Clinical Geriatrics - Original Investigations
Submitted: 2022-12-26
Published: 2023-07-20

The effect of leap motion controller based exergame therapy on hand function, cognitive function and quality of life in older adults. A randomised trial

Istanbul Medipol University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Beykoz, Istanbul, Turkey; Istanbul University-Cerrahpaşa, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Doctorate Program, Avcılar/İstanbul, Turkey
https://orcid.org/0000-0002-3099-307X
Istanbul Medipol University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Beykoz, Istanbul, Turkey
https://orcid.org/0000-0001-9804-368X
Istanbul Medipol University, Faculty of Health Sciences, Department of Occupational Therapy, Beykoz, Istanbul, Turkey
https://orcid.org/0000-0003-0552-8464
Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Beykoz, Istanbul, Turkey
https://orcid.org/0000-0002-5286-4981
exergaming exercise hand quality of life aged

Abstract

Objective. To evaluate the effect of leap motion controller based exergame therapy (LMCBET) on hand function, cognitive function and quality of life (QoL) in older adults.
Design. A parallel, double-blind trial with participants allocated (1:1) to one of two groups as the structured exercise (SE) and LMCBET.
Setting. The study was conducted in “Barınyurt Nursing Home and Elderly Care Center” in Istanbul.
Participants. Thirty-two older adults who had adequate hand function, ability to follow commands, 24 points or more in the mini mental state examination (MMSE) were included and 30 were analyzed.
Interventions. SE Group performed a Structured Hand Exercise program while LMCBET group performed “ErgoActive’’ and “HandROM” exercise apps focusing on hand exercises and fine motor skills along 30-45 minute sessions, 2 days a week, over 8 weeks.
Main outcome measures. Participants were evaluated with box and block test (BBT), Purdue Pegboard test (PPT), hand dynamometer, Duruöz hand index (DHI), stroop test (ST), digit span test (DST), and World Health Organization QoL instrument-older adults module (WHOQOL- OLD) at the beginning (T0), at 8 (T1), and 16 (T2) weeks after the study started.
Results. There were significant differences in BBT, PPT, DHI, and WHOQOL-OLD in the SE group (p < 0.05). BBT, right, left, couple, total scores of PPT, DHI and WHOQOL-OLD were found significant in the LMCBET group (p < 0.05). In Time*Group evaluations, there were no differences (p > 0.05).
Conclusions. SE and LMCBET were effective on hand function and QoL in healthy older adults.

Contribution of paper

  1. LMCBET is a feasible and effective method for healthy older adults to improve the hand function and QoL.
  2. LMCBET is an alternative to conventional approaches and recommended as home exercises in rehabilitation.
  3. Further research should be conducted to evaluate the effect of exergame therapy in adults more focusing on the cognitive improvements.

Abbreviations

ADL: activities of daily living

BBT: box and block test

DHI: Duruöz hand index

DST: digit span test

GDS: geriatric depression scale

LMC: leap motion controller

LMCBET: leap motion controller based exergame therapy

MMSE: mini mental state examination

PPT: Purdue Pegboard test

PRPS: Pittsburgh rehabilitation participation scale

QoL: quality of life

SE: structured exercise

ST: Stroop test

WHOQOL-OLD: World Health Organization quality of life instrument older adults module

INTRODUCTION

Aging is a natural process from adulthood to death, associated with decline in body functions which results in metabolic based diseases while having a remarkable impact on activities of daily living (ADL) and quality of life (QoL) 1. The functional loss is mainly mediated by a decrease in sensory function, tendon reflexes, motor movements, cognitive function and result in fine and gross motor skill problems in ADL 2. Hand grip strength is the main indicator of upper extremity strength, guides in evaluating life independence and cognitive aging 3. The loss of two-way interaction between cognition and motor systems lead to disturbances in hand-eye coordination 4. Along with physiological changes and cognitive decline, unfavorable alterations in motor planning, muscular endurance, and coordination may become more prominent in aging individuals and subsequently affect ADL 4. However, the amount of ADL can be preserved by preventing the decrease in cognitive function 4,5. Depression, another common age-related condition, can be developed via the loss of social communication, decreased self-esteem and courage plus altered biologic or physical function which results in limitation of the daily activities 6. Due to decreased productivity and economic income, elderly starts dealing with the feel of uselessness which might result in isolated lifestyle or low attendance to the activities which causes other physical limitations in the long term 6. With an altered neurochemical changes in the brain and the prolonged burden of sleep deprivation, aged individuals seem more prone to depression compared to younger individuals in accordance with decline in cognitive and physical function 6. Based on this multifactorial disease feature, the rehabilitation process requires a multidisciplinary intervention as well as adapting medication usage, psychotherapy, cognitive approaches, social structure, self-confidence, nutritional support and most importantly, incorporating physical activity into daily routine 6. While an elderly with a depression is facing with decreased performance due to the laziness and loss of motivation in later stages of the disease, the rehabilitation approaches should mainly focus on improving the function, cognition, motivating the person for social life attendance by incorporating the family and friend support to the process 6.

