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Counting Repetitions: An Observational Study of Video Game Play in People With Chronic Poststroke Hemiparesis

Peters, Denise M. DPT; McPherson, Aaron K. DPT; Fletcher, Blake DPT; McClenaghan, Bruce A. PT, PED; Fritz, Stacy L. PT, PhD

Journal of Neurologic Physical Therapy: September 2013 - Volume 37 - Issue 3 - p 105–111
doi: 10.1097/NPT.0b013e31829ee9bc
Research Articles
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Background and Purpose: The use of video gaming as a therapeutic intervention has increased in popularity; however, the number of repetitions in comparison with traditional therapy methods has yet to be investigated. The primary purpose of this study was to document and compare the number of repetitions performed while playing 1 of 2 video gaming systems for a time frame similar to that of a traditional therapy session in individuals with chronic stroke.

Methods: Twelve participants with chronic stroke (mean age, 66.8 ± 8.2 years; time poststroke, 19.2 ± 15.4 months) completed video game play sessions, using either the Nintendo Wii or the Playstation 2 EyeToy. A total of 203 sessions were captured on video record; of these, 50 sessions for each gaming system were randomly selected for analysis. For each selected record, active upper and lower extremity repetitions were counted for a 36-minute segment of the recorded session.

Results: The Playstation 2 EyeToy group produced an average of 302.5 (228.1) upper extremity active movements and 189.3 (98.3) weight shifts, significantly higher than the Nintendo Wii group, which produced an average of 61.9 (65.7) upper extremity active movements and 109.7 (78.5) weight shifts. No significant differences were found in steps and other lower extremity active movements between the 2 systems.

Discussion and Conclusions: The Playstation 2 EyeToy group produced more upper extremity active movements and weight shifting movements than the Nintendo Wii group; the number and type of repetitions varied across games. Active gaming (specifically Playstation 2 EyeToy) provided more upper extremity repetitions than those reported in the literature by using traditional therapy, suggesting that it may be a modality to promote increased active movements in individuals poststroke.

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Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia.

Correspondence: Denise M. Peters, DPT, Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly St, 3rd floor PHRC, Columbia, SC 29208 (

Parts of this article were presented in poster format at the American Physical Therapy Association's Combined Sections Meeting in (1) New Orleans, Los Angeles, California, February 2011, and (2) San Diego, California, February 2010. Corresponding abstracts were published.

Financial support for this study was provided by a grant (64450) from Health Games Research, a national program of the Robert Wood Johnson Foundation.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 Neurology Section, APTA