Impact of Gaming Technology on Stress and Hand Function in Patient with Hemiparesis: A Case Study
Vignesh Srinivasan1*, Poovarasan Murugaiyan2, Varalakshmi Ruthubalan3,
Prathap Suganthirababu4
1Assistant Professor, Saveetha College of Physiotherapy,
Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India.
2Post Graduate, Saveetha College of Physiotherapy,
Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India.
3Post Graduate, Saveetha College of Physiotherapy,
Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India.
4Professor, Saveetha College of Physiotherapy,
Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India.
*Corresponding Author E-mail: vignesh.scpt@saveetha.com
ABSTRACT:
A 44-year-old male with a known comorbidities of type 2 diabetes mellitus and hypertension and history of acute intra cerebellar hemorrhagic stroke, who was admitted and treated conservatively, now he had complaints of poor right hand function referred to physiotherapy for improve the hand function, after assessing the patient with a hand function test, there was a poor hand function compared to non affected side. during examining the patient, he was stressed because of poor hand function which had an impact on its work area and in daily activities ,the level of stress is assessed using a stress scale ,stress often associated with post stroke , so addressing stress shows improved effect on upper limb rehabilitation, App based games and other games were given to patient for 4 session per week for 2 weeks, after the intervention there was an improvement in hand function and reduction in the stress level also, using games for treatment in stroke patients becomes a new trend, A chronic residual disability of the upper limb is present in almost seventy percentage of stroke patients. hence hemiparesis associated with poor hand function leads to both short term and long-term disability in post stroke resulted in reduced quality of living. Recent trends for the upper limb rehabilitation involves app-based games show's promising result in patient with hemiparesis, this study suggests the use of an simple games to improve hand function even reducing the stress in order to prevent post stroke and stress related complication and improve in the quality of living.
KEYWORDS: Hemiparesis, Stroke, Gamification, Hand function, Stress.
INTRODUCTION:
Stroke is one of the leading causes of acquired adult impairment and a serious worldwide health issue after being discharged from the hospital, seventy to eighty percentage of stroke patients have difficulty with their everyday activities, In 2021 they conducted study related to patient knowledge about stroke risk factors in that, they found out patients had a poor knowledge on risk factors1,2, for that the structured teaching programme helps to improve knowledge regarding risk factors3,4,5. The most frequently involved artery in acute strokes is the middle cerebral artery (MCA). These vessels supply blood to deeper brain structures as well as portions of the frontal, temporal, and parietal lobes of the brain. Because of their extensive supply, strokes affecting the MCA territory can present with a wide range of symptoms, depending on which branches and structures are affected. Although both types of strokes have a serious impact, the study's findings suggest that hemorrhagic strokes have a greater impact than ischemic strokes6, in acute phase of stroke upper limb related impairment is more compare to the chronic phase. Many research reported that even in post stroke patient possess a chronic limitation in upper extremity mobility, jaw mobility7 and there were observed differences in linguistic function and orientation between the populations from the Golden Period and the non-Golden period after the stroke8.
Within the first month following a stroke, most of upper limb function often take place. According to some research, neurorehabilitation can speed up neurological recovery, and rigorous, repetitive, and task-specific exercise regimens are necessary to induce neuro-plastic adaptations, the physical activity after stroke or in post stroke helps in prevent muscle atrophy and excess fat deposition9 Furthermore, because of the increased brain plasticity during this time after a stroke, early intervention is advised. Hemiparesis associated with low hand grip strength leads to both short term and long term disability, increased dependency of ADL activities, poor hand grip strength indirectly affects the motor function of upper limb, recent studies shows that use of hand grip has an biomarker for the overall health status of an individual, Perceived stress or post-traumatic stress disorder is most common following stroke, stress disorder often hinders the rehabilitation process and recovery of upper limb functions, so addressing stress plays an significant role in the improvement of hand function through rehabilitation.
Mirror therapy a conventional method often used in hemiplegic patients for upper limb rehabilitation10,11, Now Video games (VGs) or app-based games are recent trends in the upper limb rehabilitation, shows promising results in the hand function improvement, first and foremost, the benefit of using VGs for UL rehabilitation is the chance of modification in the specific exercise regimen on intensity and duration. VGs offer goal-oriented tasks and repetitive exercises in an enriched and interactive environment, highly suspected to increase recovery after neurological lesion, VBT has a number of benefits, including the ability to be utilized at home and variation in artificial surroundings or stimuli as well as games. These benefits might increase the desire to continue a repeated intervention. By detecting and correcting movement faults, using VBT that can increase the effectiveness of learning-based training. online feedback is a crucial part due to the hands' lack of sensory input from an actual item, visual and auditory feedback are especially crucial in VBT.
