A new study led by neurology researchers at St. Michael’s Hospital in Toronto, has found that card games are as effective as virtual reality games for stroke treatment. The study’s aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke, which is a permanent brain injury that causes 61000 annual deaths.

The researchers included 141 adults aged 18 to 35 who had suffered from a first time ischaemic stroke and had an extreme depreciation of motor skills. The study was conducted between May 12, 2012, and Oct 1, 2015. Trials ran for 3 months and were conducted in 14 stroke rehabilitation units from four countries: Canada, Argentina, Peru and Thailand. 11 stroke rehabilitation units were from 11 while the rest had one each.

Participants were randomly assigned to complete either non-immersive virtual reality games using the Nintendo Wii gaming system (VRWii) or simple recreational activities such as cards games, i.e., playing Bingo or Jenga, or a ball game as additional therapies to conventional rehabilitation over a 2 week period. Both groups had equal number of patients and were allotted the groups using computer software at enrolment, to receive a program of structured, task-oriented, upper extremity sessions. There were a total of 10 sessions of 60 minutes each. The research was published in The Lancet on 27th June 2016.

The researchers were unaware of the groups assigned to the participants and measured the  performance of patients by calculating total time to complete the Wolf Motor Function Test (WMFT), a quantitative measure of upper extremity motor ability through timed and functional tasks such as lifting objects, extending arms, turning keys, etc, at the end of the two-week intervention period.

Each group improved WMFT performance time relative to baseline median time from 47 seconds to 29.7 seconds in the virtual reality gaming group compared to a performance time reduction from 38 to 27.1 seconds. The mean time of conventional rehabilitation during the trial was similar between groups, 373 minutes for VRWii group versus 397 minutes for recreational activity.

Total duration of the trial was same in both cases as well, 528 minutes for VRWii group Vs recreational activity of 521 minutes. Multivariable analysis adjusted for baseline WMFT score, age, sex, baseline Chedoke-McMaster, and stroke severity revealed no significant difference between groups in the primary outcome.

There were also three serious adverse events during the trial, all deemed to be unrelated to the intervention technique (seizure after discharge and intracerebral hemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups.

The researchers stated that the results show the type of task used in motor rehabilitation procedure after a stroke might have little to no impact on its effectiveness, as long as it is intensive enough and task-specific. They further added that simple, cost-effective, tradtitional recreational activities such as card games and Jenga are as effective as the latest virtual technology games.

Lead author Dr Gustavo Saposnik stated even he was surprised by the results, given that previous studies have shown that virtual reality games are superior to traditional recreational activities for aiding conventional rehabilitation techniques. Saposnik said, “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. In this study, we found that simple recreational activities that can be implemented anywhere may be as effective as technology.”

Stroke is a very serious, oft-times fatal, and quite common condition affecting around one in every 500 citizens annually in western countries. The incidence rises with age and men are at a greater risk than women. A stroke occurs when the brain gets damaged due to lack of blood supply due to which brain cells do not receive sufficient oxygen and the brain gets damaged. This could be due to a blood clot forming in the brain, an embolus where a blood clot travels to the brain and blocks a vessel, or it could also be caused when a blood vessel wall gets ruptured due to arteriosclerosis where blood seeps into the brain tissue, resulting in a brain hemorrhage.