The Xbox/Kinect use in poststroke rehabilitation settings: a systematic review

XAVIER-ROCHA, Túlio Brandão; CARNEIRO, Lara; MARTINS, Gustavo Celestino; VILELA-JÚNIOR, Guanis de Barros; PASSOS, Ricardo Pablo; PUPE, Camila Castelo Branco; NASCIMENTO, Osvaldo José Moreira do; HAIKAL, Desirée Sant’Ana; MONTEIRO-JUNIOR, Renato Sobral

doi:10.1590/0004-282X20200012

Túlio Brandão XAVIER-ROCHA

Universidade Federal Fluminense, Programa de Pós-Graduação em Neurociências/Neurologia, Rio de Janeiro RJ, Brasil.

Centro Universitário FIPMoc, Montes Claros MG, Brasil.

http://orcid.org/0000-0003-0360-4515

Lara CARNEIRO

Higher Institute of Educational Sciences, Penafiel, Portugal.

University Institute of Maia, Maia, Portugal.

Research Centre in Sports Sciences, Health Sciences and Human Development, CIDESD, GERON Research Community, Portugal.

http://orcid.org/0000-0002-4385-5290

Gustavo Celestino MARTINS

Universidade Metodista de Piracicaba, Programa de Pós-Graduação em Ciências do Movimento Humano, São Paulo SP, Brasil.

http://orcid.org/0000-0002-7104-1198

Guanis de Barros VILELA-JÚNIOR

Universidade Metodista de Piracicaba, Programa de Pós-Graduação em Ciências do Movimento Humano, São Paulo SP, Brasil.

http://orcid.org/0000-0001-8136-1913

Ricardo Pablo PASSOS

Universidade Metodista de Piracicaba, Programa de Pós-Graduação em Ciências do Movimento Humano, São Paulo SP, Brasil.

http://orcid.org/0000-0001-6597-9991

Camila Castelo Branco PUPE

Universidade Federal Fluminense, Programa de Pós-Graduação em Neurociências/Neurologia, Rio de Janeiro RJ, Brasil.

http://orcid.org/0000-0001-9590-435X

Osvaldo José Moreira do NASCIMENTO

Universidade Federal Fluminense, Programa de Pós-Graduação em Neurociências/Neurologia, Rio de Janeiro RJ, Brasil.

http://orcid.org/0000-0003-3516-485X

Desirée Sant’Ana HAIKAL

Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brasil.

http://orcid.org/0000-0002-0331-0747

Renato Sobral MONTEIRO-JUNIOR

Universidade Federal Fluminense, Programa de Pós-Graduação em Neurociências/Neurologia, Rio de Janeiro RJ, Brasil.

Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brasil.

http://orcid.org/0000-0002-8472-262X

Correspondence: Renato Sobral Monteiro Júnior; E-mail: monteirojuniorms@gmail.com

Conflict of interest: There is no conflict of interest to declare.

Database	Search	Number of papers found
PubMed	hemiplegia OR hemiparesis OR paresis OR monoparesis OR stroke OR cerebrovascular accident OR brain vascular accident AND Xbox AND Kinect	18
PEDro	Stroke AND Kinect	8
	Stroke AND Xbox	7
	Hemiplegia AND Xbox	1
	Hemiplegia AND Kinect	1
	Paresis AND Xbox	0
	Paresis AND Kinect	0
	Hemiparesis AND Xbox	0
	Hemiparesis AND Kinect	0
	Cerebrovascular AND Xbox	0
	Cerebrovascular AND Kinect	0
	Brain vascular AND Xbox	0
	Brain vascular AND Kinect	0
Scopus	hemiplegia OR hemiparesis OR paresis OR monoparesis OR stroke OR cerebrovascular accident OR brain vascular accident AND Xbox AND Kinect	10
Cochrane	hemiplegia OR hemiparesis OR paresis OR monoparesis OR stroke OR cerebrovascular accident OR brain vascular accident AND Xbox AND Kinect	17
Web of Science	hemiplegia OR hemiparesis OR paresis OR monoparesis OR stroke OR cerebrovascular accident OR brain vascular accident AND Xbox AND Kinect	31

