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Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up.

Journal of Stroke Cerebrovascular Disease. 2018 Feb;27(2):494-498.

Authors – Carregosa A, Aguiar Dos Santos LR, Masruha MR, Coêlho MLDS, Machado TC, Souza DCB, Passos GLL, Fonseca EP, Ribeiro NMDS, de Souza Melo A.



To evaluate in the follow-up the sensory-motor recovery and quality of life patients 2 months after completion of the Nintendo Wii console intervention and determine whether learning retention was obtained through the technique.

Five hemiplegics patients participated in the study, of whom 3 were male with an average age of 54.8 years (SD = 4.6). Everyone practiced Nintendo Wii therapy for 2 months (50 minutes/day, 2 times/week, during 16 sessions). Each session lasting 60 minutes, under a protocol in which only the games played were changed, plus 10 minutes of stretching. In the first session, tennis and hula hoop games were used; in the second session, football (soccer) and boxing were used. For the evaluation, the Fulg-Meyer and Short Form Health Survey 36 (SF-36) scales were utilized. The patients were immediately evaluated upon the conclusion of the intervention and 2 months after the second evaluation (follow-up).

Values for the upper limb motor function sub-items and total score in the Fugl-Meyer scale evaluation and functional capacity in the SF-36 questionnaire were sustained, indicating a possible maintenance of the therapeutic effects.

The results suggest that after Nintendo Wii therapy, patients had motor learning retention, achieving a sustained benefit through the technique.

Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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Validation of a Kinect V2 based rehabilitation game

Mengxuan M, Rachel Proffitt , Marjorie Skubic

PLoS One. 2018; 13(8): (August 24, 2018)




Interactive technologies are beneficial to stroke recovery as rehabilitation interventions; however, they lack evidence for use as assessment tools. Mystic Isle is a multi-planar fullbody rehabilitation game developed using the Microsoft Kinect® V2. It aims to help stroke patients improve their motor function and daily activity performance and to assess the motions of the players. It is important that the assessment results generated from Mystic Isle are accurate. The Kinect V2 has been validated for tracking lower limbs and calculating gait-specific parameters. However, few studies have validated the accuracy of the Kinect® V2 skeleton model in upper-body movements. In this paper, we evaluated the spatial accuracy and measurement validity of a Kinect-based game Mystic Isle in comparison to a goldstandard optical motion capture system, the Vicon system. Thirty participants completed six trials in sitting and standing. Game data from the Kinect sensor and the Vicon system were recorded simultaneously, then filtered and sample rate synchronized. The spatial accuracy was evaluated using Pearson’s r correlation coefficient, signal to noise ratio (SNR) and 3D distance difference. Each arm-joint signal had an average correlation coefficient above 0.9 and a SNR above 5. The hip joints data had less stability and a large variation in SNR. Also, the mean 3D distance difference of joints were less than 10 centimeters. For measurement validity, the accuracy was evaluated using mean and standard error of the difference, percentage error, Pearson’s r correlation coefficient and intra-class correlation (ICC). Average errors of maximum hand extent of reach were less than 5% and the average errors of mean and maximum velocities were about 10% and less than 5%, respectively. We have demonstrated that Mystic Isle provides accurate measurement and assessment of movement relative to the Vicon system.

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Effects of virtual reality training using Nintendo Wii and treadmill walking exercise on balance and walking for stroke patients.

J Phys Ther Sci. 2016 Nov;28(11):3112-3115.

Bang YS1, Son KH2, Kim HJ2.



[Purpose] The purpose of this study is to investigate the effects of virtual reality training using Nintendo Wii on balance and walking for stroke patients. [Subjects and Methods] Forty stroke patients with stroke were randomly divided into two exercise program groups: virtual reality training (n=20) and treadmill (n=20). The subjects underwent their 40-minute exercise program three times a week for eight weeks. Their balance and walking were measured before and after the complete program. We measured the left/right weight-bearing and the anterior/posterior weight-bearing for balance, as well as stance phase, swing phase, and cadence for walking. [Results] For balance, both groups showed significant differences in the left/right and anterior/posterior weight-bearing, with significant post-program differences between the groups. For walking, there were significant differences in the stance phase, swing phase, and cadence of the virtual reality training group. [Conclusion] The results of this study suggest that virtual reality training providing visual feedback may enable stroke patients to directly adjust their incorrect weight center and shift visually. Virtual reality training may be appropriate for patients who need improved balance and walking ability by inducing their interest for them to perform planned exercises on a consistent basis.