App based games used in home-based settings also, creates a stress free environment and indirectly plays a role in reduction of stress by playing games and motivation followed by winning the task in the game and knowledge to caregivers increase the patient’s recovery in home settings12 however they feel more burden yet they cope up with things, A study conducted on stroke patients using finger mount to assist hand movements shows improvement13. In this study Jebsen taylor hand function used to asses the hand function and perceived stress scale for progression of stress during the rehabilitation.
CASE REPORT:
A 44-year-old male was admitted with sudden weakness on his right side apparently normal before 10 pm (May 25, 2024) after which he had neck pain for 25mins and sudden weakness over the right upper and lower limbs. The patient was provisionally diagnosed with acute CVA/accelerated hypertension with right hemiparesis in emergency/T2DM and was shifted for radiological imaging. A CT brain scan was done on the same day may 25, 2024 noted with cerebral hemorrhage. The patient was medically managed with atrovastin and inj levipril, electrolytes and other supportive measures.The patient was referred to the physiotherapy rehabilitation for strengthening the right upper and lower limb, post rehabilitation was done with strengthening and gait training , now patient came to physiotherapy on June 1st week with the complaints of unable to do fine adl hand function like writing and eating even in work area, assessment done used Jebsen taylor hand function test for both dominant and non dominant hand which showed poor hand function, also patient stress level was assessed by perceived stress scale which showed moderate stress score. Patient were explained about the study, After getting consent, the patient was treated with android mobile games (whack a mole, temple run,pebbles used for hand and eye coordination), group of games were given 45mins per session in a comfortable environment, 4 sessions per week for 2 weeks, which was 4 days per week. The treatment includes app based like temple run and whack a mole which will increase the reaction time and pebbles to hold in hand and put it on a hole and throwing pebbles up and catch with a hand which will increase the hand eye coordination, the session planned for 45mins in a day and level of hard increased each day, games with an comfort environment had an positive impact on the stress level.
Table 1. Outcome measure of the pre and post test values of the hand function test
|
Outcome measure Subtest |
Test one |
Test two |
||
|
Non dominant Hand |
Dominant Hand |
Non dominant Hand |
Dominant Hand |
|
|
Writing |
20.87 sec |
38.64 sec |
20.32 sec |
24. 64 sec |
|
Simulated page turning |
4.56 sec |
6.23 sec |
4.36 sec |
5.05 sec |
|
Lifting small common objects |
7.23 sec |
8.32 sec |
6.98sec |
7.83 sec |
|
Simulated feeding |
5.38 sec |
6.20 sec |
5.40 sec |
5.32sec |
|
Stacking checkers |
4.08 sec |
3.94 sec |
3.85 sec |
3.12 sec |
|
Lifting large, light objects |
3.42 sec |
3.62 sec |
3.40 sec |
3.12 sec |
|
Lifting large, heavy objects |
3.72 sec |
3.44 sec |
3.68 sec |
3.40 sec |
OUTCOME MEASURES: (Table-1)
The hand function was measured using Jebsen Taylor hand function test (Jebsen R et al.,1969) and the level of stress was measured using Perceived stress scale both the hand function and stress level were measured before and after the physiotherapy intervention for 2 weeks.
Perceived stress scale:
In the pre intervention assessment patient score was 16 – moderate stress level according to the scale.
Post intervention after 2 weeks score- 10 – low stress according to the scale.
Jebsen Taylor Hand function test:
The subtest was performed by subject both pre and post test assessment were shown in second to complete the subtest.
DISCUSSION:
Hemorrhagic strokes account for twenty percent of all stroke cases; intracerebral hemorrhage (ICH) is the most common type. The frequency of ICH increases when hypertension is not controlled, aspirin is the most common drug used in stroke but excess intake cause ulcer so zinc compound were used along with aspirin to reduce ulcers14 and there is another compound DHF which prevents cell death by reduce hypoxia15 and there is an abnormally high risk of early death and long-term disability associated with ICH in particular the first antihypertensive drugs were given in the acute phase, according to the 2011 guidelines, and hospital clinical practice guidelines, they followed and administering IV antihypertensive dosages to severe bleeding stroke patients at the hospital16, A limited period of neuroplasticity appears to open up after a stroke, during which the best healing gains seem to occur, according to evidence from animal models. Synapse strengthening and activity-dependent rewiring are two processes of plasticity. There are studies reported use of a plant based extracts for treatment of stroke, still physiotherapy plays a better role than drugs17, also lifestyle plays a major role in prevention of stroke18, Enhancing stroke recovery requires an understanding of how to appropriately engage and modify surviving neural networks to generate innovative response strategies that compensate for tissue lost to injury19.