Authors	Objective	Variables	Instruments	Results
Ikbali Afsar et al.²⁷27. Ikbali Afsar S, Mirzayev I, Umit Yemisci O, Cosar Saracgil SN. Virtual reality in upper extremity rehabilitation of stroke patients: a randomized controlled trial J Stroke Cerebrovasc Dis. 2018 Dec;27(12):3473-8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.08.007 https://doi.org/https://doi.org/10.1016/...	To evaluate the effect of Xbox Kinect training added to standard rehabilitation on upper limb motor functions of sub-acute stroke patients	Motor function of upper limbs; motor development; gross motor skill; and activities of daily living	Fugl-Meyer assessment Upper extremity (FMA-UE); Brunnstrom stage recovery (BSR); Box and Block test (BBT); Functional Independence Measure (FIM)	Significant improvements in both groups in post-training in all the variables. The improvements on the Brunnstrom Stage of upper extremity, FMA-UE and BBT were significantly higher in the Experimental Group, but not in the Brunnstrom stage of Hand, FIM and FMA
Lee et al.²⁸28. Lee H-C, Huang C-L, Ho S-H, Sung W-H. The effect of a virtual reality game intervention on balance for patients with stroke: a randomized controlled trial. Games Health J. 2017 Oct;6(5):303-11. https://doi.org/10.1089/g4h.2016.0109 https://doi.org/https://doi.org/10.1089/...	To investigate the effects of training with Xbox Kinect associated with the standard strength training, resistance, gait, and activities of daily living in balance skill	Balance; stability limit; mobility and double task; functional independence; activities of daily living; quality of life	Berg balance scale, Functional reach test, Timed up and go-cognitive (TUG-cog); Modified Barthel Index; Activities-specific balance confidence scale (ABC); Stroke Impact Scale	Significant improvements on BBS and TUG-cog in both groups, although without significant differences between groups. The other tests presented no significant differences
Türkbey et al.²⁹29. Türkbey T, Kutlay S, Gök H. Clinical feasibility of Xbox KinectTM training for stroke rehabilitation: A single-blind randomized controlled pilot study. J Rehabil Med. 2017;49(1):22-9. https://doi.org/10.2340/16501977-2183 https://doi.org/https://doi.org/10.2340/...	To evaluate both the feasibility and security of Xbox Kinect in upper limb training	Dexterity; motor function; functional independence; muscle tone; motor recovery	Box and Block test (BBT); Wolf motor Function test (WMFT); Functional Independence Measure (FIM); Modified Ashworth Scale (MAS); Brunnstrom motor recovery stages (BMRS)	Significant improvements only on BBS and TUG-cog in both groups, although without significant differences between them. No significant differences have been found in the other tests
Park et al.³⁰30. Park D-S, Lee D-G, Lee K, Lee G. Effects of Virtual reality training using xbox kinect on motor function in stroke survivors: a preliminary study. J Stroke Cerebrovasc Dis. 2017 Jun;26(10):2313-9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.05.019 https://doi.org/https://doi.org/10.1016/...	To assess the effects of additional training of virtual reality with Xbox Kinect on motor recovery of lower limbs in stroke patients with chronic hemiplegia	Motor recovery; balance; gait	Fugl-Meyer lower extremities assessment (FMA-LE); Box and Block test (BBT); Timed Up and Go (TUG); 10-meter Walking Test (10 mWT)	Improvements on FMA-LE, BBT, TUG and 10 mWT after intervention on both groups. Only FMA-LE presented no differences between groups
Malik and Massod³¹31. Malik AN, Masood T. Virtual reality training improves balance outcome in stroke patients. Int J Rehabil Sci. 2016;05(02):8-12.	To compare the results of balance with virtual reality and task-oriented training in stroke patients	Balance and mobility	Berg Balance Scale (BBS)	Significant improvement on both groups after the interventions, and significantly better on the Experimental Group
Song and Park³²32. Song G bin, Park E cho. Effect of virtual reality games on stroke patients’ balance, gait, depression, and interpersonal relationships. J Phys Ther Sci. 2015;27(7):2057-60. https://doi.org/10.1589/jpts.27.2057 https://doi.org/https://doi.org/10.1589/...	To determine training effects with virtual reality games over balance and gait skill, as well as psychological characteristics	Weight distribution ratio; anterior limit of stability; posterior Limit of stability; gait skill; mental health	Biofeedback analysis system; Timed Up and Go (TUG); 10-m walking test; Beck Depression Inventory and relationship change scale (psychological)	Both groups have shown significant improvements in all variables after the intervention, although with significant differences between groups
Lee³³33. Lee G. Effects of training using video games on the muscle strength, muscle tone, and activities of daily living of chronic stroke patients. J Phys Ther Sci. 2013 Oct;25(5):595-7. https://doi.org/10.1589/jpts.25.595 https://doi.org/https://doi.org/10.1589/...	To investigate the effects of training with Xbox Kinect on strength and muscle tone, and activities of daily living	Muscle strength; muscle tone; activities of daily living	Manual Muscle test; Modified Ashworth Scale; Functional Independence Measure (FIM)	Significant improvements on strength of shoulder and elbow flexion-extension and FIM scores of the Experimental Group. Control Group has shown improvements on strength of elbow extension and FIM. No significant differences were found between groups
Sin and Lee³⁴34. Sin H, Lee G. Additional virtual reality training using Xbox kinect in stroke survivors with hemiplegia. Am J Phys Med Rehabil. 2013;92(10):871-80. https://doi.org/10.1097/PHM.0b013e3182a38e40 https://doi.org/https://doi.org/10.1097/...	To investigate the effects of additional training with Xbox Kinect on upper limb function	Active amplitude of movement, motor function; manual dexterity	Active range of motion (ROM); Fugl-Meyer Assessment (FMA); Box and Block Test (BBT)	Both groups have shown significant improvements on active amplitude of movement of shoulder flexion, extension and abduction, elbow flexion, wrist flexion and extension, FMA and BBT. No significant improvements were found between groups on ADM wrist

