The Effect of X Box 360 Kinect-Virtual Reality Intervention on Balance and Gait Training In Stroke Patient": An Interventional Study - Open ...
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532 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
The Effect of X Box 360 Kinect-Virtual Reality Intervention
on Balance and Gait Training In Stroke Patient”: An
Interventional Study
Nikita Girishbhai Shobhana1, Shweta Rakholiya2
1
MPT Neuromuscular Science, 2Assistance Professor, School of Physiotherapy, RK University, Rajkot
Abstract
Background: Kinect- based Virtual Reality training that includes auditory and visual stimulation, feedback
information, repetitions of the same motion that performing rehabilitation exercises. Aim: To Evaluate the
effect of XBOX 360 Kinect-Virtual Reality training on balance and gait in patient with chronic stroke.
Methodology: Consent was taken from all 30 subjects for participating in the study. Baseline measurements
berg balance scale, 6 min walk test and gait parameters will be taken. Patients randomly have divided into 2
groups. Group A: conventional PT (n=15) 60 min and Group B: conventional PT with Virtual reality XBOX
360 Kinect (n=15) 60 min. After they will be assessed for post outcome measures. Conclusion: there is
conclude that virtual reality X box 360 with physical therapy is more effective then only physical therapy
for improve balance and gait in chronic stroke patients.
Key Words: Stroke- balance and gait activity -XBOX 360-Virtual reality.
Introduction the ability to objectively measure behavior in challenging
but safe and ecologically valid environments, while
Stroke, is the second largest cause of death and a
gradually increasing the complexity of task and decrease
major cause of disability & handicap. (10,11) In people
the support provided by clinicians (1). A number of
recovery of functional ability after stroke is variable and
researchers have integrated VR into assessment &
between 30 – 60% of people remain dependent on other
rehabilitation of cognitive process, such as visual
for some activities of daily living. (5) Key functional task
perception & executive function, and into training of
such as ability to walk has been identified by patient as
activities of daily living.
being of great significance. Approximately 50 – 80% of
patient will regain some degree of walking ability after One key benefit is VR’s more naturalistic or “real
stroke. (9) – life” environments. (11) The environment is usually
referred as being ‘Immersive’ in which user has a strong
VR is an advanced technology that can display
“sense of presence” by using video capture system where
3D visual images that change rapidly in response to
the user view them self or an avatar in the scene. In a
instruction from the user which appears to provide an
Non Immersive VR the user interacts with degrees with
answer to this challenge due to its well-known assets
environment. In addition, VR can be tailored according
including opportunity for experiential active learning,
to the need of the client (1)
VR-based systems that use sensor technology to
Corresponding Author: monitor whole-body movements can elicit patients to
Dr. Shweta Rakholiya, perform high-intensity and high-energy movements.
Assistant professor, School of Physiotherapy, Kinect- based systems (Microsoft Corp, Redmond,
RK University, Rajkot. (M): 9724779333 WA) reduce the demand on staff time for intervention
Mail ID: shweta.rakholiya@rku.ac.in and increase patients’ motivation toward rehabilitation.Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 533
Kinect- based VR training that includes auditory or neurological condition, demonstrate inability to
and visual stimulation, feedback information about follow instructions.
“winning” or “losing,” and repetitions of the same
Procedure
motion can provide a variable rehabilitation tool that
reduces barriers to individuals performing rehabilitation • 30 subjects were selected as per selection
exercises. (1) criteria.
