بررسی تاثیر استفاده از بازی های رایانه ای بر مهارت های تعادلی و ترس ازافتادن بیماران سکته مغزی مزمن:single subject design

نوع مقاله : مقاله پژوهشی

نویسندگان

1 1. دانشجوی کارشناسی ارشد، گروه کاردرمانی، دانشکده توانبخشی دانشگاه علوم پزشکی ایران، تهران، ایران

2 2. دانشیار، مدیر گروه کاردرمانی، دانشکده توانبخشی دانشگاه علوم پزشکی ایران، تهران، ایران

3 3. مربی، گروه کاردرمانی، دانشکده توانبخشی دانشگاه علوم پزشکی ایران، تهران، ایران

4 4. استادیار، گروه کاردرمانی، دانشکده توانبخشی دانشگاه علوم پزشکی ایران، تهران، ایران

5 دانشیار، مدیر گروه فیزیوتراپی، دانشکده توانبخشی دانشگاه علوم پزشکی ایران، تهران، ایران

چکیده

مقدمه و اهداف
مشکلات تعادلی یکی از شایع­ترین اختلالات ناشی از سکته مغزی به شمارمی­روند. این­گونه اختلالات در بسیاری از مواقع سبب افتادن یا ترس از افتادن در بیماران      می­گردند. در این میان، بازی­های تعادلی رایانه­ای به سبب دارا بودن ویژگی­های منحصر به فرد خود، در توانبخشی بیماران با مشکلات حرکتی مورد استفاده قرار می­گیرند. در این مطالعه به بررسی تاثیر بازی­های رایانه­ای تعادلی  بر عملکرد تعادلی و ترس از افتادن بیماران سکته مغزی مزمن پرداخته شد.
 مواد و روش ها
این مطالعه تجربی به صورت single subject و از نوع A-B در چهار بیمار سکته مغزی مزمن و به صورت انداز­گیری­های مکرر  در دوفاز پایه و سپس دوازده جلسه مداخله  انجام گرفت.  در مطالعه مذکور، آزمون­های تعادلی Berg Balance Scale ، Timed Up and Go، 5 Meter Walking، Functional Reach و Step ، حداکثر میزان وزن­اندازی در جهات مختلف و میزان انحراف از خط وسط جهت بررسی مهارت­های تعادلی و پرسشنامه ترس از افتادن جهت بررسی میزان ترس از افتادن مورد استفاده قرار گرفتند.
 یافته ها
از آزمون­های آماری C Bayesian factor، و Visual Analysis جهت بررسی نتایج استفاده شد. یافته­های تحقیق  برای متغیرهای عملکرد تعادلی ، میزان      وزن­اندازی درجهات مختلف و ترس از افتادن معنادار بود. اما گراف­های میزان تغییرات انحراف از خط وسط الگوی مشخصی را نشان ندادند. 
 نتیجه گیری
بازی­های رایانه­ای می­توانند در بهبود اختلالات تعادلی ناشی از سکته مغزی و ترس از افتادن موثرواقع شوند. هرچند تاثیر اینگونه تمرینات بر ایجاد تقارن وضعیتی و نوسانات نقطه ثقل نیاز به مطالعات بیشتری دارد.

کلیدواژه‌ها

عنوان مقاله [English]

The effect of videogames on balance skills and fear of falling in chronic stroke patients: a single subject design

نویسندگان [English]

  • Neshat Rahimi Shamaei Monfared 1
  • Afsoon Hassani Mehraban 2
  • Ghorban Taghizade 3
  • Malahat Akbarfahimi 4
  • Mehdi dadgoo 5
1 1. M.Sc. student, Occupational therapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
2 Ph.D., Head of Occupational therapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
3 3. Ph.D. Student, Occupational therapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
4 4. Ph.D., Occupational therapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
5 PhD., Physiotherapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
چکیده [English]

Background and Aim: Balance disorder is one of the most common problems after stroke causes falling and fear of falling in some patients. The balance based video games are used in people with motor problems. The current study conducted to investigate the effectiveness of videogames on balance and fear of falling in patients with chronic stroke.
Materials and Methods: This experimental study organized in a single subject system, A-B design for four patients with chronic stroke. This method including repetitive measures conducted in two phases, baseline and then twelve intervention sessions. Berg Balance Scale, Timed up and go, Functional Reach, Step test, the maximum weight bearing in different directions and the deviation from center were conducted for balance assessing. Fear of falling questionnaire was used to assess the fear of falling. The results were considered using C-statistic, Bayesian factor, Mann Whitney U, and visual analysis
Results: The results were significant for balance skills, the maximum force produced by lower extremities at different directions and fear of falling parameters but the deviation from center did not show distinct pattern.
Conclusion: The results related to balance skills, the maximum force produced by lower extremities and also fear of falling confirmed the efficacy of videogames, however the deviation from center did not show any improvement.