In parallel with the high impact of physical activity on QoL and cognition, interventions that focus on muscle function and strength are essential 7. While exercise promotes neuroplasticity, blood circulation, the prevention of the chronic and cognitive diseases, structured exercise (SE) programs which are more preferable as a supervised exercise than a home exercise alone, can be applied in geriatric rehabilitation 8. In a study examining the effectiveness of physical exercises in conjunction with a mental task, the combination of the cognitive and physical training is emphasized to improve cognition 9. So focusing on various domains in rehabilitation can provide better outcomes instead of a single intervention alone 9. It is also suggested that a combination of mobility, endurance, strength and aerobic exercises two/three times a week can improve mental health and QoL, while some studies explain the sedentary lifestyle in older adults as reduced motivation for movement 10,11.

Technology and game-based rehabilitation systems such as exergames can contribute to the development of both motor and cognitive functions with task-specific upper extremity exercises, by providing fun and challenging tasks that enable participants to rehabilitate without being aware of it 12. The leap motion controller (LMC) can be used for hand exercises with advantages like cheap, no sensor needed, portable, safe and inspiratory environment 13. The LMC based exergame therapy (LMCBET) is widely used, particularly in pediatric rehabilitation, to evaluate hand fine motor function 14. Although the LMCBET has been applied for a specific disease group in previous studies 14,15, to our knowledge, there is no study focusing on virtual reality and cognitive function in healthy older adults. This study is intended to be a pioneering study.

The aim of this study was to evaluate the effectiveness of the SE and LMCBET in hand function, cognitive function and QoL in older adults.

METHOD

STUDY DESIGN

This study is a parallel, double-blind (participants and evaluators) trial with participants allocated (1:1) to one of two groups.

STUDY POPULATION

The study was conducted with participants who were living in Nursing Home and Elderly Care Center. The study was conducted between June 2021 and March 2022.

The participants who were ≥ 50 years old, had hand and cognitive function ability to follow commands, and got ≥ 24 points in the mini mental state examination (MMSE) were included in the study. The exclusion criteria were defined as presence of exercise contraindications, getting ≥ 14 points on the geriatric depression scale (GDS), diagnosis of dementia and acute upper extremity injury.

Thirty-nine participants were screened, thirty two participants who met the inclusion criteria were included in the study. During the study process, one is excluded due to not following the exercise sessions and one is dropped out due to the COVID-19 related death. In total, the study was completed with 30 participants. The algorithm for allocation was shown in Figure 1.

The sample size was determined using the “G*power sample size calculator” and was calculated as 30 subjects using “ANOVA: Repeated measures, within-between interaction” design for two groups, with a power of 95% (α = 0.05, β = 0.95) and an effect size of 0.35 16.

EXPERIMENTAL DESIGN

Thirty two participants were included in the study and were randomly divided into two groups using block randomization in Microsoft Excel ‘RAND(WS)’ function as the SE (n = 16) and LMCBET group (n = 16). Participants were evaluated at the beginning of the study (T0), at 8 (T1), and 16 (T2) weeks after the study started.

T0-T1 period

An 8-week active washout period in which both groups resumed their usual physical activity routines and ADLs. The logic of the active control period was dissociating the affect of the current daily life activities or the experimental intervention prescribed by the study protocol. Because of the participants were already taking a physical therapy or a group exercise session based on balance or postural parameters twice a week in the usual nursing home setting, the continuation of the routine was asked from all participants for the first 8 weeks and then they randomized into two groups. This period was thought-out to answer the question of "Did the development in the outcome measures is occured under favour of the personal daily routine activities or one or two of the structured exercise programs?" to increase the reliability of the achievements. Adding the control group into rehabilitation design was suggested in some other studies which practiced the exergame systems 15.

T1-T2 period

An intervention period in addition to the routine physical activities of participants. Participants in the SE Group performed a structured hand exercise program in the form of 30-45 minute sessions, 2 days a week, over 8 weeks. Participants in the LMCBET Group performed “ErgoActive” and “HandROM” exercise apps in the form of a 30-45 minute session, 2 days a week, over 8 weeks.

SE PROTOCOL

Structured hand exercises were applied in 30-45 minute sessions, 2 days a week, over 8 weeks. They consisted of warm-up, basic exercise, and cognitive exercise phases (Tab. I). Each exercise was performed as 10 repetitions. The weights were used in the wrist exercises and the difficulty level of the cognitive games were started at the intensity that the participants could tolerate and adapt in the first session, in accordance with the beginner level. Exercise intensity was increased in accordance with the BORG scale 17.

LMCBET PROTOCOL

The LMC device, which was the design of the “Becure (formerly Fizyosoft)” system, whose validity and reliability was specified, and which was developed with the cooperation of a physiotherapist and an engineer, was used in this protocol 18.

“ErgoActive” and “HandROM” exercise apps focusing on hand exercises and fine motor skills were performed in the form of an average 30-45 minute session, 2 days a week, over 8 weeks.

“ErgoActive”

It includes 6 different exercises (Master Chef, Key Flip, Piano, Hold Book, Pinch Peg, and Hold And Put) allowing participants to perform similar movements in their ADL (Tab. II).

