Effect of Virtual Motor Rehabilitation on Balance and Mobility among Patients with Acquired Brain Injury

Balance disorder is one of the most common problems after acquired brain injury (ABI). Traditionally, ABI patient's rehabilitation focuses on recovery of postural control and coordination to increase stability and reduce the risk of falling. Some researchers who challenge the traditional physiotherapy techniques in the treatment of balance disorders suggest that these techniques are costly and time consuming and not very effective because the low engagement of the patient. New technologies such as virtual motor rehabilitation provide new features to rehabilitation. Virtual motor rehabilitation often uses play therapy so that patient's participation is strengthened, fatigue minimized and adherence and motivation toward rehabilitation process increase. Although, some research suggests that virtual reality rehabilitation lead to more favorable outcomes than traditional rehabilitation, there are also some limitations. For example, in the majority of studies, expensive tools were used which are not easily available. Therefore, the method is not suitable for use in clinical settings or at home. Due to these limitations, in recent years, video games (such Nintendo Wii Fit) have caught the attention of researchers and clinicians in treatment of patients with motor problems. In Wii Fit game, patient transmits his/her weight backward and forward and sides of the center of pressure (COP) to achieve the objective and raise stability. This game utilizes a visual-perceptual system, provides information about the performance, shows the direction, changes speed and acceleration, and is interactive, motivating, cheap and usable. Therefore, the current study compares the effect of virtual reality games (Wii Fit) with conventional rehabilitation on balance and mobility in patients with acquired brain injury.
A quasi-experimental study was carried out. Convenience sampling was used to recruit 30 participants with acquired brain injury who were attending a rehabilitation program. The participants were randomly divided into two experimental and control groups in equal numbers. In the intervention phase, the control group participated in 15 sessions of 60 minutes of conventional physiotherapy three times a week. The intervention included stretching exercises such as stretching the hamstring, gastrocnemius and soleus muscles; rotational movements such as rotation of the trunk, knee extensions, dorsiflexion and plantar flexion in standing position; static balance training: subjects with a small base of support, feet close together, unstable surfaces (like a sponge) stands with open and closed eyes; and dynamic balance exercises such as walking exercises, exercises that involve moving the body in a standing position and postural changes. The participants of the virtual reality group performed 15 sessions of 40-minutes of conventional therapy plus training with Wii Fit games (Balance Bubble, Table Tilt, Soccer Heading, Penguin Slide and Ski Slalom) three times a week for 20 minutes. Berg balance scale, Timed up and go, Functional reach, Dynamic gait index were conducted for balance assessing. Independent sample t-test was conducted. The level of significance was set at 𝑝=0.05. SPSS22 software was used to analyze the data.
There was not significant difference between the two treatments in Berg balance scale (p=0.149), Timed up and go (p=0.197), and Dynamic gait index (p=0.201). But, in the Functional reach test, the control group was significantly better than virtual reality group (p˂0.001).
With regard to BBS and DGI, Nintendo Wii associated with conventional rehabilitation is beneficial in dynamic balance and mobility, promoting benefits, which are similar to obtained by conventional physiotherapy. However, one must be attentive to potential risks related to the acquisition of compensatory movements (TUG and FR), as eventually the dynamism of virtual reality can stimulate in acquired brain injury patients.