Chronic patient with stoke had cognitive relative impairments also, for that the prefrontal region of the brain, which controls cognitive performance, was more efficiently activated by high-intensity aerobic exercise combined with dual-task training20. This resulted in favorable physiological changes in the brain that improved cognitive function, the cognitive related impairment will have a negative impact on the rehabilitation process and anxiety a major problem during therapy especially dealing with elderly stroke patients for that the vagal nerve stimulation helps to reduce anxiety21. Hemiparesis is the weakness of the affected upper and lower limb in patient with stroke, followed by stroke there is a motor impairment due to paralysis or weakness of the limbs to perform the task. Due to the weakness there is difficulty in walking and doing the normal ADL activity and while the rehabilitation process also strengthening and other conventional therapies were used to improve the overall strength and condition of the patient, the neurological rehabilitation shows marked improvement22, the ACA type stroke affects gait more than the MCA type the recent trend VR-based gait training helps a lot for the rehabilitation23, the most common MCA type stroke affects the upper limb, so there will be an poor hand function and grip to even perform the exercise also, now its showed that gamification also had an significant improvement in the hand function24. Therefore, the gamification can be used to treat hand function in patient with stroke, on the other hand there is an increased stress25 level in patient while performing exercise and adl activity also, now its showed gamification also helps in reduction of stress.
CONCLUSION:
The study conclude that gamification was effective in improving the hand function of patient with hemiparesis followed by stroke, specifically we noticed fine dexterity function was improved and also helps in reduction of the stress level.
CONFLICT OF INTEREST:
No conflict of interest.
ACKNOWLEDGMENTS:
It gives me great pleasure to thank the department and all the people who helped us build the framework for this case study for my research project. Sincere thanks go extended to my patient and their caregivers, It gives us great pleasure to extend our sincere gratitude to the authors of the outcome measures Sheldon Cohen and Jebsen, along with the authors citation for the references used in this study.
REFERENCES:
1. Sathiya K, Vijayasamudeeswari P, Poongodi R. Awareness of Risk factor and Warning symptoms of Stroke among patients with hypertension at Tertiary care hospital of South India. Research Journal of Pharmacy and Technology. 2021; 14(11): 5769-74. DOI: 10.52711/0974-360X.2021.01003
2. Bhatia R, Sharma G, Gopichandran L. A Comparative Study to Assess the Knowledge on Risk Factors, Warning Signs and Immediate Treatment of Stroke among Stroke Survivors and Patients of Cardiovascular Disorders who are at risk of Stroke. Asian Journal of Nursing Education and Research. 2016; 6(3): 391-6.
3. Mary AS, Devi SS, Devi LD. Effectiveness of structured teaching programme on knowledge regarding warning signs and prevention of stroke among hypertensive patients in selected hospitals at Bangalore. Asian Journal of Nursing Education and Research. 2022; 12(3): 313-6. DOI: 10.52711/2349-2996.2022.00065
4. Patidar U, Patel H. A Study to assess The Effectiveness of Structured Teaching programme on Knowledge regarding prevention of stroke among Hypertensive patients in selected Hospitals of Mehsana District. Asian Journal of Nursing Education and Research. 2020; 10(1): 89-92. DOI: 10.5958/2349-2996.2020.00020.8
5. Wiselin CS, Lekshmi C. Effect of Structured Teaching Programme on Knowledge regarding Prevention and Warning signs of Stroke among High Risk Patients. International Journal of Advances in Nursing Management. 2018; 6(4): 293-8. DOI: 10.5958/2454-2652.2018.00067.7
6. Ali DK. Quality of life of patients with ischemic stroke versus hemorrhagic stroke: comparative study. Research Journal of Pharmacy and Technology. 2018; 11(11): 4911-5. DOI: 10.5958/0974-360X.2018.00893.4
7. Umasankar Y, Srinivasan V, Suganthirababu P, Murugaiyan P. Efficacy of Proprioceptive Neuromuscular Facilitation on Jaw Function in Bruxism Among Post Stroke Survivor: A Case Study. International Journal of Experimental Research and Review. 2024;42.
8. Gabrielle A, Adam OM, Mulyati S, Diarsvitri W. Onset-To-Door and Cognitive Function in Ischemic Stroke patients. Age. 2024 Mar 31; 14: 45-2. DOI: 10.52711/0974-360X.2024.00161
9. Jee H. Comparisons of the body Composition and the effects of Physical activity on the Upper and Lower Limbs of the Female Post-Stroke Patients. Research Journal of Pharmacy and Technology. 2017; 10(9): 3074-80. DOI: 10.5958/0974-360X.2017.00545.