The most recently released Xbox Kinect system • Then Informed consent obtained from the
has an RGB camera and a dual infrared depth sensor patients.
for the automatic detection of limb and body position
and motion. The system uses these elements to capture • Patient randomly divided into group A and
data to create a 3-dimensional human body model in group B.
real time, called an avatar, which allows for patient to
• Group A - conventional Physical Therapy with
use their own body as the controls to play a game. The
Virtual reality XBOX 360 Kinect(1,3,4). (n = 15)
reliable visual feedback from the on-screen player’s
avatar may provide accurate feedback on movement(1). • Group B - conventional Physical Therapy(1). (n
= 15)
Although the Kinect gaming system has been
shown to be of therapeutic benefit in rehabilitation, the GROUP A
applicability of Kinect-based VR training to improve
motor function in patients following the occurrence of a Patients was exposed to two software for XBOX
stroke has not been evaluated. (1) 360 kinect.
1. Kinect Sports.
Methodology
· Study type: Interventional Study Kinect Sports consists of 6 sports, including
Bowling, Boxing, Track and field, Table tennis,
· Study setting: Rajkot city Volleyball and Soccer (football). Players can also play
improving mini-games. The game includes interactive
· Sample size: 30
cut scenes, music that plays in replays and highlights
· Study duration: 6 weeks. while playing the sports.
CRITERIA FOR SELECTION 2. Kinect Adventure:
Inclusion Criteria: Kinect Adventures uses full body motion to allow
the player to engage in a variety of mini games, all of
• Age: 40 – 60 years. which feature jump-in, jump-out multiplayer play. Each
• Gender: male and female mini game lasts about three minutes. While most of the
mini games are co-operative in two player mode, Reflex
• Chronic stroke patient: more than 6 months Ridge is a competitive game. The object of all the mini
games is to get the highest number of adventure pins,
• Could walk independently or with a guide (with
which are collected in different ways.
or without an assistive device) for 10 m.
GROUP B
• With a MMSE rating >24.
ROM exercises, Balance training, Gait training: 3
Exclusion Criteria:
days per week, 60 min
• Uncooperative patient.
Outcome measures
• Subjects with any progressive, critical or long
Berg Balance Scale.
term illness, an unstable cardiovascular, musculoskeletal534 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
6 Min Walk Test. Pre intervention, baseline characters BBS, 6 min walk
test, gait parameters of both groups were matched using
Gait parameters - step length, stride length, cadence
statistical tests.
Results The data was analyzed in SPSS version 21.0 windows
The effect of Virtual reality using X BOX 360 Kinect was used for the statistical analysis. Accordingly, paired
on postural control and gait calculated and entered in t test was used for Intra group analysis for 6 min walk
MS-EXCEL. It analyzed and graphs were made in test and gait parameters and Wilcoxon test for BBS and
MS-EXCEL sheets. Before beginning with analysis, Unpaired t Test for Inter group analysis and p-value less
than 0.05 were considered statistically significant.
Table 1 GROUP A INTRA GROUP ANALYSIS
Post PRE POST
Outcome Measure Pre Mean P-value
Mean Standard Deviation Standard Deviation
BBS 43.73 50.13 4.11 3.70
6 MWT 53.06 62.53 4.46 4.73
STEP LENGTH 43.86 59.53 5.39 8.36 0.000
STRIDE LENGTH 85.33 108.13 10.54 14.62
CADENCE 87.2 102.46 10.54 10.94
Intra group analysis of group A in Table 1 suggest that there is significant difference in all the outcomes after 6
weeks of Virtual reality X box 360 and conventional therapy.