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Upper extremity movement reliability and validity of the Kinect version 2


Purpose: Studies have shown that marker-less motion detection systems, such as the first generation Kinect (Kinect 1), have good reliability and potential for clinical application. Studies of the second generation Kinect (Kinect 2) have shown a large range of accuracy relative to balance and joint localization; however, few studies have investigated the validity and reliability of the Kinect 2 for upper extremity motion. This investigation compared reliability and validity among the Kinect 1, Kinect 2 and a video motion capture (VMC) system for upper extremity movements.

Design: One healthy, adult male performed six upper extremity movements during two separate sessions. All movements were recorded on the Kinect 1, Kinect 2 and VMC simultaneously. Data were analyzed using MATLAB (Natick, MA), Microsoft Excel (Redmond, WA), and SPSS (Armonk, NY).

Results: Results indicated good reliability for both Kinects within a day; results between days were inconclusive for both devices due to the inability to exactly repeat the desired movements. Range of motion (ROM) magnitudes for both Kinects were different from the VMC, yet patterns of motion were very highly correlated for both devices.

Conclusion: Simple transformations of Kinect data could bring magnitudes in line with those of the VMC, allowing the Kinects to be used in a clinical setting.

  • Implications for Rehabilitation
  • The clinical implications of the investigation support the notion that the Kinects could be used in the clinical setting if an understanding of their limitations exists.

  • Using the Kinects to make assessments with a given data collection session is acceptable. Using the Kinects to make comparisons across different days such as before or after an intervention should be approached with caution.

  • The Kinect 2 provides a more cost effective option compared to the VMC. Additionally, the Kinect is more portable, requires less time to set-up, and takes up less space, thus increasing its overall usability compared to the VMC.

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Using data from the Microsoft Kinect 2 to determine postural stability in healthy subjects: A feasibility trial

Dehbandi B, Barachant A, Smeragliuolo AH, Long JD, Bumanlag SJ, He V, et al. (2017) Using data from the Microsoft Kinect 2 to determine postural stability in healthy subjects: A feasibility trial. PLoS ONE 12(2): e0170890. doi:10.1371/journal.pone.0170890



The objective of this study was to determine whether kinematic data collected by the Microsoft Kinect 2 (MK2) could be used to quantify postural stability in healthy subjects. Twelve subjects were recruited for the project, and were instructed to perform a sequence of simple postural stability tasks. The movement sequence was performed as subjects were seated on top of a force platform, and the MK2 was positioned in front of them. This sequence of tasks was performed by each subject under three different postural conditions: “both feet on the ground” (1), “One foot off the ground” (2), and “both feet off the ground” (3). We compared force platform and MK2 data to quantify the degree to which the MK2 was returning reliable data across subjects. We then applied a novel machine-learning paradigm to the MK2 data in order to determine the extent to which data from the MK2 could be used to reliably classify different postural conditions. Our initial comparison of force plate and MK2 data showed a strong agreement between the two devices, with strong Pearson correlations between the trunk centroids “Spine_Mid” (0.85 ± 0.06), “Neck” (0.86 ± 0.07) and “Head” (0.87 ± 0.07), and the center of pressure centroid inferred by the force platform. Mean accuracy for the machine learning classifier from MK2 was 97.0%, with a specific classification accuracy breakdown of 90.9%, 100%, and 100% for conditions 1 through 3, respectively. Mean accuracy for the machine learning classifier derived from the force platform data was lower at 84.4%. We conclude that data from the MK2 has sufficient information content to allow us to classify sequences of tasks being performed under different levels of postural stability. Future studies will focus on validating this protocol on large populations of individuals with actual balance impairments in order to create a toolkit that is clinically validated and available to the medical community.

