Dr Penelope McNulty with stroke patient Si Saegusa, who is using a Nintendo Wii for rehabilitation. Photo: Michele Mossop
Here’s the good news: we know that playing video games can help stroke survivors regain lost movement.
And here’s the better news: according to new research, it works just as well as the best available conventional therapy, and it’s a lot more pleasant.
A team led by Penelope McNulty at Neuroscience Research Australia has just published a study comparing rehab using a Nintendo Wii with rehab using the best-practice technique, the intimidatingly named constraint-induced movement therapy.
Constraint therapy involves the patient wearing a restrictive mitt on their more functional hand, to force them to use their affected limb. It’s an effective but frustrating method, which people tend to endure rather than enjoy.
In the two-week study, one group of participants played a modified Wii game for up to three hours a day, while the other wore a mitt for up to 90 per cent of their waking hours. Both groups showed considerable improvement, but the Wii group found it pleasurable, challenging and were much more inclined to continue the therapy.
“We’ve seen improvements in cognitive and memory and mood as well, and we know it is translating into completely unrelated activities in daily living,” Dr McNulty said. “They can tie their shoes more easily or open a drawer.
“What’s really cool is children and grandchildren can see a difference in their parent or grandparent over the two weeks, and these are people who are many years post-stroke.
“It was thought for a long time that if you’d had a stroke, after a certain period you weren’t going to get any better. My work clearly shows you can get better motor function.”
Hisao “Si” Saegusa is an unabashed fan of Dr McNulty’s work. The Sydney resident had a stroke in 2011 and spent three months in a rehab hospital at the time. Since enlisting in the study last year, he has worked out with the Wii at least once a day. He particularly enjoys the golf program, as he hasn’t been able to get out on the course since his stroke.
“It’s very much fun doing it, and at the same time it’s helping my recovery,” the 65-year-old says. “Without the Wii I’d never have been like I am now.”
Dr McNulty said movement therapy tried to teach the brain to act more like it did before a stroke. She said when a part of the brain was damaged, other parts would try to pick up functions once governed by the injured region. Rehab forced it back towards a healthy pattern.
Part of Dr McNulty’s work is trying to track down the neurological processes responsible for rehab, but that was still a work in progress. “We don’t know if the brain changes underpinning these very big changes in movement ability are very small and we’re just not looking in the right places, or whether they take time to build up to where we can pick it up with the equipment we have,” she said.
“The neurophysiology is a lot slower to measure than the day to day activities, which we can measure very easily.”
While the team’s finding are a promising development for the 420,000 Australians living with the effects of stroke, it could be the thin edge of the wedge.
Professor Julie Bernhardt, of Melbourne’s Florey Institute, said “rehab is the new black” when it comes to stroke research, and games and technology were one of the boom areas. The institute had success with a similar trial using an adapted Xbox Kinect, and she said there were many purpose-designed rehab games in development.
“It’s a really exciting period,” Professor Bernhardt said. “Finally attention is really clearly focused on recovery phase. We know there’s heightened period for potential change early but changes can continue for a very long time – families shouldn’t give up.
“We need to find ways to help people keep working on their recovery, and the advantage of some of these technologies is they can continue in their home at their own pace for as long as they like.
“We need to get to who recovers and why. In 10 years’ time we may have a much more targeted and personalised intervention, not a one-size-fits-all approach. There’s a huge role for science right now. We’re on the tip – we’re halfway up Mount Everest but we’re not quite at the top.”