Exergaming as a Supportive Tool for Home-Based Rehabilitation in the COVID-19 Pandemic Era
2020; Mary Ann Liebert, Inc.; Volume: 9; Issue: 5 Linguagem: Inglês
10.1089/g4h.2020.0095
ISSN2161-7856
AutoresPasquale Ambrosino, Salvatore Fuschillo, Antimo Papa, Matteo Nicola Dario Di Minno, Mauro Maniscalco,
Tópico(s)Intensive Care Unit Cognitive Disorders
ResumoGames for Health JournalVol. 9, No. 5 EditorialFree AccessExergaming as a Supportive Tool for Home-Based Rehabilitation in the COVID-19 Pandemic EraPasquale Ambrosino, Salvatore Fuschillo, Antimo Papa, Matteo Nicola Dario Di Minno, and Mauro ManiscalcoPasquale AmbrosinoAddress correspondence to: Pasquale Ambrosino, MD, PhD, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri 4, Pavia 27100, Italy E-mail Address: [email protected]Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.Search for more papers by this author, Salvatore FuschilloIstituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.Search for more papers by this author, Antimo PapaIstituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.Search for more papers by this author, Matteo Nicola Dario Di MinnoDepartment of Translational Medical Sciences, Federico II University, Naples, Italy.*The two Authors share co-seniorship.Search for more papers by this author, and Mauro ManiscalcoIstituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.*The two Authors share co-seniorship.Search for more papers by this authorPublished Online:13 Oct 2020https://doi.org/10.1089/g4h.2020.0095AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in Wuhan, China.1,2 Despite the attempts to limit its diffusion in the frame of a global containment strategy, SARS-CoV-2 reached pandemic levels in March 2020.3SARS-CoV-2 infection can determine the coronavirus disease 2019 (COVID-19), a condition with a broad spectrum of clinical manifestations, ranging from a flu-like disease to an acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) management.4To date, considering the number of dark points, the long-term outcomes of COVID-19 are still to be determined. In particular, little is known about the possibility to return to a baseline functional status and to baseline levels of health care needs after SARS-CoV-2 infection. However, based on literature data, some preliminary reflections can be made on this topic.In recent years, the advanced treatment strategies in ICU significantly reduced mortality among ARDS patients.5 Spirometry reveals a good capacity of recovery in terms of lung function after ARDS, with a complete resolution of consolidation in all survivors and 18 million cases and 680,000 COVID-19 deaths have been recorded worldwide. Considering the rapidly increasing number of confirmed cases with at least one in five COVID-19 patients needing semi-intensive or intensive supportive care,4 the health providers had to rethink their organization, being forced to rapidly increase the critical care capacity. As a result, many rehabilitation hospitals have been converted into medical emergency wards, whereas others have been closed or their access has been reduced by regional laws aimed at limiting SARS-CoV-2 spread. This rearrangement of health care facilities has negatively impacted the possibility to access the rehabilitation services even for non-COVID-19 patients.16 Thus, although the major concern so far has been the shortage of ICU beds, now a "tsunami of rehabilitation needs" is expected.17A further aspect to consider is that some COVID-19 patients who have physically recovered and found negative to the swab test may result positive again up to 13 days later when using a different manufacturer's test kit.18 Moreover, it has been shown that the virus may also persist in the oropharyngeal cavity or in the stools for up to 15 days after a patient has been declared cured of COVID-19 (no fever, no respiratory symptoms, and two negative swab tests).19 This is of particular concern for patients intending to be directed to rehabilitation facilities or long-term care, because they may still be able to transmit the disease.Overall, new solutions are urgently needed to meet the increased rehabilitation demand while facing the current difficulties imposed by the pandemic.Considering the need to limit contacts and contagion opportunities during the SARS-CoV-2 