to measure whether the system can supply extra patient benefits ( Eng K et Al, 2006 ) . Three acute stroke patients with manus paresis between the ages of 56 to 63 were take parting in this survey. Two groups were accomplished, the experimental group and the control group. Both groups received medical intervention and physical therapy. The experimental group received, in add-on, cognitive VR therapy during the session. The consequences have shown betterment in the public presentation of the impaired manus. To day of the month, VR has been tested for its efficaciousness in assortment Fieldss. Besides practical world therapy showed its effectivity in handling phobic disorder, burn patients while dressing altering, and hurting in kids having chemotherapy. In the rehabilitation of shot patients, healers use a assortment of exercisings to recover the loss of map. Weight bearing exercisings is used to better motor control in these patients. Physical healers besides provide balance preparation and pace preparation in the rehabilitation plan. Another manner for shot patients ‘ rehabilitation is utilizing centripetal stimulation which shows its efficaciousness in bettering motor map in these patients. Using practical world system ( VR ) is one of the centripetal exercisings to handle post-stroke patients. An experimental blind survey was done by Sung H. ( 2004 ) , to look into the effects of VR intercession on cortical reorganisation and associated locomotor recovery in shot patients. Ten chronic shot patients ( 6 male and 4 female with average age of 57.1 -+ 9.8 ) was selected indiscriminately into two groups. The first group was a control group in which they did non received any intercession. The 2nd group was the experimental group in which patients received the VR preparation for 60 min/day ( five sessions/ hebdomad ) for four hebdomads. The patients were hemiplegic of less than 1 twelvemonth and they were able to widen their articulatio genus & gt ; 60degree. Steping up/down, shark come-on, and snowboarding are the three VR plans which were used in this survey. All these plans were designed in order to let patients to better their scope of gesture, balance, mobility, stepping, and ambulation accomplishments and were modified harmonizing to patient ‘s public presentation degree. The writers noticed that VR bring on cortical reorganisation of nervous locomotors tracts. The consequence showed that patients who received VR intercession perform significantly better than the control group in their locomotor map. The little sample size could restrict the generalisation of the consequence of this survey.

Wii Program

Virtual world therapy is provided in the rehabilitation clinics through many systems such as: manus Cyber baseball mitt, computing machine with mouse or control stick, or Wii video game. Wii game is released by Nintendo 2006. The Wii game consists of hardware, remote, driver wheel, game plan, balance board and theraband. For shot patients it is easier to utilize the Wii game. Most shot victims are older grownups and have the game in their place for their childs. Wii game is available in Kuwait in many shops and it is low-cost. The old elderly shot patients like to play the Wii game with their grandsons at place instead than traveling to the Physical therapy every twenty-four hours. The Wii plan should include motor, sensory, balance, and coordination exercisings. The physical therapy session should include the traditional PT in add-on to the VR plan which is the Wii therapy. The patients should adhere to the plan and finish the undertaking at place. The patients will be seen 3 yearss per hebdomad. Each game will be played 60 min daily at place.

Goals of Wii Therapy:

Increase upper appendage ROM, strength, coordination, and map.

Increase dynamic balance in sitting and standing.

Improve general motor control ; bole and pelvic girdle control.

Improve coordination and organic structure consciousness.

Curative Activities:

Balance preparation

Siting and standing

Switching weight between lower appendages

Physical motions

Motor planning/ organic structure consciousness


Endurance preparation

Strengthening exercisings

Functional motion & A ; exercising ( pace )

Cognitive preparation


Following waies

Visual-perceptual accomplishments


Video Games used:

Wii athleticss: Tennis, golf, pugilism, bowling.

Wii drama

Wii active


Super Mario

Smooth moves

Mario kart Wii

Rayman Raving Rabbits 2

Large beach athleticss

Super Monkey Ball Banana Blitz

Boom Blox


Carnival games


In this paper, I have presented a new rehabilitation plan for post-stroke patients, the Wii therapy plan. The plan utilizes augmented world engineering to represent more realistic and entertaining exercisings. The system provides the healer with the agencies to quantitatively mensurate the patient ‘s public presentation and intervention advancement. Furthermore, the system contains a determination support engine that helps the healer proctor patient advancement and be cognizant of important alterations. Each Patient has an ID in the Wii package game. Wii can be used in physical therapy sections in the GYM or can be transferred straight in the word for in-patients.

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