“HandROM”

It includes 4 different exercises (LeapBall, LeapPong, LeapMaze, CatchaPet) allowing participants to perform exercises and evaluates the range of motion (ROM) of the fingers and wrist (Tab. III).

Each exercise was performed first right and then left hand, respectively together with a certified physiotherapist who is blinded to the group randomisation. The intensity of the sessions and the level of the games were determined according to the cognitive and motor performance of the participants in the first session. After the first session trial, the number of targets or the duration was determined in accordance with the wrist angle values or the time he was able to focus on the task and continue the game. Participants who were successful at the previous level, who could continue this success for a few sessions, and who were able to reach the goal with less verbal cues, were moved to the next level. The participant’s ability to easily reach the goal in the game was accepted as the necessary criterion for transitioning to the next level. In case of high difficulty during the session, it was returned to a lower level.

OUTCOME MEASUREMENTS

Demographic information was taken from participants at the beginning of the study and Pittsburgh rehabilitation participation scale (PRPS) was taken at the end of each session. Participants were evaluated by a physiotherapist in terms of gross motor skills and coordination with box and block test (BBT), in terms of fine motor skills and coordination with Purdue Pegboard test (PPT), in terms of grip strength with hand dynamometer, in terms of hand activity limitation and daily living skills with Duruöz hand index (DHI), in terms of executive functions with Stroop test (ST), in terms of attention with digit span test (DST), and in terms of QoL with World Health Organization QoL instrument-older adults module (WHOQOL-OLD) at the beginning of the study (T0), at 8 (T1), and 16 (T2) weeks after the study started.

Demographic Information Form

It was prepared to record the sociodemographic characteristics of participants.

PRPS

It is a 6-likert scale (1-none/6-excellent) and examines the participation in therapy and motivation. Test duration is 5 minutes 19.

BBT

It examines unilateral gross motor skills 20. A stopwatch, a wooden box with a middle section, and 150 wooden cubes are the required materials. It lasts 2-5 minutes. BBT can be applied between the ages of 6 and 65. Within 60 seconds, which is kept by the stopwatch, it is requested to pass the cubes one by one from one compartment to the other and the number of cubes is noted. It is applied separately for both extremities 21.

PPT

It consists of a board with holes into which metal pegs are inserted by the patient. It comes with washers and collars to be placed on the pins. PPT measures movements, coordination and speed of hand and finger dexterity 22. The participant is asked to use their right hand to properly insert as many pins as possible into the holes within 30 sec. Then the same process is repeated for the left hand. The participant is then given 30 sec to simultaneously place the pins, washers and collars using both hands. At the final stage, the participant is asked to perform a combined task with the pins within prescribed 60 sec.

Grip strength.

A hand dynamometer (pinch meter gauge; Jamar® Hand Dynamometer - Hydraulic - 200 lb Capacity. Patterson Medical Illinois, USA) was used to determine the grip strength. The shoulder was measured in adduction and neutral rotation, the elbow was in 90° flexion, and the forearm and wrist were measured in neutral position. Each test was repeated three times and the average score was obtained for the affected extremity 23.

DHI

It is an 18-item, self-answered scale that assesses hand activity limitations and its effect on ADL. It is scored from 0 to 90, and high scores indicate low functioning 24.

ST

It measures the processing speed, the ability to suppress habitual behavior, focused attention, the ability to do unusual behavior, the ability to change the perceptual setup according to changing demands, and under a disturbing effect 25,26.

DST

It consists of forward and backward number range, and evaluates attention 27. Numbers 1 to 9 are said in a predetermined and mixed order. In the forward span, it is expected to repeat the numbers in the same order. In the backward span, it is expected to say the numbers from the back to the beginning. The point corresponding to the last correctly known line is recorded as the score.

WHOQOL-OLD

Evaluates QoL in elderly individuals. WHOQOL-OLD consists of 6 sections: sensory skills, autonomy, past-present-future activities, social participation, death and relationships, and each section contains 4 items with a total of 24 questions 28.

STATISTICAL ANALYSIS

IBM SPSS (statistical package for social science) version 25.0 was used for statistical analysis. Kolmogrov Smirnov was used for normality assessment and all variables were found in normal distribution. Mean, standard deviation and percentage values were presented in the descriptive statistics of the data. The nominal data of the independent variables were evaluated with the Chi-Square test, and the numerical data were evaluated with the Independent Sample-T Test. Time-dependent differences within groups were analyzed with Two-Way Repeated Measure ANOVA. Intention to treat analysis is performed by adjusting time as dependent and group as independent variable to use Time*Group variable for analysis with intent to view the effect of the interventions. Time*Group interactions between groups were analyzed with MANOVA. Bonferroni correction was used for Post-Hoc tests. The significance value was accepted as p < 0.05.

RESULTS

DEMOGRAPHIC DATA

Demographic datas of the participants were shown in Table IV. There was no statistically significant difference in terms of age, gender, MMSE, education, job, history of injury, history of upper extremity surgery, and PRPS between groups (p > 0.05).

WITHIN GROUP DIFFERENCES

Within-group differences in the SE Group were shown in Table V. There were significant differences in terms of BBT, PPT, DHI, and WHOQOL-OLD in favor of the T1-T2 period (p < 0.05). There were no differences in terms of grip strength, ST and DST (p > 0.05).