Author	Intervention Experimental Group	Games	Number of sessions (time-min)	Intervention Control Group	Number of sessions (time-min)
Afsar et al.²⁸28. Lee H-C, Huang C-L, Ho S-H, Sung W-H. The effect of a virtual reality game intervention on balance for patients with stroke: a randomized controlled trial. Games Health J. 2017 Oct;6(5):303-11. https://doi.org/10.1089/g4h.2016.0109 https://doi.org/https://doi.org/10.1089/...	Standard occupational therapy + Xbox	Mouse Mayhem, Traffic Control, Balloon Buster, and Mathercising from Dr. Kawashima's Body and Brain Exercise package	20 (90’), five times a week	Control of static and dynamic position, balance training, weight loss, functional training (activities of daily living), proprioceptive neuromuscular facilitation, neurodevelopmental treatment principles	20 (60’), five times a week
Lee et al.²⁹29. Türkbey T, Kutlay S, Gök H. Clinical feasibility of Xbox KinectTM training for stroke rehabilitation: A single-blind randomized controlled pilot study. J Rehabil Med. 2017;49(1):22-9. https://doi.org/10.2340/16501977-2183 https://doi.org/https://doi.org/10.2340/...	Standard therapy (as in Control Group) + Xbox	Darts; Golf; Bowling; Virtual smash; Light race; Space Pop; Rally Ball; Table Tennis; River rush	12 (90’), twice a week	Balance training, weight loss, postural transition, postural disturbances, cognitive-motor training	12 (90’), twice a week
Türkbey et al.³⁰30. Park D-S, Lee D-G, Lee K, Lee G. Effects of Virtual reality training using xbox kinect on motor function in stroke survivors: a preliminary study. J Stroke Cerebrovasc Dis. 2017 Jun;26(10):2313-9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.05.019 https://doi.org/https://doi.org/10.1016/...	Standard therapy (as in Control Group) + Xbox	Bowling (Kinect sports), Mouse Mayen (Dr Kawashima's body and brain exercise package)	20 (120’), five times a week	Passive and active exercises for ADM, stretching and muscle reinforcement, neurophysiological exercises, gait training and balance and functional activities	20 (60’), five times a week
Park et al.³¹31. Malik AN, Masood T. Virtual reality training improves balance outcome in stroke patients. Int J Rehabil Sci. 2016;05(02):8-12.	Standard therapy (as in Control Group) + Xbox	Boxing, table tennis, and soccer from the Kinect Sports Pack; and golf, ski, and football from the Kinect Sports Pack 2	30 (30’), five times a week	Exercises for ADM, muscle reinforcement, functional training of balance and gait. Neurodevelopment treatment and proprioceptive neuromuscular facilitation	30 (30’), five times a week
Malik and Masood³²32. Song G bin, Park E cho. Effect of virtual reality games on stroke patients’ balance, gait, depression, and interpersonal relationships. J Phys Ther Sci. 2015;27(7):2057-60. https://doi.org/10.1589/jpts.27.2057 https://doi.org/https://doi.org/10.1589/...	Task-oriented therapy (as in Control Group) + Xbox	20,000 Water leaks, River rush and Reflex ridge	18 (undetermined) three times a week	Lateral gait, gait with hip flexion, gait on different surfaces, transfer from sitting position to standing position; grip an object, anterior reach	18 (undetermined), three times a week
Song and Park³³33. Lee G. Effects of training using video games on the muscle strength, muscle tone, and activities of daily living of chronic stroke patients. J Phys Ther Sci. 2013 Oct;25(5):595-7. https://doi.org/10.1589/jpts.25.595 https://doi.org/https://doi.org/10.1589/...		Kinect Sport, Kinect Sport Season 2, Kinect Adventure and Kinect Gunstringer	40 (30’), five times a week	Training with cycle ergometer	40 (30’), five times a week
Lee³⁴34. Sin H, Lee G. Additional virtual reality training using Xbox kinect in stroke survivors with hemiplegia. Am J Phys Med Rehabil. 2013;92(10):871-80. https://doi.org/10.1097/PHM.0b013e3182a38e40 https://doi.org/https://doi.org/10.1097/...	Occupational therapy + Xbox	Kinect sports (Boxing and Bowling) and Kinect adventure (Rally Ball, 20,000 Leaks, and Space Pop)	18 (60’), three times a week	Occupational therapy (without treatment description)	18 (30’), three times a week
Sin and Lee³⁵35. Viñas-Diz S, Sobrido-Prieto M. Virtual reality for therapeutic purposes in stroke: A systematic review. Neurol (English Ed.). 2016 May;31(4):255-77. https://doi.org/10.1016/j.nrleng.2015.06.007 https://doi.org/https://doi.org/10.1016/...	Standard occupational therapy + Xbox	Boxing and Bowling in the Kinect sports pack and Rally Ball, 20,000 Leaks, and Space Pop in the Kinect adventure pack	18 (30’), three times a week	Passive and active exercises for ADM, stretching and muscle reinforcement	18 (30’), three times a week