کلیدواژه‌ها [English]

  • Chronic Stroke
  • Videogames
  • Fear of Falling
  • Balance Skill

مراجع

  1. Kim JH, Jang SH, Kim CS, Jung JH, You JH. Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. American Journal of Physical Medicine & Rehabilitation. 2009;88(9):693-701.##
  2. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart Disease and Stroke Statistics—2012 Update A Report From the American Heart Association. Circulation. 2012;125(1): 2-220.##
  3. Warlow C vGJ, Dennis M, et al. Stroke: practical management. 3nd ed. Oxford: Blackwell Publishing; 2008 .p.45-47.##
  4. Dalvandi A, Ekman S-L, Maddah SSB, Khankeh HR, Heikkilà K. Post Stroke life in Iranian people: used and recommended strategies. Iranian Rehabilitation Journal. 2009; 7(9):17-24.##
  5. Geurts AC, de Haart M, van Nes IJ, Duysens J. A review of standing balance recovery from stroke. Gait & posture. 2005; 22(3):267-81.##
  6. Marigold DS, Eng JJ. The relationship of asymmetric weight-bearing with postural sway and visual reliance in stroke. Gait & posture. 2006; 23(2):-5559.##
  7. Messier S, Bourbonnais D, Desrosiers J, Roy Y. Dynamic analysis of trunk flexion after stroke. Archives of Physical Medicine and Rehabilitation. 2004; 85(10):1619-24.##
  8. Lin C-LH, S.-F. Hsiao, M.-H. Huang, J-H. Predicting long-term care institution utilization among post-rehabilitation stroke patients in Taiwan: a medical centre-based study. Disability & Rehabilitation. 2001;23(16):722-30##.
  9. Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Archives of Physical Medicine and Rehabilitation. 2002;83(2):165-70.##
  10. Schmid AA, Van Puymbroeck M, Knies K, Spangler-Morris C, Watts K, Damush T, et al. Fear of falling among people who have sustained a stroke: a 6-month longitudinal pilot study. The American Journal of Occupational Therapy. 2011; 65(2):125-32.##
  11. Barclay-Goddard R, Stevenson T, Poluha W, Moffatt M, Taback S. Force platform feedback for standing balance training after stroke. Cochrane Database Syst Rev. 2004;4(6):34-6.##
  12. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing. 2006; 35(2): 37-41.##
  13. Tutuarima J, Van der Meulen J, De Haan R, Van Straten A, Limburg M. Risk factors for falls of hospitalized stroke patients. Stroke. 1997; 28(2):297-301.##
  14. Watanabe Y. Fear of falling among stroke survivors after discharge from inpatient rehabilitation. International Journal of Rehabilitation Research. 2005; 28(2):149-52.##
  15. Andersson ÅG, Kamwendo K, Appelros P. Fear of falling in stroke patients: relationship with previous falls and functional characteristics. International Journal of Rehabilitation Research. 2008; 31(3):261-4.##
  16. Pang MY, Eng JJ, Miller WC. Determinants of satisfaction with community reintegration in older adults with chronic stroke: role of balance self-efficacy. Physical therapy. 2007;  87(3):282-91.##
  17. Weerdesteyn V, de Niet M, van Duijnhoven HJ, CH A, Geurts M. Falls in individuals with stroke. differences. 2008;45(8) 33-36.##
  18. Szturm T, Betker AL, Moussavi Z, Desai A, Goodman V. Effects of an interactive computer game exercise regimen on balance impairment in frail community-dwelling older adults: a randomized controlled trial. Physical Therapy. 2011; 91(10):1449-62.##
  19. Schultheis MT, Rizzo AA. The application of virtual reality technology in rehabilitation. Rehabilitation Psychology. 2001; 46(3):296.##
  20. You SH, Jang SH, Kim Y-H, Hallett M, Ahn SH, Kwon Y-H, et al. Virtual reality–induced cortical reorganization and associated locomotor recovery in chronic stroke an experimenter-blind randomized study. Stroke. 2005; 36(6):1166-71.##
  21. Morone G, Tramontano M, Iosa M, Shofany J, Iemma A, Musicco M, et al. The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial. BioMed research international. 2014;32(4):75-81.##
  22. Lee SH, Byun SD, Kim CH, Go JY, Nam HU, Huh JS, et al. Feasibility and Effects of Newly Developed Balance Control Trainer for Mobility and Balance in Chronic Stroke Patients: A Randomized Controlled Trial. Annals of Rehabilitation Medicine. 2012; 36(4):521-9.##