Within-group differences in the LMCBET group were shown in Table VI. Significant differences in terms of BBT, right, left, couple, and total scores of PPT, DHI, and WHOQOL-OLD were found in favor of the T1-T2 period (p < 0.05). There were no differences in terms of grip strength, ST and DST (p > 0.05).

BETWEEN GROUP DIFFERENCES

Between-group differences and Time*Group interactions were shown in Table VII. In T0, there were significant differences in terms of PPT-Both hands score and ST-Color time score in favor of the LMCBET Group (p < 0.05). In T1, significant differences were found in terms of PPT-Both hands score and DHI in favor of the LMCBET group (p < 0.05). In T2, there were no differences between groups (p > 0.05). In Time*Group evaluations, no difference was found (p > 0.05).

DISCUSSION

In the present study, we investigated the effectiveness of the LMCBET in hand function, cognitive function and QoL in healthy older adults. We observed that SE and LMCBET were effective on hand function and QoL in healthy older adults.

Degeneration in the central nervous system begins to progress with aging, causing loss of muscle mass and strength, decrease in coordination, fine motor skills, hand sensation, and ultimately loss of manual function in ADL 29. In a study involving 24 older adults to evaluate hand pinch and grip strength, a correlation was found between the DHI and grip strength parameters, and it was suggested that grip strength is the main predictor of manual function 29. In our study, while there were significant improvements in hand activity limitations after both treatments, we did not find any significant change in hand grip strength 29. We believe that older adults tolerance to exercises requiring muscular endurance, such as holding the hand 25 cm above the LMC device during playtime, and difficulties during hand resistance training is significantly reduced 29. With aging, motor deficiencies, cognitive impairments, and impairments in function and QoL can be seen 30. In particular, functional impairment may affect bilateral and coordinated hand movements more. In our study, we observed that one-handed tasks performed in a shorter time compared to two-handed tasks in PPT 30. McGrath et al., reported that the amount of grip strength in the elderly with appropriate motor unit and skeletal muscle activation was half that of healthy older adults 31. It is important to consider a holistic approach in rehabilitation, as hand functions can be affected by dominant hand use, age, gender, and ADL 32.

Cognitive decline, seen in 15-20% of older adults over the age of 65, is another complication associated with aging and is affected by the reduction in ADL 33. A SE program may result in better improvements in hand and cognitive function in people with cognitive decline 33. It has been reported that for every 5 kg increase in muscle strength in elderly individuals, the risk of cognitive decline will decrease by 3% 30. Therefore, engaging in regular physical activity can prevent neurodegeneration and cognitive decline, thereby preventing the consequences of aging on the brain and muscles 30. In our study, we examined the effects of LMCBET and SE on hand functions and compared their superiority over each other. Participants who underwent SE enjoyed PRPS and showed significant improvements in hand function and QoL outcomes, although there was no significant change in grip strength. We observed that SE is beneficial in improving the QoL secondary to the improvement in hand functions in the elderly.

In recent years, the use of exergames such as LMCBET, which can be used to increase motivation and movement in all age groups, especially for hand functions, is gaining popularity 34. Yıldırım et al. reported that LMCBET provides improvements in ROM, fine motor skills, hand grip, and compression strength 15. Similar to studies using LMCBET and reporting improvements in hand function and bilateral coordination, we achieved positive results in the dual task of PPT using LMCBET in older adults 35,36. We think that this result is due to the fact that exergame includes both cognitive and motor activities. 71.7% of the participants find the exergames easy to use and fun, and want to repeat the game 33. The similarity of PRPS results in individuals who underwent LMCBET and SE in our study suggests that the use of exergame in rehabilitation may also be preferred by older adults. On the other hand, it is claimed that even though exergames do not include all ADLs, they can improve non-repetitive ADL by improving their general problem-solving skills 32. We found that LMCBET improved QoL and hand function. We are of the opinion that LMCBET in healthy older adults can provide significant improvements in hand function and QoL without major differences in grip strength and cognitive function.

STRENGTHS OF THE STUDY

This study’s capacity to evaluate both cognitive and functional outcomes and to compare LMCBET versus SE in healthy older adults was one of its great strengths. The second strength of the study was that we added some cognitive tasks to equate the SE group with the LMCBET group to avoid any bias during the study. The third strength of the study was the better results obtained in dominant manual tasks, showing that focusing on ADL in healthy older individuals should be one of the main goals of rehabilitation programs.

LIMITATIONS OF THE STUDY

The limitation of this study is the inability to use an objective neuroimaging tool for cognitive outcome measures. And since the loss of achievements in elderly is expected without the continuation of the intervention, the follow up period might be needed and maybe added into the study design in our future studies.

CONCLUSIONS

In conclusion, SE and LMCBET can be effective in increasing hand function and QoL in healthy older adults. Consequently, LMCBET can be used as an alternative to conventional approaches and recommended as home exercises in rehabilitation.

