Cards, dominoes as good as virtual reality games in stroke recovery

Simple recreational activities such as playing cards or repeatedly tossing a foam ball into a wastepaper basket are as effective as playing virtual reality games like Wii in helping patients recover hand strength and dexterity following a stroke, a Canadian-led study has found.

"We all like technology and have the tendency to think that new technology is better than old-fashioned strategies, but sometimes that's not the case," said Dr. Gustavo Saposnik, a neurologist at St. Michael's Hospital in Toronto, who led the study published Monday in the journal Lancet Neurology.

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"In this study, we found that simple recreational activities that can be implemented anywhere may be as effective as technology," he said.

"This is very important for access to care."

Researchers from 14 centres in Canada, Argentina, Peru and Thailand enrolled a total of 141 patients who had suffered a stroke that affected one arm. Half were randomly assigned to receive 10 one-hour sessions over a two-week period using the Nintendo Wii platform to play such virtual games as tennis and bocce ball.

The other half engaged in low-cost activities such as card-playing, dominoes, bingo and ball-tossing during an equal number of sessions over that interval.

The extra therapy was in addition to conventional rehabilitation each patient received to try to regain strength and co-ordination in their arm and hand that was lost as a result of brain damage caused by their stroke.

Saposnik said patients in both groups saw a 30 per cent and 40 per cent improvement in arm and hand function at the end of the two-week intervention and four weeks after the intervention, respectively.

"There was no significant difference between the two groups in terms of strength, dexterity, gross motor skills, quality of life or activities of daily living," said Saposnik, who admitted to being surprised at the outcome.

"I thought that technology — so virtual reality — would be more effective by far than a simple recreational activity. But I was wrong."

Enjoyable activities

Stephen Glass, who was diagnosed with a stroke last week at St. Michael's Hospital, said Monday the fine motor skills in his hand and his walking have been affected. While not noticeable to anyone listening, he also feels he is struggling somewhat to speak with his usual ease.

The 51-year-old will be starting traditional rehabilitation this week, but does not know if he will be offered one of the adjunct therapies described in the study.

Still, he believes the principles of the two therapies are the same — it's just the methodologies that differ.

"I would imagine to somebody of my age, maybe a little older and below, something that speaks to the way they function in their daily lives — with iPads, with screens, with technology —would be enjoyable, would be something they would relate to," said Glass, who last year gave up his career as a pianist and conductor to pursue a lifelong dream to become a broadcaster.

"But I would imagine if a 60- or 70- or 80-year-old had a debilitating stroke, the idea of finding an activity that spoke to their cultural norms — playing cards, putting a ball into a wastepaper basket — would be something that would bypass any anxiety they feel [about technology] and would allow them to focus on the actual task."

Saposnik said many previous studies, including a 2010 pilot study of his own, had concluded that virtual reality therapy was an effective way to boost stroke patients' recovery. Overall, the research suggested that patients given such therapy experienced up to a 30 per cent improvement in their motor skills.

This new trial involved far more participants — making the power of its findings more robust — than previous studies, which also differed in design: they compared a combination of conventional rehab and virtual reality therapy against conventional therapy alone. The interactive game technology was not compared to other hand-focused pursuits like card-playing, he said.

"Now I can say you can do conventional rehab plus either virtual reality or simple recreational activities, whatever you like better, because non-immersive virtual reality is no more effective."

That's important for those living in areas of Canada or in developing countries without access to virtual reality technology, he said.