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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02735265
Other study ID # TMU-JIRB 201412023
Secondary ID
Status Completed
Phase N/A
First received March 21, 2016
Last updated April 11, 2016
Start date February 2015
Est. completion date February 2016

Study information

Verified date March 2016
Source Taipei Medical University Shuang Ho Hospital
Contact n/a
Is FDA regulated No
Health authority Taiwan: Ministry of Health and Welfare
Study type Interventional

Clinical Trial Summary

Virtual reality balance training has already been used in stroke rehabilitation, and previous studies supported that could improve balance ability. Although the treatment effects were supported in studies, there are still limitations in clinical intervention and the study power is not enough.

Study will use Kinect for Xbox games for balance intervention. Investigators will recruit 60 patients with chronic stroke from Shung-ho hospital clinical rehabilitation and randomly assign participants to "standard treatment plus virtual reality group" (N=30) and "standard treatment only group" (N=30). There are total 12 sessions (2 times weekly) for both groups. Investigators will assess subjects' ability for 3 times (pre- and post-intervention, follow up in post 3 month).Investigators will also record the pleasure scale and adverse event after every training session. Hypothesis is that Kinect for Xbox intervention can significantly improve subjects' balance ability, confidence of balance, ADL, and QOL compared to the conventional rehabilitation. It may help to develop a new clinical model of virtual reality training for patients with chronic stroke.


Description:

Many stroke survivors suffered postural and balance problems. Decreased mobility limits their daily life activities. Virtual reality balance training has already been used in stroke rehabilitation, and previous studies supported that could improve balance ability. The mechanism is multi-sensory feedback and repeated practices that could facilitate motor learning and brain neuroplasticity. Compared to conventional rehabilitation, VR rehabilitation could increase subjects' motivation and pleasure. Although the treatment effects were supported in studies, there are still limitations in clinical intervention and the study power is not enough.

The study will use Kinect for Xbox games for balance intervention. Kinect for Xbox doesn't need additional controller held by subjects and can detect the movement in real time to give subjects visual and auditory feedback immediately. Investigators will recruit 60 patients with chronic stroke from Shung-ho hospital clinical rehabilitation and randomly assign them to "standard treatment plus virtual reality group" (N=30) and "standard treatment only group" (N=30). There are total 12 sessions (2 times weekly) for both groups. Investigators will assess subjects' ability for 3 times (pre- and post-intervention, follow up in post 3 month). The outcome measures include Force plate, Functional reach test, Berg Balance Scale, Time up and go for balance evaluations, Modified barthel index for ADL ability, Activities-specific Balance Confidence scale for balance confidence, and Stroke Impact Scale for quality of life. Investigators will also record the pleasure scale and adverse event after every training session. Collected data will be analyzed with repeated measures 2-way analysis of variance (ANOVA), Turkey test post hoc and independent T sample test. Hypothesis is that Kinect for Xbox intervention can significantly improve subjects' balance ability, confidence of balance, ADL, and QOL compared to the conventional rehabilitation. It may help to develop a new clinical model of virtual reality training for patients with chronic stroke.


Recruitment information / eligibility

Status Completed
Enrollment 60
Est. completion date February 2016
Est. primary completion date February 2016
Accepts healthy volunteers No
Gender Both
Age group 20 Years to 75 Years
Eligibility Inclusion Criteria:

- Chronic stroke person (onset>6m)

- Could understand game command

- Could stand unsupported or stand with advice at least 15 minute

- Brunnstrom stage of LE =?

Exclusion Criteria:

- Age >75 years old or <20 years old

- Severe visual or auditory impairment

- Modified Ashworth Scale of LE = 3

- The Montreal Cognitive Assessment<16

- Other medication(neural, cardio-pulmonary, musculoskeletal) that influence motor command during the game

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment


Related Conditions & MeSH terms


Intervention

Behavioral:
Virtual reality
12 training sessions (90 minutes a time, 2 times a week) IG:45 minute of Kinect for Xbox games and 45 minute of standard treatment.
Standard treatment
CG: 90 minute of standard treatment. 12 training sessions (90 minutes a time, 2 times a week)

Locations

Country Name City State
n/a

Sponsors (1)

Lead Sponsor Collaborator
Taipei Medical University Shuang Ho Hospital

References & Publications (36)

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Deutsch JE, R. D., Morrison J, Guarrera Bowlby P (2009). Wii-Based Compared to Standard of Care Balance and Mobility Rehabilitation for Two Individuals Post-Stroke. In Virtual Rehabilitation International Conference; Haifa., 117-120.

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Lange B, Flynn S, Proffitt R, Chang CY, Rizzo AS. Development of an interactive game-based rehabilitation tool for dynamic balance training. Top Stroke Rehabil. 2010 Sep-Oct;17(5):345-52. doi: 10.1310/tsr1705-345. — View Citation

Lange, B., Flynn, S., & Rizzo, A. (2009). Initial usability assessment of off-the-shelf video game consoles for clinical game-based motor rehabilitation. Physical Therapy Reviews, 14(5), 355.