Acknowledgements

We gratefully acknowledge Dr. Bülent Özsezikli, PT, PhD, for his encouragement and providing the resources required for us to conduct this study at a Nursing Home and Elderly Care Center.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

SA: the conception and design of the study, acquisition of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted; DT: the conception and design of the study, acquisition of data, the analysis and interpretation of data, final approval of the version to be submitted; FH: the conception and design of the study, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted; MB: the analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted.

Ethical consideration

The protocol of the study was registered at (NCT05317377). This trial was approved by the Non-interventional Ethics Committee at Istanbul Medipol University, Turkey (protocol number: E-10840098-772.02-3137).

The research was conducted ethically, with all study procedures being performed in accordance with the requirements of the World Medical Association’s Declaration of Helsinki.

Written informed consent was obtained from each participant/patient for study participation and data publication.

Figures and tables

Figure 1.Flow-chart for the participant allocation. RCT: randomized controlled trial.

Table I.Structured hand exercise program.

Table II.LMCBET- “ErgoActive”.

Table III.LMCBET- “HandROM”.

SE group (n = 15) LMBET group (n = 15) x/t P value
Age (Avg ± SD) 75.93 ± 8.85 73.73 ± 12.46 0.557 0.582
Gender (n / %) Female 5/33.3 9/60 2.143 0.143
Male 10/66.7 6/40
MMSE (Avg ± SD) 25.86 ± 1.68 26.53 ± 1.59 -1.112 0.276
Education (n/%) Illiterate 0/0 1/6.7 4.154 0.527
Primary school 7/46.7 1/6.7
Middle school 1/6.7 6/40
High school 6/40 7/46.7
University 1/6.7 0/0
Job (n/%) Housewife 10/66.7 2/13.3 11.273 0.010*
Officer 1/6.7 0/0
Small business 1/6.7 5/33.3
Self-employment 3/20 8/53.3
History of injury (n/%) No injury 13/86.7 10/66.7 1.725 0.422
Hand and wrist tendon injury 1/6.7 2/13.3
Shoulder fracture, subluxation or frozen shoulder 1/6.7 3/20
History of surgery (n/%) Yes 0/0 0/0 -- --
No 15/100 15/100
PRPS (n/%) None 0/0 0/0 5.943 0.114
Poor 0/0 0/0
Fair 3/20 2/13.3
Good 6/40 2/13.3
Very good 4/26.7 3/20
Excellent 2/13.3 8/53.3
SE: structured exercise; LMCBET: leap motion based exergame; Avg: average; SD: standard deviation; n: number of persons; %: percentage; MMSE: mini-mental state examination; PRPS: Pittsburgh rehabilitation participation scale- *p < 0.05.
Table IV.Demographic data description.
T0 T1 T2 F Effect size (Cohen’s d) P value
Avg ± SD Avg ± SD Avg ± SD
Box and block test Right 34.00 ± 14.06 32.73 ± 16.98 36.80 ± 16.26 4.421 0.240 0.025*
Left 28.06 ± 10.09 28.33 ± 13.49 32.26 ± 14.41 5.529 0.283 0.015*
Purdue Pegboard test Right 6.60 ± 2.89 6.13 ± 3.64 7.66 ± 3.47 9.929 0.415 0.001*
Left 5.80 ± 2.93 6.00 ± 3.42 7.20 ± 3.52 8.767 0.385 0.001*
Both hands 3.20 ± 1.61 3.06 ± 1.62 4.13 ± 2.26 7.655 0.353 0.006*
Combined 1.73 ± 1.38 1.80 ± 1.56 2.46 ± 1.84 6.241 0.308 0.009*
Total 22.53 ± 12.28 22.53 ± 14.19 28.86 ± 16.06 15.000 0.517 0.000*
Grip strength Right 0.37 ± 0.17 0.34 ± 0.18 0.35 ± 0.17 0.491 0.034 0.547
Left 0.34 ± 0.14 0.32 ± 0.14 0.34 ± 0.16 0.702 0.048 0.462
Duruöz hand Index 25.73 ± 16.93 26.80 ± 17.45 21.46 ± 17.16 15.223 0.521 0.001*
Stroop test Reading time 53.15 ± 39.88 53.37 ± 42.19 61.34 ± 49.84 1.806 0.114 0.200
Colour time 166.69 ± 82.91 160.24 ± 100.65 168.17 ± 120.59 0.068 0.005 0.921
Time difference 76.59 ± 67.91 63.58 ± 96.72 68.78 ± 117.47 0.300 0.021 0.659
Digit Span test Forward 5.26 ± 1.48 5.20 ± 1.82 5.06 ± 1.90 0.566 0.039 0.554
Backward 2.60 ± 1.76 2.66 ± 1.87 2.53 ± 1.92 0.286 0.020 0.726
WHOQOL-OLD 70.80 ± 9.42 69.80 ± 9.95 75.53 ± 11.63 13.401 0.489 0.001*
SE: structured exercise; Avg: average; SD: standard deviation; n: number of persons; %: percentage; WHOQOL-OLD: World Health Organization quality of life ınstrument-older adults module. *p < 0.05.
Table V.Within group differences in SE Group.
T0 T1 T2 F Effect Size (Cohen’s d) p value
Avg ± SD Avg ± SD Avg ± SD
Box and block test Right 38.00 ± 10.67 38.33 ± 12.65 45.60 ± 12.79 10.974 0.439 0.000*
Left 34.46 ± 11.35 34.66 ± 10.56 39.06 ± 10.50 7.960 0.355 0.003*