pandemic, telemedicine with home-based interventions is becoming a useful tool to support remote health care for several clinical conditions.20 In keeping with this, telerehabilitation may be an emerging and innovative approach for both COVID-19 and non-COVID-19 patients.21 However, technologies and health care providers may not be ready to manage an everyday telerehabilitation approach. Moreover, further studies are needed to optimize techniques.In the frame of a home-based approach during a period of global emergency, exercise games (exergames) may be particularly suited to implement the rehabilitative interventions, ensuring an adequate level of physical activity at home with long-term adherence to exercise.22 Commercially available exergames are made for recreation and fitness and, of course, they cannot achieve all the goals of a multidisciplinary inhospital rehabilitation. However, the use of this technological support for an unsupervised physical activity may be particularly tailored for rehabilitative purposes in a pandemic era.Exergaming is based on the use of videogames and devices converting body movements into avatar's movements on screen,23 thus offering the possibility of an immersive experience in a realistic three-dimensional setting (immersive virtual reality) or a nonrealistic experience with no sensation of being immersed in the virtual world (nonimmersive virtual reality).24 In other words, besides the different simulation technologies, physical activity is translated into the game activity, thus ensuring the primary objective of exercise, which is exercise itself. However, the lack of supervision does not ensure the secondary objective of exercise, which is "how" the exercise should be performed. Moreover, the lack of therapist's supervision may potentially increase the risk of falls in older and fragile patients.These potential limitations of commercially available exergames call into question some considerations. First, the limited research that has been conducted on movement quality and patterns in exergaming mainly involved younger subjects, showing that the movements performed during exercise are highly variable, with different exergames being tested before obtaining the intended movement characteristics for a specific clinical setting.25 Moreover, it should be considered that younger patients, who may have a lower susceptibility to SARS-CoV-2 infection and a lesser propensity to show clinical symptoms,26,27 are conversely the most likely to be compliant to the use of videogames, particularly outside the rehabilitation hospital.24Overall, it seems clear that commercial exergaming may support—not replace—traditional rehabilitation of younger patients during the pandemic, thus contributing to cope with the increased demand. However, a minimum of supervision should be ensured (at least remotely by a therapist), particularly in the early phases of the rehabilitative intervention and for those patients using home-based exergaming as the sole exercise-based rehabilitative approach. In this regard, the use of a web conferencing software could help patients to choose the games and to identify the correct movement patterns.Of course, although exercise remains the cornerstone of intensive and extensive rehabilitation, a multidisciplinary approach (e.g., nutrition counseling, psychological support, and pharmacological intervention) is usually required for patients discharged from the acute setting,28 and exergaming may only partially address the needs of COVID-19 and non-COVID-19 patients requiring rehabilitation. Thus, considering the necessity to maintain social distancing, exergaming may be used to support another home-based and more structured approach, namely telerehabilitation. Exergaming and telerehabilitation share many advantages and limitations. Thus, as a supportive tool, exergaming may be integrated in the programs of telerehabilitation for younger patients in the COVID-19 era. In this regard, if commercially available exergames cannot guarantee correct movement quality and patterns, the development of new "therapeutic exergames" supporting both primary and secondary goals of exercise could be implemented to promote a safe and autonomous home-based intervention.Several studies have already shown the effectiveness of exergaming