Author (year)	Score
Afsar et al.²⁹29. Türkbey T, Kutlay S, Gök H. Clinical feasibility of Xbox KinectTM training for stroke rehabilitation: A single-blind randomized controlled pilot study. J Rehabil Med. 2017;49(1):22-9. https://doi.org/10.2340/16501977-2183 https://doi.org/https://doi.org/10.2340/...	7
Lee et al.³⁰30. Park D-S, Lee D-G, Lee K, Lee G. Effects of Virtual reality training using xbox kinect on motor function in stroke survivors: a preliminary study. J Stroke Cerebrovasc Dis. 2017 Jun;26(10):2313-9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.05.019 https://doi.org/https://doi.org/10.1016/...	8
Türkbey et al.³¹31. Malik AN, Masood T. Virtual reality training improves balance outcome in stroke patients. Int J Rehabil Sci. 2016;05(02):8-12.	8
Park et al.³²32. Song G bin, Park E cho. Effect of virtual reality games on stroke patients’ balance, gait, depression, and interpersonal relationships. J Phys Ther Sci. 2015;27(7):2057-60. https://doi.org/10.1589/jpts.27.2057 https://doi.org/https://doi.org/10.1589/...	7
Malik and Masood³³33. Lee G. Effects of training using video games on the muscle strength, muscle tone, and activities of daily living of chronic stroke patients. J Phys Ther Sci. 2013 Oct;25(5):595-7. https://doi.org/10.1589/jpts.25.595 https://doi.org/https://doi.org/10.1589/...	6
Song and Park ³⁴34. Sin H, Lee G. Additional virtual reality training using Xbox kinect in stroke survivors with hemiplegia. Am J Phys Med Rehabil. 2013;92(10):871-80. https://doi.org/10.1097/PHM.0b013e3182a38e40 https://doi.org/https://doi.org/10.1097/...	6
Lee³⁵35. Viñas-Diz S, Sobrido-Prieto M. Virtual reality for therapeutic purposes in stroke: A systematic review. Neurol (English Ed.). 2016 May;31(4):255-77. https://doi.org/10.1016/j.nrleng.2015.06.007 https://doi.org/https://doi.org/10.1016/...	7
Sin and Lee³⁶36. Gatica-Rojas V, Méndez-Rebolledo G. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases. Neural Regen Res. 2014 May;9(8):888-96. https://doi.org/10.4103/1673-5374.131612 https://doi.org/https://doi.org/10.4103/...	6

[1] Correspondence: Renato Sobral Monteiro Júnior; E-mail: monteirojuniorms@gmail.com

Brasil

Brasil

The Xbox/Kinect use in poststroke rehabilitation settings: a systematic review

A utilização do Xbox/Kinect na reabilitação pós-acidente vascular cerebral: uma revisão sistemática

ABSTRACT

Background:

Objective:

Methods:

Results:

Conclusion: