The effects of exergaming on individuals with limb loss: a systematic review

Background: Losing a limb is a life-changing experience. Affected individuals (amputees) have to learn how to care for their amputated limb, how to walk, and how to cope and adjust with limb loss and prosthesis use. They also have reduced physical range of motion, poorer balance control, strength, and experience pain and fatigue. Exergaming is currently used in physical rehabilitation for Parkinson’s disease, multiple sclerosis and post-stroke. There is currently no consensus on the efficacy of exergaming delivered to people with missing limbs. AIM: The aim of this systematic review is to evaluate and summarize the current research on the effects of exergaming among individuals with missing limbs. Method: Studies reporting on exergaming intervention delivered to individuals receiving prosthetic rehabilitation were included in the analysis. Eight electronic databases were searched. Twelve articles were identified. Data were extracted and assessed for quality. Results: Three main categories of exergaming interventions comprised custom made exergames, Nintendo Wii games and exergames provided by the Computer Assisted Rehabilitation Environment (CAREN) system. Of these, seven interventions were delivered by research staff, four by a physiotherapist and one by a physiotherapist and an occupational therapist. Custom made exergames were used in five studies, of which four involved people with lower limb amputations and one involved people with upper limb amputations. The Nintendo Wii was used in five studies involving people with lower limb amputations, whilst the remaining two used the CAREN system, also involving people with lower limb amputations. All participants in the studies were adults except for one which evaluated exergaming in adolescents and children. Studies reported improvements in EMG muscle control, cognitive-motor ability, walking capacity, function, balance and reduced pain. Most participants enjoyed the exergaming intervention and found the experience to be positive. Results suggest that exergaming supports improvements in physical activity, balance, cognition, emotional states, quality of life and pain. Conclusion: Exergaming interventions administered to people with missing limbs show heterogeneity in protocol, duration and gaming platform. Although there was evidence of improved outcomes in participants, the efficacy of exergaming is inconclusive due to varied differences in types of amputation, participant characteristics and assessed outcome measures. Nevertheless, reported enjoyment, acceptance and levels of motivation during exergaming appear to support the feasibility of exergaming for prosthetic training