and virtual reality in the rehabilitation of poststroke patients,29 of those with Parkinson's disease,30 or with acquired brain injury.31 Furthermore, we recently demonstrated the usefulness of exergaming in prolonging the benefits of inhospital rehabilitation for young patients with rheumatoid arthritis.24 Further supporting its potential use in a pandemic era, a recent study suggested the use of exergaming as a coping strategy for preventing and treating anxiety disorders in a home-based environment during the COVID-19 quarantine period.32Overall, despite being designed for recreational purposes, commercially available exergames may help to cope with the rehabilitation needs of a population that, due to the limitations imposed by the lockdown and the containment strategies, does not have access to traditional rehabilitation therapy. In addition, it has been shown that exergaming may prolong the benefits of traditional exercise-based rehabilitation after inhospital stay and potentially reduce the time spent in hospital for rehabilitation. This may be of major interest during the current pandemic, to limit both the duration and the number of hospitalizations to rehabilitate COVID-19 and non-COVID-19 patients.In conclusion, exergames may have the potential to be strongly implemented in the near future in the rehabilitation setting, also considering that such a constant increase in rehabilitation demand cannot be sustained in the long term.AcknowledgmentThe authors thank Professor Tom Baranowski for assistance and editorial support.Authors' ContributionsP.A. conceived the study and drafted the article. S.F. and A.P. drafted the article and made critical revisions. M.N.D.D.M. and M.M. drafted the article and supervised the project. All authors read and approved the final version for submission.Author Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020; 55:105924. Crossref, Medline, Google Scholar2. Lauer SA, Grantz KH, Bi Q, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: Estimation and application. Ann Intern Med 2020; 172:577–582. Crossref, Medline, Google Scholar3. World Health Organization. Coronavirus disease 2019 (COVID-19). Situation Report—51. 2020; https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports (accessed on July 30, 2020). Google Scholar4. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutierrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 34:101623. Crossref, Medline, Google Scholar5. Chiumello D, Coppola S, Froio S, Gotti M. What's next after ARDS: Long-term outcomes. Respir Care 2016; 61:689–699. Crossref, Medline, Google Scholar6. Wilcox ME, Patsios D, Murphy G, et al. Radiologic outcomes at 5 years after severe ARDS. Chest 2013; 143:920–926. Crossref, Medline, Google Scholar7. Marra A, Pandharipande PP, Girard TD, et al. Co-occurrence of post-intensive care syndrome problems among 406 survivors of critical illness. Crit Care Med 2018; 46:1393–1401. Crossref, Medline, Google Scholar8. Herridge MS, Tansey CM, Matte A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364:1293–1304. Crossref, Medline, Google Scholar9. Lechowicz K, Drozdzal S, Machaj F, et al. COVID-19: The potential treatment of pulmonary fibrosis associated with SARS-CoV-2 infection. J Clin Med 2020; 9:E1917. Crossref, Medline, Google Scholar10. Di Minno MND, Calcaterra I, Lupoli R, et al. Hemostatic changes in patients with COVID-19: A meta-analysis with meta-regressions. J Clin Med 2020; 9:E2244. Crossref, Medline, Google Scholar11. Di Minno A, Ambrosino P, Calcaterra I, Di Minno MND. COVID-19 and venous thromboembolism: A meta-analysis of literature studies. Semin Thromb Hemost 2020. DOI: 10.1055/s-0040-1715456. Crossref, Medline, Google Scholar12. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323:1061–1069. Crossref, Medline, Google Scholar13. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77:1–9. Crossref, Google Scholar14. Ambrosino P, Papa A, Maniscalco M, Di Minno MND. COVID-19 and functional disability: Current insights and rehabilitation strategies. Postgrad Med J 2020. DOI: 10.1136/postgradmedj-2020-138227. Crossref, Medline, Google Scholar15. Li J. Rehabilitation management of patients with COVID-19: lessons learned from the first experience in China. Eur J Phys Rehabil Med 2020; 56:335–338. Crossref, Medline, Google Scholar16. Brugliera L, Spina A, Castellazzi P, et al. Rehabilitation of COVID-19 patients. J Rehabil Med 2020; 52:jrm00046. Crossref, Medline, Google Scholar17. Thornton J. Covid-19: The challenge of patient rehabilitation after intensive care. BMJ 2020; 369:m1787. Crossref, Medline, Google Scholar18. Lan L, Xu D, Ye G, et al. Positive RT-PCR test results in patients recovered from COVID-19. JAMA 2020; 323:1502–1503. Crossref, Medline, Google Scholar19. Sheehy LM. Considerations for post-acute rehabilitation for survivors of COVID-19. JMIR Public Health Surveill 2020; 6:e19462. Crossref, Medline, Google Scholar20. Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med 2020; 382:1679–1681. Crossref, Medline, Google Scholar21. Turolla A, Rossettini G, Viceconti A, Palese A, Geri T. Musculoskeletal physical therapy during the COVID-19 pandemic: Is telerehabilitation the answer? Phys Ther 2020; DOI:10.1093/ptj/pzaa093. Crossref, Medline, Google Scholar22. Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC. Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev 2005; 2005:CD004017. Google Scholar23. Hoenig H, Sanford JA, Butterfield T, Griffiths PC, Richardson P, Hargraves K. Development of a teletechnology protocol for in-home rehabilitation. J Rehabil Res Dev 2006; 43:287–298. Crossref, Medline, Google Scholar24. Ambrosino P, Iannuzzi GL, Formisano R, et al. Exergaming as an additional tool in rehabilitation of young patients with rheumatoid arthritis: A pilot randomized controlled trial. Games Health J 2020 [Epub ahead of print]; DOI: 10.1089/g4h.2019.0167. Link, Google Scholar25. Skjaeret-Maroni N, Vonstad EK, Ihlen EA, Tan XC, Helbostad JL, Vereijken B. Exergaming in older adults: Movement characteristics while playing stepping games. Front Psychol 2016; 7:964. Crossref, Medline, Google Scholar26. Davies NG, Klepac P, Liu Y, et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med 2020 [Epub ahead of print]; DOI: 10.1038/s41591-020-0962-9. Crossref, Google Scholar27. Lavezzo E, Franchin E, Ciavarella C, et al. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'. Nature 2020 [Epub ahead of print]; DOI: 10.1038/s41586-020-2488-1. Crossref, Medline, Google Scholar28. Kim T, Huh S, Kim SY, et al. ICU rehabilitation is associated with reduced long-term mortality from sepsis in patients with low skeletal muscle mass: A case control study. Ann Transl Med 2019; 7:430. Crossref, Medline, Google Scholar29. Turolla A, Dam M, Ventura L, et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke: A prospective controlled trial. J Neuroeng Rehabil 2013; 10:85. Crossref, Medline, Google Scholar30. Feng H, Li C, Liu J, et al. Virtual reality rehabilitation versus conventional physical therapy for improving balance and gait in Parkinson's disease patients: A randomized controlled trial. Med Sci Monit 2019; 25:4186–4192. Crossref, Medline, Google Scholar31. Gil-Gomez JA, Llorens R, Alcaniz M, Colomer C. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: A pilot randomized clinical trial in patients with acquired brain injury. J Neuroeng Rehabil 2011; 8:30. Crossref, Medline, Google Scholar32. Viana RB, de Lira CAB. Exergames as coping strategies for anxiety disorders during the COVID-19 quarantine period. Games Health J 2020; 9:147–149. Link, Google ScholarFiguresReferencesRelatedDetailsCited byAcute Hemodynamic, Metabolic, and Hormonal Responses to a Boxing Exergame with and without Blood Flow Restriction in Non-Athlete Young Individuals23 February 2024 | Sports, Vol. 12, No. 3Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities10 January 2024 | International Journal of Environmental Research and Public Health, Vol. 21, No. 1A New Player in the Game: Can Exergame Be of Support in the Management of Atrial Fibrillation?17 January 2024 | Medicina, Vol. 60, No. 1Understanding continuance intention to play exergames during the COVID-19 pandemic: hedonic and utilitarian aspects3 August 2023 | Managing Sport and Leisure, Vol. 28The Role of Gamification in a Post-Pandemic WorldAn ML pipeline for real-time activity detection on low computational power devices for metaverse applicationsHome-Based Exergame Program to Improve Physical Function, Fall Efficacy, Depression and Quality of Life in Community-Dwelling Older Adults: A Randomized Controlled Trial12 April 2023 | Healthcare, Vol. 11, No. 8Implementing Translational Research to Understand the Future of COVID-19 and Its Long-Term Consequences: A Degrowth Perspective or the Transformation of a Global Emergency?3 January 2023 | Biomedicines, Vol. 11, No. 1The Change in Exergaming From Before to During the COVID-19 Pandemic Among Young Adults: Longitudinal Study22 May 2023 | JMIR Serious Games, Vol. 11Unsupervised Machine Learning to Identify Convalescent COVID-19 PhenotypesMotor Rehabilitation of Upper Limbs Using a Gesture-Based Serious Game: Evaluation of Usability and User Experience Rodrigo Baluz, Ariel Teles, José Everton Fontenele, Rayele Moreira, Renan Fialho, Patrícia Azevedo, Daniel Sousa, Fernando Santos, Victor Hugo Bastos, and Silmar Teixeira2 June 2022 | Games for Health Journal, Vol. 11, No. 3Endothelial Dysfunction in COVID-19: A Unifying Mechanism and a Potential Therapeutic Target30 March 2022 | Biomedicines, Vol. 10, No. 4Playing during a crisis: The impact of commercial video games on the reconfiguration of people's life during the COVID-19 pandemic30 March 2022 | Human–Computer Interaction, Vol. 8Physical and Psychological Health Behavior Changes During the COVID-19 Pandemic that May Inform Surgical Prehabilitation: a Narrative Review18 February 2022 | Current Anesthesiology Reports, Vol. 12, No. 1Cognitive Impairment in Convalescent COVID-19 Patients Undergoing Multidisciplinary Rehabilitation: The Association with the Clinical and Functional Status4 March 2022 | Healthcare, Vol. 10, No. 3A Machine Learning Approach to Predict the Rehabilitation Outcome in Convalescent COVID-19 Patients22 February 2022 | Journal of Personalized Medicine, Vol. 12, No. 3Design of Somatosensory Interactive Balance Training Exergame for the Elderly Based on Tai Chi24 May 2022Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic19 January 2022 | JMIR Serious Games, Vol. 10, No. 1Immersive Virtual Reality Exergames to Promote the Well-being of Community-Dwelling Older Adults: Protocol for a Mixed Methods Pilot Study13 June 2022 | JMIR Research Protocols, Vol. 11, No. 6Effect of the Nintendo Ring Fit Adventure Exergame on Running Completion Time and Psychological Factors Among University Students Engaging in Distance Learning During the COVID-19 Pandemic: Randomized Controlled Trial22 March 2022 | JMIR Serious Games, Vol. 10, No. 1Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review14 December 2021 | Nutrients, Vol. 13, No. 12Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era20 October 2021 | Nutrients, Vol. 13, No. 11Seeking Inspiration: Examining the Validity and Reliability of a New Smartphone Respiratory Therapy Exergame App28 September 2021 | Sensors, Vol. 21, No. 19Immersive Virtual Reality Exergame Promotes the Practice of Physical Activity in Older People: An Opportunity during COVID-191 September 2021 | Multimodal Technologies and Interaction, Vol. 5, No. 9Persistent Endothelial Dysfunction in Post-Acute COVID-19 Syndrome: A Case-Control Study4 August 2021 | Biomedicines, Vol. 9, No. 8Rehabilitation games in a world in digital transition20 June 2021 | REVISTA CIÊNCIAS EM SAÚDE, Vol. 11, No. 2COVID-19 and diffusing capacity of the lungs for carbon monoxide: a clinical biomarker in postacute care settingsBiomarkers in Medicine, Vol. 15, No. 8Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation28 May 2021 | Biomedicines, Vol. 9, No. 6Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis: A systematic reviewMultiple Sclerosis and Related Disorders, Vol. 51Educational and Social Exergaming: A Perspective on Physical, Social, and Educational Benefits and Pitfalls of Exergaming at Home During the COVID-19 Pandemic and Afterwards9 April 2021 | Frontiers in Psychology, Vol. 12CeVRicale: A VR app for Cervical RehabilitationTelerehabilitation Solution for Hand Therapy Volume 9Issue 5Oct 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Pasquale Ambrosino, Salvatore Fuschillo, Antimo Papa, Matteo Nicola Dario Di Minno, and Mauro Maniscalco.Exergaming as a Supportive Tool for Home-Based Rehabilitation in the COVID-19 Pandemic Era.Games for Health Journal.Oct 2020.311-313.http://doi.org/10.1089/g4h.2020.0095Published in Volume: 9 Issue 5: October 13, 2020Online Ahead of Print:August 25, 2020 TopicsCOVID-19Rehabilitation PDF download
Referência(s)