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NeuRA Magazine #20

IMPROVING HEALTH WITH A WII

Using Wii computer games as rehabilitation therapy has proven to be beneficial for people after a stroke. New research has shown it can also improve their fitness.

Dr Penelope McNulty with a research participant

Wii-based Movement Therapy (WMT) not only restores upper limb mobility, but also improves lower limb movement and cardiovascular health in people after a stroke, according to two new studies by Dr Penelope McNulty.

Both studies compared WMT with modified Constraint-induced Movement Therapy (mCMIT) and found that WMT boasts additional benefits. While CMIT is currently considered best-practice in stroke rehabilitation, results from these studies indicate that WMT is equally as effective, with better lifestyle outcomes at six months.

Sixty-five percent of people living with stroke suffer a disability that impedes their ability to carry out daily living activities unassisted. 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 is a significant risk factor for subsequent stroke and is responsible for 19 percent of stroke readmissions.

“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.”

WMT provides neurorehabilitation, resulting in multi-domain improvements in limb movement and fitness, according to researchers.

The Wii-based therapy involved 60-minute 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.

“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 percent 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.”

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Own Your Balance

Research investigating the impacts of cognitive behavioural therapy and balance programs on fear of falling, funded by Mindgardens. Falls and fear of falling affect many older people and can impose limitations upon daily activities. Over one third of community dwelling older people fall each year with about 15% of falls being injurious. However, two thirds of older people express a fear of falling during common daily activities, making it more common than falls itself. Fear of falling has been associated with needless restriction in physical and social activities, and subsequent deterioration of health and wellbeing. Previous research has suggested that fear of falling can be reduced through cognitive behavioural therapy (CBT) and balance exercise programs. However, these face-to-face treatments are resource intensive and not readily accessible to people. Furthermore, the effects of these treatments on fear of falling are small and often do not last beyond the duration of the program. By utilising technology and providing tailored physical activity guidance we are aiming to reduce a fear of falling in an accessible, efficient and lasting way. A thee-arm randomised clinical trial will be conducted in 189 community-dwelling older adults with a substantial concern of falling. Participants will be randomly allocated into one of three groups in order to test whether a self-managed CBT intervention, alone or in combination with a graded balance activity program, can reduce concerns about falling in older adults when compared to usual care. We are collaborating with the Black Dog institute to provide a home-based cognitive behavioural therapy program that addresses a fear of falling. We will also be utilising our cutting-edge balance program StandingTall to provide a graded balance program.   Related studies: https://www.neura.edu.au/project/reducing-fear-of-falling-and-activity-avoidance-in-older-adults-with-disproportionate-levels-of-fear-of-falling/ https://www.neura.edu.au/project/standingtall-plus-a-multifactorial-program-to-prevent-falls-in-older-people/ https://www.neura.edu.au/project/standing-tall/
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