#CIMT #m-CIMT #game based CIMT #game based rehab #skisollam #wii balance board #functional restraint #COM displacement #stroke rehab

1. Welcome
to
Journal club
Moderator- DR. Answesh Pradhan
Associate professor, NIHS, Kolkata
Presented by –Suparna Bandyopadhyay
2nd year MPT(Neurology)

2. Trial details
Trial name
Effects of Game-Based Constraint-
Induced Movement Therapy on
Balance in Patients with Stroke A
Single-Blind Randomized Controlled
Trial
Author
Ho-Suk Choi, Won-Seob Shin,
Dae-Hyouk Bang, and Sung-Jin
Choi,
Journal name, issue
&volume
American Journal of Physical
Medicine & Rehabilitation
96 & 3
Contact information
Year of
publication
2017
Won-Seob Shin, PT, PhD,
Department of Physical
Therapy, Daejeon University,
62 Daehak-ro, Dong-gu,
Daejeon, 300–716, Republic of
Korea
Country
Republic of korea

3. Journal details
4
1
2
3
Indexing
Medline
Impact factor(2022)
3
ISSN
Publishers
0894-9115
Lippincott Williams & Wilkins (LWW)

4. Author details
Correspondence Author
Won-Seob Shin
PT, PhD,
Department of Physical Therapy,
Daejeon University, 62 Daehak-ro,
Dong-gu, Daejeon, 300–716,
Republic of Korea

5. C O N C E P T
Abstract
Objectiv
e
Result &
conclusio
n
Methodology
CONCEPT
Key points
1.Sample size
2.Intervention
3.Duration of the
intervention
4.Outcome
measures
Concept
Game based CIMT improve
static dynamic balance and
weight bearing asymmetries
1. Effectiveness of
game based CIMT
2. Provide clinical
knowledge on game
based CIMT

6. Key words
Constrain
t induced
moveme
nt
therapy
Stroke
Game
based
training
Balance

7. Weight bearing
asymmetry
• Postural sway
• Asymmetric posture
• Higher incidence of
fall
Physiological
effects of
CIMT
• Restoration of the size of the
cerebral cortex
• Omit the use of restraint device in
lower limb CIMT Robot assisted
Vs
home based gaming
device
Affordable &
accessible
Wii balance
board
Reduce the movement of the
nonparalyzed side and increase the
movement of the paralyzed side
through feed back
Hypothes
is
There will be significant
difference in post
intervention weight
bearing asymmetry
Introduction

8. The purpose of this research was to apply balance training based
on CIMT using the Wii Fit game in patients with chronic stroke to
discover whether this intervention is effective at improving
weight-bearing symmetry and dynamic balance ability

9. Sample size calculation

10. Inclusion criteria
Diagnosis of
stroke for more than 6 months Ability to stand independ
No cognitive impairment
based on Mini-Mental
State Examination results.

11. Exclusion criteria
Neurologic problem
apart from stroke,
Orthopaedic impairment
Abnormal senses of vision and/or
hearing

12. INTERVENTIONS
SAMPLE DESIGN
Randomized
closed envelop
sampling
GROUP
ALLOTMENT
3 groups
DURATION
60MINS /DAY
5 DAYS / WEEK
FOR 4 WEEKS
Post intervention data
obtained
SAMPLE SIZE
36, 12 IN EACH
GROUP
STUDY DESIGN
SINGLE BLINDED
RCT

13. Group 1
Game based CIMT+ Conventional
PT
Group 2
General game based rehab +
Conventional PT
Group 3
Conventional PT
Group Allocation
30Mins Game based
rehab+1hour
conventional
training
30Mins Game based
rehab+1hour
conventional
training
1hour conventional
training

14. Game based CIMT intervention
group
Nintendo Wii Fit

15. COP MEASUREMENT
COP virtual= α X COP nonparalyzed + β X COP paralyze
1 2
α
.
α:β ratio were 0.8, 1.05, 1.08, 1.1, 1.2, and 1.4 for
experimental group
For control group α:β ratio were 1

16. 4
PLAN
PLAN
3
PLAN
2
PLAN
1
Outcome measure
COP
DISPLACEME
NT
WEIGHT
BEARING
ASSYMETRY
FUNCTIONA
LREACH
TEST
TIME UP
AND GO

17. COP DISPLACEMENT
• The medial-lateral axis (ML-axis)
distance (cm),
• Anteroposterior axis (AP-axis)
distance (cm),
• Sway mean velocity(cm/s),
• Sway area (cm2).
Weight bearing symmetry
Weight-bearing symmetry was
calculated by dividing the weight-
bearing value of the paralyzed side
by the weight bearing value of the
nonparalyzed side

18. Functional reach test
It is a simple tool to measure standing balance, and
has high intra- and interrater reliability (r = 0.92

19. Modified functional reach test
The modified Functional Reach Test
(mFRT) is a tool to measure the
limits of stability in the lateral
direction and has high interrater
reliability (r =0.92–0.97).Subjects
leaned their back against the wall
during this test. They moved their
trunk as far as possible to the
paralyzed side without lifting their
feet. Then, the distance the

20. Time up and GO (TUG)
It is used to measure functional mobility and
dynamic balance ability, and has high intra rater
and interrater reliability
(r =0.99and0.98, respectively)

21. 1
4
2
Scheffe
method
One-way
ANOVA
• Homogeneit
y
• Multiple
comparison
• Pre and post
data analysis
between
group
Statistica
l
Analysis
Tool
χ2 test
Statistical analysis
All data were statistically significant at P = 0.05.
T
test
3
• Pre and post
data analysis
within group

22. Significant improvement was found in game based
CIMT group in COP Displacement, weight bearing
symmetry, sway area velocity
• In general game base group statistically significant
Improvement was found in weight bearing symmetry
and sway area
In control group statistically significant improvement
was found in COP displacement , sway area and weight
bearing symmetry
Result

23. Postintervention analysis revealed that the game-
based CIMT group showed significantly greater
improvement IN COP displacement, sway area,
weight bearing symmetry, than the other 2 groups
No difference found in terms of sway velocity
between the group
Result

24. Statistically Significant improvement was found in
game in all 3 groups for FRT, m-FRT, TUG
Result
Between
Group
analysis
No intergroup difference found in FRT
and TUG
In case of m-FRT significant difference
was found in both game based rehab
group

25. Discussion
1
2
4
Weight bearing
Stroke survivors shift their weight
toward the paralyzed side
through game based CIMT
Functional restraint
Functional limitations of the
nonparalyzed side and increase use
of the paralyzed side. Reducing the
frequency of use of the
nonparalyzed side through these
functional limitations is aimed to
achieve the same effect as that
obtained through CIMT.
COP
displacement
The game-based CIMT increased
the use of paralyzed side, and this
had a positive effect on the static
balancing control ability. These
effects were shown in ML-axis
and AP-axis distance, sway mean
No significant
difference FRT
Stroke survivors use
compensatory strategies to
perform tasks owing to motor
function impairments
3

26. Discussion
5
FRT Improved More In
Conventional Training Group
If a program that allows weight-shift
training not left and right, but forward
and backward, was used for game-based
training, it would be expected to affect
the FRT

27. Conclusion
Game-based CIMT and general game-based training were
effective at improving static and dynamic balance ability,
Game-based CIMT was more effective at improving static
balance control (APaxis distance and sway area) , weight-
bearing symmetry compared with the other groups
There were no differences between the game-based CIMT
and general game-based training groups in dynamic balance
ability, except for mFRT
Thus, game-based CIMT can be applied for the purpose of
improving static balance control, weight-bearing symmetry,
and side-to-side weight shift