Purdue Pegboard test Right 7.40 ± 2.74 7.86 ± 1.76 9.33 ± 2.25 8.760 0.385 0.001*
Left 7.40 ± 2.61 8.06 ± 2.49 8.66 ± 2.25 6.032 0.301 0.009*
Both hands 4.60 ± 2.02 4.73 ± 1.57 5.66 ± 2.09 9.333 0.400 0.002*
Combined 2.46 ± 0.99 2.44 ± 0.91 2.86 ± 0.99 3.308 0.191 0.054
Total 29.33 ± 10.65 30.26 ± 8.77 35.13 ± 10.04 8.979 0.391 0.003*
Grip strength Right 0.39 ± 0.15 0.38 ± 0.14 0.39 ± 0.17 0.223 0.016 0.775
Left 0.37 ± 0.13 0.36 ± 0.14 0.34 ± 0.14 1.542 0.099 0.232
Duruöz hand index 25.53 ± 10.99 15.73 ± 10.97 11.33 ± 8.84 25.386 0.645 0.000*
Stroop test Reading time 54.67 ± 48.96 64.81 ± 56.33 55.43 ± 39.62 2.575 0.155 0.101
Colour time 114.48 ± 50.25 110.60 ± 30.71 103.02 ± 42.69 0.577 0.040 0.517
Time difference 79.27 ± 64.04 87.75 ± 0.97 56.96 ± 67.19 2.478 0.150 0.131
Digit Span test Forward 4.86 ± 1.59 5.00 ± 1.60 5.06 ± 1.03 0.237 0.017 0.758
Backward 3.00 ± 1.73 3.00 ± 1.41 2.93 ± 1.33 0.055 0.004 0.899
WHOQOL-OLD 71.13 ± 11.10 69.93 ± 11.24 77.60 ± 7.25 21.832 0.609 0.000*
LMCBET: leap motion controller based exergame therapy; Avg: average; SD: standard deviation; n: number of persons; %: percentage; WHOQOL-OLD: World Health Organization quality of life ınstrument-older adults module. *p < 0.05.
Table VI.Within group differences in LMCBET group.
Between-groups Time*Group interactions
T0 T1 T2 Mean Difference CI (lower to upper) F Effect Size (Cohen’s d) P value
SE group (n = 15) LMCBET group (n = 15) P value SE group (n = 15) LMCBET group (n = 15) P value SE group (n = 15) LMCBET Group (n = 15) P value
Avg ± SD Avg ± SD Avg ± SD Avg ± SD Avg ± SD Avg ± SD
Box and block test Right 34.00 ± 14.06 38.00 ± 10.67 0.388 32.73 ± 16.98 38.33 ± 12.65 0.315 36.80 ± 16.26 45.60 ± 12.79 0.111 6.133 -4.035 to 16.302 2.245 0.074 0.119
Left 28.06 ± 10.09 34.46 ± 11.35 0.114 28.33 ± 13.49 34.66 ± 10.56 0.163 32.26 ± 14.41 39.06 ± 10.50 0.151 6.511 -2.051 to 15.074 0.034 0.001 0.961
Purdue Pegboard test Right 6.60 ± 2.89 7.40 ± 2.74 0.444 6.13 ± 3.64 7.86 ± 1.76 0.108 7.66 ± 3.47 9.33 ± 2.25 0.131 1.400 -0.629 to 3.429 1.520 0.051 0.229
Left 5.80 ± 2.93 7.40 ± 2.61 0.126 6.00 ± 3.42 8.06 ± 2.49 0.069 7.20 ± 3.52 8.66 ± 2.25 0.186 1.711 -0.381 to 3.803 0.752 0.026 0.466
Both hands 3.20 ± 1.61 4.60 ± 2.02 0.046* 3.06 ± 1.62 4.73 ± 1.57 0.008* 4.13 ± 2.26 5.66 ± 2.09 0.064 1.533 0.204 to 2.862 0.221 0.008 0.745
Combined 1.73 ± 1.38 2.46 ± 0.99 0.107 1.80 ± 1.56 2.44 ± 0.91 0.210 2.46 ± 1.84 2.86 ± 0.99 0.466 0.578 -0.349 to 1.505 0.617 0.022 0.531
Total 22.53 ± 12.28 29.33 ± 10.65 0.117 22.53 ± 14.19 30.26 ± 8.77 0.083 28.86 ± 16.06 35.13 ± 10.04 0.211 6.933 -1.931 to 15.797 0.280 0.010 0.714
Grip strength Right 0.37 ± 0.17 0.39 ± 0.15 0.679 0.34 ± 0.18 0.38 ± 0.14 0.535 0.35 ± 0.17 0.39 ± 0.17 0.595 0.033 -0.090 to 0.155 0.119 0.004 0.888
Left 0.34 ± 0.14 0.37 ± 0.13 0.653 0.32 ± 0.14 0.36 ± 0.14 0.455 0.34 ± 0.16 0.34 ± 0.14 1.000 0.021 -0.086 to 0.128 1.498 0.051 0.234
Duruöz hand index 25.73 ± 16.93 25.53 ± 10.99 0.061 26.80 ± 17.45 15.73 ± 10.97 0.047* 21.46 ± 17.16 11.33 ± 8.84 0.052 -10.467 -20.969 to 0.036 0.354 0.012 0.582
Stroop test Reading time 53.15 ± 39.88 54.67 ± 48.96 0.927 53.37 ± 42.19 64.81 ± 56.33 0.534 61.34 ± 49.84 55.43 ± 39.62 0.722 2.346 -31.470 to 36.162 3.100 0.100 0.058
Colour time 166.69 ± 82.91 114.48 ± 50.25 0.046* 160.24 ± 100.65 110.60 ± 30.71 0.078 168.17 ± 120.59 103.02 ± 42.69 0.059 -55.669 -106.103 to -5.235 0.217 0.008 0.781
Time difference 76.59 ± 67.91 79.27 ± 64.04 0.912 63.58 ± 96.72 87.75 ± 0.97 0.442 68.78 ± 117.47 56.96 ± 67.19 0.738 5.009 -51.359 to 61.377 1.339 0.046 0.267
Digit Span test Forward 5.26 ± 1.48 4.86 ± 1.59 0.484 5.20 ± 1.82 5.00 ± 1.60 0.752 5.06 ± 1.90 5.06 ± 1.03 1.000 -0.200 -1.322 to 0.922 0.645 0.023 0.511
Backward 2.60 ± 1.76 3.00 ± 1.73 0.536 2.66 ± 1.87 3.00 ± 1.41 0.587 2.53 ± 1.92 2.93 ± 1.33 0.513 0.378 -0.838 to 1.593 0.035 0.001 0.955
WHOQOL-OLD 70.80 ± 9.42 71.13 ± 11.10 0.930 69.80 ± 9.95 69.93 ± 11.24 0.973 75.53 ± 11.63 77.60 ± 7.25 0.564 0.844 -6.518 to 8.206 0.764 0.027 0.417
SE: structured exercise; LMCBET: leap motion controller based exergame therapy; Avg: average; SD: standard deviation; n: number of persons; %: percentage; WHOQOL-OLD: World Health Organization quality of life ınstrument-older adults module. *p < 0.05.
Table VII.Between group differences and Time*Group interactions.

