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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FEEL THE BUZZ IN THE AIR? US TOO.

Brain and Knee Muscle Weakness Study

Why Does Quadriceps Weakness Persist after Total Knee Replacement? An Exploration of Neurophysiological Mechanisms Total knee replacement is a commonly performed surgery for treating end-staged knee osteoarthritis. Although most people recover well after surgery, weakness of the quadriceps muscles (the front thigh muscles) persists long after the surgery (at least for 12 months), despite intensive physiotherapy and exercise. Quadriceps muscle weakness is known to be associated with more severe pain and greatly affect daily activities. This study aims to investigate the mechanisms underlying weakness of the quadriceps muscles in people with knee osteoarthritis and total knee replacement. We hope to better understand the relationship between the changes of the brain and a loss of quadriceps muscle strength after total knee replacement. The study might be a good fit for you if you: Scheduled to undergo a total knee replacement; The surgery is scheduled within the next 4 weeks; Do not have a previous knee joint replacement in the same knee; Do not have high tibial osteotomy; Do not have neurological disorders, epilepsy, psychiatric conditions, other chronic pain conditions; Do not have metal implants in the skull; Do not have a loss of sensation in the limbs. If you decide to take part you would: Be contacted by the researcher to determine your eligibility for the study Be scheduled for testing if you are eligible and willing to take part in the study Sign the Consent Form when you attend the first testing session Attend 3 testing sessions (approximately 2 hours per session): 1) before total knee replacement, 2) 3 months and 3) 6 months after total knee replacement. The testing will include several non-invasive measures of brain representations of the quadriceps muscles, central pain mechanisms, and motor function and questionnaires. Will I be paid to take part in the research study? You will be reimbursed ($50.00 per session) for travel and parking expenses associated with the research study visits. If you would like more information or are interested in being part of the study, please contact: Name: Dr Wei-Ju Chang Email: w.chang@neura.edu.au Phone: 02 9399 1260 This research is being funded by the Physiotherapy Research Foundation.  
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