Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study

Bernadette C Tobler-Ammann, Elif Surer, Eling D de Bruin, Marco Rabuffetti, N Alberto Borghese, Renato Mainetti, Michele Pirovano, Lia Wittwer, Ruud H Knols

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames-games based on therapeutic principles-aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility.

OBJECTIVES: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke.

METHODS: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention.

RESULTS: The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%).

CONCLUSIONS: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations-for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.

Original languageEnglish
Pages (from-to)e17
JournalJMIR serious games
Volume5
Issue number3
DOIs
Publication statusPublished - Aug 25 2017

Fingerprint

Space Flight
Feasibility Studies
Stroke
Calibration
Safety
Patient Compliance
Education
Equipment and Supplies
Therapeutics

Cite this

Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect : A Feasibility Study. / Tobler-Ammann, Bernadette C; Surer, Elif; de Bruin, Eling D; Rabuffetti, Marco; Borghese, N Alberto; Mainetti, Renato; Pirovano, Michele; Wittwer, Lia; Knols, Ruud H.

In: JMIR serious games, Vol. 5, No. 3, 25.08.2017, p. e17.

Research output: Contribution to journalArticle

Tobler-Ammann, BC, Surer, E, de Bruin, ED, Rabuffetti, M, Borghese, NA, Mainetti, R, Pirovano, M, Wittwer, L & Knols, RH 2017, 'Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study', JMIR serious games, vol. 5, no. 3, pp. e17. https://doi.org/10.2196/games.7923
Tobler-Ammann, Bernadette C ; Surer, Elif ; de Bruin, Eling D ; Rabuffetti, Marco ; Borghese, N Alberto ; Mainetti, Renato ; Pirovano, Michele ; Wittwer, Lia ; Knols, Ruud H. / Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect : A Feasibility Study. In: JMIR serious games. 2017 ; Vol. 5, No. 3. pp. e17.
@article{ca22acc8a9d94dc4982fc2f5195fb1e3,
title = "Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study",
abstract = "BACKGROUND: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames-games based on therapeutic principles-aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility.OBJECTIVES: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke.METHODS: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Z{\"u}rich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention.RESULTS: The median was 14 out of 15 (93{\%}) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71{\%}) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6{\%}).CONCLUSIONS: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations-for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.",
author = "Tobler-Ammann, {Bernadette C} and Elif Surer and {de Bruin}, {Eling D} and Marco Rabuffetti and Borghese, {N Alberto} and Renato Mainetti and Michele Pirovano and Lia Wittwer and Knols, {Ruud H}",
note = "{\circledC}Bernadette C Tobler-Ammann, Elif Surer, Eling D de Bruin, Marco Rabuffetti, N Alberto Borghese, Renato Mainetti, Michele Pirovano, Lia Wittwer, Ruud H Knols. Originally published in JMIR Serious Games (http://games.jmir.org), 25.08.2017.",
year = "2017",
month = "8",
day = "25",
doi = "10.2196/games.7923",
language = "English",
volume = "5",
pages = "e17",
journal = "JMIR serious games",
issn = "2291-9279",
number = "3",

}

TY - JOUR

T1 - Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect

T2 - A Feasibility Study

AU - Tobler-Ammann, Bernadette C

AU - Surer, Elif

AU - de Bruin, Eling D

AU - Rabuffetti, Marco

AU - Borghese, N Alberto

AU - Mainetti, Renato

AU - Pirovano, Michele

AU - Wittwer, Lia

AU - Knols, Ruud H

N1 - ©Bernadette C Tobler-Ammann, Elif Surer, Eling D de Bruin, Marco Rabuffetti, N Alberto Borghese, Renato Mainetti, Michele Pirovano, Lia Wittwer, Ruud H Knols. Originally published in JMIR Serious Games (http://games.jmir.org), 25.08.2017.

PY - 2017/8/25

Y1 - 2017/8/25

N2 - BACKGROUND: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames-games based on therapeutic principles-aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility.OBJECTIVES: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke.METHODS: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention.RESULTS: The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%).CONCLUSIONS: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations-for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.

AB - BACKGROUND: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames-games based on therapeutic principles-aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility.OBJECTIVES: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke.METHODS: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention.RESULTS: The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%).CONCLUSIONS: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations-for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.

U2 - 10.2196/games.7923

DO - 10.2196/games.7923

M3 - Article

C2 - 28842388

VL - 5

SP - e17

JO - JMIR serious games

JF - JMIR serious games

SN - 2291-9279

IS - 3

ER -