  23. Pietrzak E, Cotea C, Pullman S. Using commercial video games for falls prevention in older adults: The way for the future? Journal of geriatric physical therapy (2001). 2013;28(6)734-38.##
  24. Khajavi D, Validation and Reliability of Persian Version of Fall Efficacy Scale-Internatinal (FES-I) in community-dwelling older adults, Iranian Journal of Ageing, 2013; 8 (2) ;39-47. [In Persian].##
  25. Cikajlo I, Matjacic Z. Advantages of virtual reality technology in rehabilitation of people with neuromuscular disorders. Recent advances in biomedical engineering. 2009:301-20.##
  26. Singh DK, Rajaratnam BS, Palaniswamy V, Pearson H, Raman VP, Bong PS. Participating in a virtual reality balance exercise program can reduce risk and fear of falls. Maturitas. 2012; 73(3):239-43.##
  27. Agmon M, Perry CK, Phelan E, Demiris G, Nguyen HQ. A pilot study of Wii Fit exergames to improve balance in older adults. Journal of Geriatric Physical Therapy. 2011; 34(4):161-7.##
  28. Bateni H. Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study. Physiotherapy. 2012; 98(3):211-6.##
  29. Clark R, Kraemer T. Clinical use of nintendo Wii (TM) bowling simulation to decrease fall risk in an elderly resident of a nursing home: A case report. Journal of geriatric physical therapy. 2009; 32(4):174-80.##
  30. Gil-Gómez J-A, Lloréns R, Alcañiz M, Colomer C. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal of neuroengineering and rehabilitation. 2011;8(1):30##
  31. Chow RTK, Chan ACM, Tong JMC. Effectiveness of virtual reality in balance training in stroke rehabilitation: A pilot study. Hong Kong Physiotherapy Journal. 2013;31(2):100.##
  32. Singh DK, Rajaratnam BS, Palaniswamy V, Pearson H, Raman VP, Bong PS. Participating in a virtual reality balance exercise program can reduce risk and fear of falls. Maturitas. 2012;40(3)123-6.##
  33. Bell CS, Fain E, Daub J, Warren SH, Howell SH, Southard KS, et al. Effects of Nintendo Wii on quality of life, social relationships, and confidence to prevent falls. Physical & Occupational Therapy in Geriatrics. 2011;29(3):213-21.##
  34. Flynn S, Palma P, Bender A. Feasibility of using the Sony PlayStation 2 gaming platform for an individual poststroke: a case report. Journal of neurologic physical therapy. 2007; 31(4):180-9.##
  35. Mirelman A, Patritti BL, Bonato P, Deutsch JE. Effects of virtual reality training on gait biomechanics of individuals post-stroke. Gait & posture. 2010; 31(4):433-7.##
  36. Cho KH. Virtual reality balance training with video games system improves dynamic balance in chronic stroke patients. Tohoku JExpMed. 2012 Sep; 228(1):69-74.##
  37. Bisson E, Contant B, Sveistrup H, Lajoie Y. Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training. Cyberpsychology & behavior. 2007; 10(1):16-23.##
  38. Winstein C, Gardner E, McNeal D, Barto P, Nicholson D. Standing balance training: effect on balance and locomotion in hemiparetic adults. Archives of physical medicine and rehabilitation. 1989; 70(10):755-62.##
  39. Lee SW, Song CH. Virtual Reality Exercise Improves Balance of Elderly Persons with Type 2 Diabetes: a Randomized Controlled Trial. Journal of Physical Therapy Science. 2012.24(3): p. 261-265.##
  40. Pluchino A, Lee SY, Asfour S, Roos BA, Signorile JF. Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs. Archives of physical medicine and rehabilitation. 2012; 93(7):1138-46.##
  41. Brumels KA, Blasius T, Cortright T, Oumedian D, Solberg B. Comparison of efficacy between traditional and video game based balance programs. Clin Kinesiol. 2008; 62(4):26-31.##
دوماهنامه علمی - پژوهشی طب توانبخشی
دوره 4، شماره 3 - شماره پیاپی 3
مهر و آبان 1394
صفحه 27-37

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سابقه مقاله

  • تاریخ دریافت: 05 آبان 1393
  • تاریخ بازنگری: 07 اردیبهشت 1394
  • تاریخ پذیرش: 20 خرداد 1394
  • تاریخ اولین انتشار: 01 مهر 1394

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