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Effectiveness of Exergaming Training (Wii) in Reducing Risk and Incidence of Falls in Frail Older Adults With a History of Falls.

Arch Phys Med Rehabil. 2015 Dec;96(12):2096-102. doi: 10.1016/j.apmr.2015.08.427. Epub 2015 Sep 7.

Fu AS, Gao KL, Tung AK, Tsang WW, Kwan MM.



To use Nintendo’s Wii Fit balance board to determine the effectiveness of exergaming training in reducing risk and incidence of falls in older adults with a history of falls.


Randomized controlled trial.


Nursing home for older adults.


Adults aged 65 years and older (N=60).


Participants who lived in a nursing home had 6 weeks of balance training with either Wii Fit equipment or conventional exercise.


Physiological Profile Assessment scores and incidence of falls were observed with subsequent intention-to-treat statistical analyses.


Physiological Profile Assessment scores and incidence of falls improved significantly in both groups after the intervention (all P<.01), but participants in the Wii Fit training group showed a significantly greater improvement in both outcome measures (P=.004 and P<.001, respectively).


In institutionalized older adults with a history of falls, Wii Fit balance training was more effective than conventional balance training in reducing the risk and incidence of falls.

Link to full article here

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Automated extraction and validation of children’s gait parameters with the Kinect

Authors: Saeid Motiian, Paola Pergami, Keegan Guffey, Corrie A Mancinelli and Gianfranco Doretto

BioMedical Engineering OnLine 2015 14:112

Published: 2 December 2015



Gait analysis for therapy regimen prescription and monitoring requires patients to physically access clinics with specialized equipment. The timely availability of such infrastructure at the right frequency is especially important for small children. Besides being very costly, this is a challenge for many children living in rural areas. This is why this work develops a low-cost, portable, and automated approach for in-home gait analysis, based on the Microsoft Kinect.


A robust and efficient method for extracting gait parameters is introduced, which copes with the high variability of noisy Kinect skeleton tracking data experienced across the population of young children. This is achieved by temporally segmenting the data with an approach based on coupling a probabilistic matching of stride template models, learned offline, with the estimation of their global and local temporal scaling. A preliminary study conducted on healthy children between 2 and 4 years of age is performed to analyze the accuracy, precision, repeatability, and concurrent validity of the proposed method against the GAITRite when measuring several spatial and temporal children’s gait parameters.


The method has excellent accuracy and good precision, with segmenting temporal sequences of body joint locations into stride and step cycles. Also, the spatial and temporal gait parameters, estimated automatically, exhibit good concurrent validity with those provided by the GAITRite, as well as very good repeatability. In particular, on a range of nine gait parameters, the relative and absolute agreements were found to be good and excellent, and the overall agreements were found to be good and moderate.


This work enables and validates the automated use of the Kinect for children’s gait analysis in healthy subjects. In particular, the approach makes a step forward towards developing a low-cost, portable, parent-operated in-home tool for clinicians assisting young children.

Link to full article HERE

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Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy.

Terry TrinhSarah E. ScheuerAngelica G. Thompson-ButelChristine T. Shiner & Penelope A. McNulty