References

  1. Li Z, Zhang Z, Ren Y. Aging and age-related diseases: from mechanisms to therapeutic strategies. Biogerontology. 2021; 22:165-187. DOI
  2. Schott JM. The neurology of ageing: what is normal?. Pract Neurol. 2017; 17:172-182. DOI
  3. Zammit AR, Robitaille A, Piccinin AM. Associations between aging-related changes in grip strength and cognitive function in older adults: a systematic review. J Gerontol A Biol Sci Med Sci. 2019; 74:519-527. DOI
  4. Chan PT, Chang WC, Chiu HL. Effect of interactive cognitive-motor training on eye-hand coordination and cognitive function in older adults. BMC Geriatr. 2019; 19:27. DOI
  5. Evans IEM, Martyr A, Collins R. Social isolation and cognitive function in later life: a systematic review and meta-analysis. J Alzheimer’s Dis. 2019; 70:S119-S144. DOI
  6. Tayaa S, Berrut G, Seigneurie AS. Diagnostic et prise en charge de la dépression chez le sujet âgé [Diagnosis and management of depression in the elderly]. Geriatr Psychol Neuropsychiatr Vieil. 2020; 18:88-96. DOI
  7. Cordes T, Bischoff LL, Schoene D. A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project. BMC Geriatr. 2019; 19:369. DOI
  8. Mora JC, Valencia WM. Exercise and older adults. Clin Geriatr Med. 2018; 34:145-162. DOI
  9. Cui MY, Lin Y, Sheng JY. Exercise intervention associated with cognitive improvement in Alzheimer’s disease. Neural Plast. 2018; 2018:9234105. DOI
  10. Naczk M, Marszalek S, Naczk A. Inertial training improves strength, balance, and gait speed in elderly nursing home residents. Clin Interv Aging. 2020; 15:177-184. DOI
  11. Rugbeer N, Ramklass S, Mckune A. The effect of group exercise frequency on health related quality of life in institutionalized elderly. Pan Afr Med J. 2017; 26:35. DOI
  12. Rogers JM, Duckworth J, Middleton S. Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study. J Neuroeng Rehabil. 2019; 16:56. DOI
  13. Cortés-Pérez I, Zagalaz-Anula N, Ibancos-Losada MDR. Virtual reality-based therapy reduces the disabling impact of fibromyalgia syndrome in women: systematic review with meta-analysis of randomized controlled trials. J Pers Med. 2021; 11:1167. DOI
  14. Tarakci E, Arman N, Tarakci D. Leap motion controller-based training for upper extremity rehabilitation in children and adolescents with physical disabilities: a randomized controlled trial. J Hand Ther. 2020; 33:220-228.E1. DOI
  15. Yildirim Y, Budak M, Tarakci D. The effect of video-based games on hand functions and cognitive functions in cerebral palsy. Games Health J. 2021; 10:180-189. DOI
  16. Faul F, Erdfelder E, Lang AG. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39:175-191. DOI
  17. Milot MH, Léonard G, Corriveau H. Using the Borg rating of perceived exertion scale to grade the intensity of a functional training program of the affected upper limb after a stroke: a feasibility study. Clin Interv Aging. 2018; 14:9-16. DOI
  18. Arman N, Oktay AB, Tarakci D. The validity of an objective measurement method using the Leap Motion Controller for fingers wrist, and forearm ranges of motion. Hand Surg Rehabil. 2021; 40:394-399. DOI
  19. Lenze EJ, Munin MC, Quear T. The Pittsburgh rehabilitation participation scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation. Arch Phys Med Rehabil. 2004; 85:380-384. DOI
  20. Mathiowetz V, Volland G, Kashman N. Adult norms for the Box and Block test of manual dexterity. Am J Occup Ther. 1985; 39:386-391. DOI