Table 2 GROUP B INTRA GROUP ANALYSIS
Pre PRE POST
Outcome Measure Post Mean P-value
Mean Standard Deviation Standard Deviation
BBS 44.06 48.6 4.19 3.35
6 MWT 52.8 59.26 3.25 3.55
STEP LENGTH 44 55.53 3.56 5.12 0.000
TRIDE LENGTH 82 91.13 6.33 6.05
CADENCE 87.46 95.8 8.83 7.60
Intra group analysis of group B in Table 2 suggest that there is significant difference in all the outcomes after 6
weeks of conventional therapy.Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 535
Table 3 INTER GROUP ANALYSIS
Group A Group B
Group A Group B
Outcome Measure Standard Standard T value P-value
Mean Mean
Deviation Deviation
BBS 50.13 48.60 1.29 1.40 3.77 0.001
6 MWT 62.53 59.26 2.38 2.92 3.07 0.005
STEP LENGTH 59.53 55.53 3.81 3.04 3.28 0.003
STRIDE LENGTH 108.13 91.13 10.01 3.70 4.95 0.000
CADENCE 102.46 95.80 3.90 3.67 5.01 0.000
Inter group analysis in table 3 suggest that group the in-depth research as there have been several motion
A shown significant improvement than group B. There tracking devices introduced by gaming industry, like
is more significant improvement in balance and gait in Nintendo Wii, PlayStation 3 eye and Microsoft XBOX
patients with chronic stroke. 360 Kinect & if these techniques can be used for home
based upper extremity rehabilitation. The results are
However, for the BBS, 6 min walk test and gait
promising and test results show that the techniques
parameters the intervention group demonstrated
meet the requirements and already proved to help in
significant improvement as compared with the control
rehabilitation.(7) VR training may have contributed to
group.
the improvements in balance and gait function observed
Discussion in the participants by encouraging more interest,
concentration on the task, fast response, repetition of
In the result of the study, group A - shows more exercise, motivation for patients, provide feed to patients
significant difference than group B. Previous studies during exercise and other side alternative to programs of
have reported improved upper extremity function repetitious exercise that are often performed in front of
in patients with stroke following use of VR gaming a mirror that can provide low intrinsic motivation(1,2) In
systems. (1) Hsin-Chieh Lee suggested, VR balance the present study, a combination of 2 games (the Kinect
training by using Kinect for Xbox games plus the Sports and the Kinect adventure) was used for stroke
traditional method had positive effects on the balance patients. The programs required active movements, and
ability of patients with chronic stroke. The VR group the participants usually performed the active movements
experienced higher pleasure than the ST group during the of the hip, knee, or ankle, as well as the lower extremity.
intervention. (2) Pohl, concluded that the stroke related There measure BBS, 6 min walk test and gait parameters
impairments are powerful modifiers of performance in scores. That the VR had a positive effect on improving
a 6-minute walk test. Motor deficits of lower limb and participation in balance and gait. Group B had 15
decrease balance contribute to the distance travelled by patients performing conventional physiotherapy in this
an adult in 6 minutes. (6) Albert de Graaf investigated ROM, Balance training in weight bearing and weight536 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
shifting exercises weight bearing with reach out, and Study can be done to know effect of Virtual reality
in Gait training walking forward, backward, sidewalk, Xbox 360 exercise in patients with Parkinsonism or
obstacle walk. Which all exercises are done in VR other neurological disorders.
with feedback and in form of game so patient become
motivation and feedback and also they also like to do Conclusion
exercise with game. Virtual reality training using X box 360 Kinect as
effective therapeutic approach for improving balance
Balance and gait is improved in virtual reality
and gait in stroke patients in rehabilitation. Their level of
group reason could be Virtual reality training is given
experienced by VR group was higher than conventional
in simulated environment providing visual input like
physical therapy group. So there is conclude that virtual
subject can recognize their body on screen through
reality X box 360 with physical therapy is more effective
Kinect and can move body part in order to play different
then only physical therapy for improve balance and gait
games, auditory input were also provided, subjects were
in chronic stroke patient.
instructed for each game and continuous live feedback of
their progress are provided through speakers, they were Source of Funding: Self
appreciated for their gains in every move, Somatosensory
feedback is also provided to subjects by keeping hand on Conflict of Interest: Nil
patients paretic arm to move it in right direction and also
CTRI No: CTRI/2019/10/021499
through trunk belt which gives feedback for, appropriate
movements in different directions which work on proper Ethical Clearance: Ethics Committee, RK
dissociation of trunk during game. Therefore, all three University.
components necessary to improve balance are provided
in VR technique. Which shows significant improvement References
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