10. Dave K. Effects of Mirror Therapy on Upper Extremity Functions among Hemiplegic patients: An Experimental Study. International Journal of Advances in Nursing Management. 2020; 8(2): 141-4. DOI: 10.5958/2454-2652.2020.00033.5
11. Jose N. Mirror Box Therapy. International Journal of Advances in Nursing Management. 2014; Apr 28; 2(2): 97-9.
12. Bhavya SV, Vidya M. Knowledge and Attitude of Care Givers regarding Home Care Management of Stroke patients. International Journal of Nursing Education and Research. 2017; 5(3): 341-3. DOI: 10.5958/2454-2660.2017.00071.0
13. Divakaran S, Bethanney JJ, Umashankar G, Nangai VL. Rehabilitative Finger Mount to assist Finger Movement in Chronic Stroke Patients. Research Journal of Pharmacy and Technology. 2017; 10(4): 1034-6. DOI: 10.5958/0974-360X.2017.00187.1
14. Chouhan P, Mishra J. Role of zinc (II) bio metal in complexation of aspirin as anti stroke drug. Research Journal of Pharmacy and Technology. 2022; 15(10): 4416-8. DOI: 10.52711/0974-360X.2022.00740
15. Arviana SD, Yueniwati Y, Rahayu M, Syaban MF. 7, 8-dihydroxyflavone as a neuroprotective agent in ischemic stroke through the regulation of HIF-1α protein. Research Journal of Pharmacy and Technology. 2022; 15(9): 3980-6. DOI: 10.52711/0974-360X.2022.00667.
16. Widyaningrum DA, Nilamsari WP, Islamiyah WR, Shinta DW. The Patterns of Antihypertensive Drugs use in Acute Hemorrhagic Stroke Patients. Research Journal of Pharmacy and Technology. 2020; 13(2): 547-54. DOI: 10.5958/0974-360X.2020.00103.1
17. Thomas P, Jeyarani S, Choephel T, Manisha C, Antony J. Recent Plant Based Remedies for Alzheimer's Disease, Parkinson's Disease and Cerebral Ischemic Stroke. Research Journal of Pharmacy and Technology. 2019; 12(8): 3951-9. DOI: 10.5958/0974-360X.2019.00681.4
18. Swathi S, Swathi B, Swapna K, Venkateshwarlu G, Swathi B, Sharada N, Laxmi SP. Changes of life style prevent heart stroke, kidney failure, paralysis. Asian Journal of Pharmaceutical Research. 2015; 5(1): 48-50. DOI: 10.5958/2231-5691.2015.00007.6
19. Murphy TH, Corbett D. Plasticity during stroke recovery: from synapse to behaviour. Nature Reviews Neuroscience. 2009; Dec; 10(12): 861-72. https://doi.org/10.1038/nrn2735
20. Kim TG, Bae SH, Kim KY. Effects of dual-task training with different intensity of aerobic exercise on cognitive function and neurotrophic factors in chronic stroke patients. Research Journal of Pharmacy and Technology. 2019; 12(2): 693-8. DOI: 10.5958/0974-360X.2019.00123.9
21. Srinivasan V, Ruthuvalan V, Raja S, Jayaraj V, Sridhar S, Kothandaraman M, Suganthirababu P, Abathsagayam K, Vishnuram S, Alagesan J, Vasanthi RK. Efficacy of Vagal nerve stimulation on anxiety among elderly retired teachers during COVID-19 pandemic. Work. 2024 Mar 15(Preprint):1-8.
22. Amuthu A. Effectiveness of Neurological Rehabilitation Intervention [NRI] on Functional Disability among patients with Stroke. Asian Journal of Nursing Education and Research. 2019; 9(3): 354-60. DOI: 10.5958/2349-2996.2019.00076.4
23. Vishnuram S, Suganthirababu P, Ramalingam V, Srinivasan V, Alagesan J. Effect of Peripheral Nerve Mobilization and VR-Based Gait Training on Gait Parameters Among Patients With Chronic ACA Stroke–A Pilot Study. Physical and Occupational Therapy In Geriatrics. 2024; Mar 21: 1-1.
24. Vanbellingen T, Filius SJ, Nyffeler T, Van Wegen EE. Usability of videogame-based dexterity training in the early rehabilitation phase of stroke patients: a pilot study. Frontiers in neurology. 2017; Dec 8; 8: 310641. https://doi.org/10.3389/fneur.2017.00654
25. Bisson JI, CosgroveS, LewisC, Roberts NP. Post-traumatic stress disorder. Bmj. 2015 No26; 351 doi:https://doi.org/10.1136/bmj.h6161.
|
Received on 01.07.2024 Revised on 19.11.2024 Accepted on 20.01.2025 Published on 02.08.2025 Available online from August 08, 2025 Research J. Pharmacy and Technology. 2025;18(8):3537-3540. DOI: 10.52711/0974-360X.2025.00509 © RJPT All right reserved
|
|
|
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License. |
|