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Lee G. Effects of training using video games on the muscle strength, muscle tone, and activities of daily living of chronic stroke patients. J Phys Ther Sci. 2013 May;25(5):595-7. doi: 10.1589/jpts.25.595. Epub 2013 Jun 29. — View Citation

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Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil. 2005 Aug;86(8):1552-6. — View Citation

Parry I, Carbullido C, Kawada J, Bagley A, Sen S, Greenhalgh D, Palmieri T. Keeping up with video game technology: objective analysis of Xbox Kinect™ and PlayStation 3 Move™ for use in burn rehabilitation. Burns. 2014 Aug;40(5):852-9. doi: 10.1016/j.burns.2013.11.005. Epub 2013 Dec 2. — View Citation

Peters DM, McPherson AK, Fletcher B, McClenaghan BA, Fritz SL. Counting repetitions: an observational study of video game play in people with chronic poststroke hemiparesis. J Neurol Phys Ther. 2013 Sep;37(3):105-11. doi: 10.1097/NPT.0b013e31829ee9bc. — View Citation

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Shin JH, Ryu H, Jang SH. A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: a usability test and two clinical experiments. J Neuroeng Rehabil. 2014 Mar 6;11:32. doi: 10.1186/1743-0003-11-32. — View Citation

Sin H, Lee G. Additional virtual reality training using Xbox Kinect in stroke survivors with hemiplegia. Am J Phys Med Rehabil. 2013 Oct;92(10):871-80. doi: 10.1097/PHM.0b013e3182a38e40. — View Citation

Singh, D. K. A., Nordin, N. A.M., Aziz,N. A., Zarim, S.N. A., Kooi, L. B., Ching, S. L. . (2014). Can virtual reality balance games enhance activities of daily living among stroke survivors? BMC Public Health, 14, 1.

Smith, C., Read, J., Bennie, C., Hale, L., & Milosavljevic, S. (2012). Can non-immersive virtual reality improve physical outcomes of rehabilitation? Physical Therapy Reviews, 17(1), 1-15.

Ustinova KI, Perkins J, Leonard WA, Hausbeck CJ. Virtual reality game-based therapy for treatment of postural and co-ordination abnormalities secondary to TBI: a pilot study. Brain Inj. 2014;28(4):486-95. doi: 10.3109/02699052.2014.888593. Epub 2014 Apr 4. — View Citation

Vernadakis N, Derri V, Tsitskari E, Antoniou P. The effect of Xbox Kinect intervention on balance ability for previously injured young competitive male athletes: a preliminary study. Phys Ther Sport. 2014 Aug;15(3):148-55. doi: 10.1016/j.ptsp.2013.08.004. Epub 2013 Sep 4. — View Citation

Wüest S, van de Langenberg R, de Bruin ED. Design considerations for a theory-driven exergame-based rehabilitation program to improve walking of persons with stroke. Eur Rev Aging Phys Act. 2014;11(2):119-129. Epub 2013 Dec 7. Review. — View Citation

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You SH, Jang SH, Kim YH, Hallett M, Ahn SH, Kwon YH, Kim JH, Lee MY. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study. Stroke. 2005 Jun;36(6):1166-71. Epub 2005 May 12. Erratum in: Stroke. 2005 Jul;36(7):1625. — View Citation

Zhang L, Abreu BC, Seale GS, Masel B, Christiansen CH, Ottenbacher KJ. A virtual reality environment for evaluation of a daily living skill in brain injury rehabilitation: reliability and validity. Arch Phys Med Rehabil. 2003 Aug;84(8):1118-24. — View Citation

* Note: There are 36 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Berg Balance Scale balance function Change from Baseline at 6 weeks and 3 month follow up Yes
Secondary Modified barthel index Activity of daily live ability Change from Baseline at 6 weeks and 3 month follow up Yes
Secondary Activities-specific Balance Confidence scale balance confidence Change from Baseline at 6 weeks and 3 month follow up Yes
Secondary Stroke Impact Scale quality of life Change from Baseline at 6 weeks and 3 month follow up Yes
Secondary Modified Physical Activity Enjoyment Scale pleasure scale Every training session during 6 weeks (total 12 sessions (2 times weekly)) Yes
Secondary Adverse event times Every training session during 6 weeks (total 12 sessions (2 times weekly)) Yes
Secondary Force plate balance function for Weight bearing symmetry and dynamic standing balance Change from Baseline at 6 weeks and 3 month follow up Yes
Secondary Functional reach test balance function Change from Baseline at 6 weeks and 3 month follow up Yes
Secondary Timed up and go-cognition balance function Change from Baseline at 6 weeks and 3 month follow up Yes
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