The Complementary Role of the Kinect Virtual Reality Game Training in a Patient With Metachromatic Leukodystrophy

Metachromatic leukodystrophy (MLD) is a lysosomal storage disease characterized by demyelination of the peripheral and central nerves. Patients with MLD can present with gait disturbances, progressive spastic quadriparesis, diffuse muscle atrophy, and areflexia attributable to central or peripheral nerve involvements. The rehabilitation of patients with MLD generally focuses on gait disturbances, balance impairments, and muscle weaknesses. Here, we present a case of MLD in which virtual reality (VR) training was used as an adjunctive therapy. We also discuss the complementary role of VR therapy, which was successfully integrated with a conventional rehabilitation program for a young patient with MLD who had impaired balance and gait. After completion of the integrated rehabilitation program, the patient demonstrated improvements in functional independency, mobility, walking speed, and balance. His total Functional Independence Measure score increased from 97 to 109, 6‐minute walk test increased from 342 to 396 m, 10‐minute walk test decreased from 11 to 7 seconds, and Berg Balance Scale score increased from 38 to 42 points. Moreover, 6 weeks after completion of the therapy, these improvements were sustained for the most part. Adding VR to a conventional rehabilitation program is an emerging trend in neurologic rehabilitation. Our patient with MLD demonstrated considerable improvements with a high level of enjoyment and satisfaction.

[1]  V. Gieselmann Metachromatic leukodystrophy: genetics, pathogenesis and therapeutic options , 2008, Acta paediatrica.

[2]  Martin A. Giese,et al.  Video game–based coordinative training improves ataxia in children with degenerative ataxia , 2012, Neurology.

[3]  I. Krägeloh-Mann,et al.  Metachromatic Leukodystrophy – An Update , 2010, Neuropediatrics.

[4]  Ki-Hun Cho,et al.  Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. , 2012, The Tohoku journal of experimental medicine.

[5]  D. Rand,et al.  Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: implications for stroke rehabilitation. , 2013, European journal of physical and rehabilitation medicine.

[6]  P. McNulty,et al.  Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study. , 2011, Journal of rehabilitation medicine.

[7]  J. Stein,et al.  Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. , 2006, Archives of physical medicine and rehabilitation.

[8]  Yao-Jen Chang,et al.  A Kinect-based system for physical rehabilitation: a pilot study for young adults with motor disabilities. , 2011, Research in developmental disabilities.

[9]  Yoram Baram,et al.  Virtual reality cues for improvement of gait in patients with multiple sclerosis , 2006, Neurology.

[10]  D. Zafeiriou,et al.  Developing treatment options for metachromatic leukodystrophy. , 2012, Molecular genetics and metabolism.

[11]  G. Lucchini,et al.  Metachromatic leukodystrophy: an overview of current and prospective treatments , 2008, Bone Marrow Transplantation.

[12]  K. Fong,et al.  Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. , 2001, Brain injury.

[13]  S. Studenski,et al.  Meaningful Change and Responsiveness in Common Physical Performance Measures in Older Adults , 2006, Journal of the American Geriatrics Society.

[14]  Tung-Wu Lu,et al.  Effects of Virtual Reality–Augmented Balance Training on Sensory Organization and Attentional Demand for Postural Control in People With Parkinson Disease: A Randomized Controlled Trial , 2011, Physical Therapy.

[15]  Oddom Demontiero,et al.  Effects of balance training using a virtual-reality system in older fallers , 2013, Clinical interventions in aging.

[16]  J. Deutsch,et al.  Cochrane review: virtual reality for stroke rehabilitation. , 2012, European journal of physical and rehabilitation medicine.