Introduction: Post-stroke cardiovascular fitness is typically half that of healthy age-matched people. Cardiovascular deconditioning is a risk factor for recurrent stroke that may be overlooked during routine rehabilitation. This study investigated the cardiovascular responses of two upper limb rehabilitation protocols.
Methods: Forty-six stroke patients completed a dose-matched program of Wii-based Movement Therapy (WMT) or modified Constraint-induced Movement Therapy (mCIMT). Heart rate and stepping were recorded during early (day 2)- and late (day 12–14)-therapy. Pre- and post-therapy motor assessments included the Wolf Motor Function Test and 6-min walk.
Results: Upper limb motor function improved for both groups after therapy (WMTp = 0.003, mCIMT p = 0.04). Relative peak heart rate increased from early- to late-therapy WMT by 33% (p < 0.001) and heart rate recovery (HRR) time was 40% faster (p = 0.04). Peak heart rate was higher and HRR faster during mCIMT than WMT, but neither measure changed during mCIMT. Stepping increased by 88% during Wii-tennis (p < 0.001) and 21% during Wii-boxing (p = 0.045) while mCIMT activities were predominantly sedentary. Six-min walk distances increased by 8% (p = 0.001) and 4% (p = 0.02) for WMT and mCIMT, respectively.
Discussion: Cardiovascular benefits were evident after WMT as both a cardiovascular challenge and improved cardiovascular fitness. The peak heart rate gradient across WMT activities suggests this therapy can be further individualized to address cardiovascular needs. The mCIMT data suggest a cardiovascular stress response.
Conclusions: This is the first study to demonstrate a cardiovascular benefit during specifically targeted upper limb rehabilitation. Thus, WMT not only improves upper limb motor function but also improves cardiovascular fitness.
Full article link HERE
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The Effects of Nintendo Wii-Fit Video Games on Balance in Children with Mild Cerebral Palsy

Pediatrics International


Devrim Tarakci Assisstant Professor1,*,
Burcu Ersoz Huseyinsinoglu Assisstant Professor2,
Ela Tarakci Associate Professor2 and
Arzu Razak Ozdinçler Professor2

DOI: 10.1111/ped.12942



This study aimed to compare the effects of Nintendo Wii-Fit balance-based video games and conventional balance training in children with mild Cerebral Palsy (CP).


This randomized controlled trial included thirty ambulatory pediatric patients (5 to 18 years) with CP. Participants were randomized to either conventional balance training group (Control Group) or Wii-Fit balance-based video games group (Wii Group). Both group received Neuro-developmental treatment (NDT) during 24 sessions. In addition, while control group received conventional balance training in each session, Wii group performed Nintendo Wii Fit games like ski slalom, tightrope walk and soccer heading on balance board. Primary outcomes were Functional Reach Test (forward and sideways), Sit-to-Stand Test and Timed Get up and Go Test. Nintendo Wii Fit balance, age and game scores, 10-meter walk test, 10-step climbing test and Wee-Functional Independence Measure (Wee FIM) were secondary outcomes.


After the treatment, changes at balance scores and independence level in activities of daily living were significant (p<0.05) in both groups. Statistically significant improvements were found in Wii-based game group over control group in all balance tests and total Wee FIM score (p<0.05).


Wii-fit balance based video games are better at improving both static and performance-related balance parameters when combined with NDT treatment in children with mild CP.


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Is There Evidence That Active Videogames Increase Energy Expenditure and Exercise Intensity for People Poststroke and with Cerebral Palsy?

Deutsch Judith E., Guarrera-Bowlby Phyllis, Myslinski Mary Jane, and Kafri Michal. Games for Health Journal. January 2015, 4(1): 31-37. doi:10.1089/g4h.2014.0082.


This article asked and answered the question of whether there was evidence to support the use of videogames for promotion of wellness and fitness for people poststroke and those with cerebral palsy (CP). A literature search of PubMed, CINAHL, and PEDro using a population, intervention, and outcome (PIO) approach and the key words “stroke (or CP) AND video games (and synonyms) AND energy expenditure (EE) (and synonyms)” was conducted. It yielded two relevant references for people poststroke and five references for people with CP. The literature extraction and synthesis by the categories of the PIO indicated that most studies used only the population of interest, except two that compared the EE with that of healthy controls. The main finding is that both people poststroke (moderate severity) and people with CP (mild severity) can achieve moderate EE playing Wii(™) (Nintendo, Kyoto, Japan), PlayStation(®) (Sony, Tokyo, Japan), and Kinect(™) (Microsoft, Redmond, WA) games. Adults with CP of mild severity played the videogames at vigorous levels, whereas those with severe CP played them at low levels. There appears to be an interaction between development and severity that influences the exercise intensity measured by EE. The findings suggests that videogames are a gateway for wellness promotion.


Link to article HERE

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