  21. Desrosiers J, Bravo G, Hébert R. Validation of the Box and Block test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Arch Phys Med Rehabil. 1994; 75:751-755.
  22. Tiffin J, Asher EJ. The Purdue pegboard; norms and studies of reliability and validity. J Appl Psychol. 1948; 32:234-47. DOI
  23. Hogrel JY. Grip strength measured by high precision dynamometry in healthy subjects from 5 to 80 years. BMC Musculoskelet Disord. 2015; 16:139. DOI
  24. Duruoz T, Topcu E, Duruoz E. AB1391 The validity of duruOz hand index (DHI) in geriatric population. Ann Rheum Dis. 2014; 71:717-717. DOI
  25. Scarpina F, Tagini S. The Stroop Color and Word test. Front Psychol. 2017; 8:557. DOI
  26. Houx PJ, Shepherd J, Blauw GJ. Testing cognitive function in elderly populations: the PROSPER study. PROspective Study of Pravastatin in the Elderly at Risk. J Neurol Neurosurg Psychiatry. 2002; 73:385-389. DOI
  27. Maviş I, Özbabalik Adapinar BD, Yenilmez Ç. Test your memory-Turkish version (TYM-TR): reliability and validity study of a cognitive screening test. Turk J Med Sci. 2015; 45:1178-1185. DOI
  28. Gobbens RJ, van Assen MA. Psychometric properties of the Dutch WHOQOL-OLD. Health Qual Life Outcomes. 2016; 14:103. DOI
  29. Incel NA, Sezgin M, As I. The geriatric hand: correlation of hand-muscle function and activity restriction in elderly. Int J Rehabil Res. 2009; 32:213-218. DOI
  30. Riaz M, Vangberg TR, Vasylenko O. What does hand motor function tell us about our aging brain in association with WMH?. Aging Clin Exp Res. 2021; 33:1577-1584. DOI
  31. McGrath R, Vincent BM, Hackney KJ. The longitudinal associations of handgrip strength and cognitive function in aging Americans. J Am Med Dir Assoc. 2020; 21:634-639.E1. DOI
  32. Sebastjan A, Skrzek A, Ignasiak Z. The effects of age and sex on hand movement structure. Aging Clin Exp Res. 2017; 29:1221-1229. DOI
  33. Liao YY, Tseng HY, Lin YJ. Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment. Eur J Phys Rehabil Med. 2020; 56:47-57. DOI
  34. Syed-Abdul S, Malwade S, Nursetyo AA. Virtual reality among the elderly: a usefulness and acceptance study from Taiwan. BMC Geriatr. 2019; 19:223. DOI
  35. Avcil E, Tarakci D, Arman N. Upper extremity rehabilitation using video games in cerebral palsy: a randomized clinical trial. Acta Neurol Belg. 2021; 121:1053-1060. DOI
  36. Do JH, Yoo EY, Jung MY. The effects of virtual reality-based bilateral arm training on hemiplegic children’s upper limb motor skills. Neuro Rehabilitation. 2016; 38:115-127. DOI

Affiliations

Simay Akdemir

Istanbul Medipol University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Beykoz, Istanbul, Turkey; Istanbul University-Cerrahpaşa, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Doctorate Program, Avcılar/İstanbul, Turkey

Devrim Tarakci

Istanbul Medipol University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Beykoz, Istanbul, Turkey

Miray Budak

Istanbul Medipol University, Faculty of Health Sciences, Department of Occupational Therapy, Beykoz, Istanbul, Turkey

Farzin Hajebrahimi

Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Beykoz, Istanbul, Turkey

Copyright

© JOURNAL OF GERONTOLOGY AND GERIATRICS , 2023

How to Cite

[1]
Akdemir, S., Tarakci, D., Budak, M. and Hajebrahimi, F. 2023. The effect of leap motion controller based exergame therapy on hand function, cognitive function and quality of life in older adults. A randomised trial. JOURNAL OF GERONTOLOGY AND GERIATRICS. 71, 3 (Jul. 2023), 152-165. DOI:https://doi.org/10.36150/2499-6564-N606.
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