A gamified therapeutic exercise experience in a patient with Wernicke-Korsakoff syndrome
DOI:
https://doi.org/10.47197/retos.v72.116820Keywords:
Wernicke-Korsakoff syndrome, virtual reality, virtual reality exposure therapy, active videogame, exercise, physiotherapyAbstract
Introduction: Wernicke-Korsakoff syndrome (WKS) is a brain disorder caused by a thiamine deficiency, the most common cause being alcoholism. Physiotherapy focuses its treatment on improving balance, gait, and coordination, and cognitive aspects must be addressed. The use of immersive virtual reality (IVR) could address these aspects.
Objective: To report a case of using IVR to manage the symptoms of a patient with WKS.
Methodology: A 57-year-old male (WKS 1 year since diagnosis) used IVR for 16 weeks, 2 sessions/week. Physical and functional capacity, quality of life, neurocognition, and intrinsic aspects of IVR were assessed.
Results: Positive trend in the physical and functional variables: grip strength (improvements of 8.33% in the dominant hand and 4% in the non-dominant hand), lower limb mobility and strength (improvements of 5.74%), functionality and dynamic balance (improvements of 14.22%), and gait and risk of falls (improvements of 18.12%). No changes in quality of life or neurocognitive tests.
Discussion: In the absence of similar studies, the improvements found, while not clinically relevant, support the idea that an IVR and therapeutic exercise intervention could maintain and/or improve the health status of a person with WKS.
Conclusions: IVR in a patient with WKS of alcoholic origin proved to be a feasible and safe intervention, with improvements in gait, balance, mobility, and lower limb strength. These findings pave the way for future research into this syndrome that could confirm the benefits that IVR could provide to these patients.
References
Arts, N., Walvoort, S., & Kessels, R. (2017). Korsakoff's syndrome: A critical review. Neuropsychiatric Disease and Treatment, Volume 13, 2875-2890. https://doi.org/10.2147/NDT.S130078
Bohannon, R. W. (2019). Minimal clinically important difference for grip strength: A systematic review. Journal of Physical Therapy Science, 31(1), 75-78. https://doi.org/10.1589/jpts.31.75
Borg, G. A. (1982). Psychophysical bases of perceived exertion. Medicine and Science in Sports and Ex-ercise, 14(5), 377-381.
Brooke, J. (1996). SUS-A quick and dirty usability scale. Usability Evaluation in Industry, 189(194), 4-7.
Burile, G. C., Arya, N., Seth, N. H., & Fating, T. (2024). Rehabilitation Strategies for Wernicke-Korsakoff Syndrome: Physiotherapy Interventions and Management Approaches. Cureus, 16(2), e53948. https://doi.org/10.7759/cureus.53948
Campo-Prieto, P., Rodríguez-Fuentes, G., & Cancela Carral, J. M. (2021). Traducción y adaptación trans-cultural al español del Simulator Sickness Questionnaire. Retos, 43, 503-509. https://doi.org/10.47197/retos.v43i0.87605
Canbek, J., Fulk, G., Nof, L., & Echternach, J. (2013). Test-Retest Reliability and Construct Validity of the Tinetti Performance-Oriented Mobility Assessment in People With Stroke. Journal of Neurologic Physical Therapy, 37(1), 14-19. https://doi.org/10.1097/NPT.0b013e318283ffcc
Chamorro Fernández, A. J., Marcos Martín, M., & Laso Guzmán, F. J. (2011). Encefalopatía de Wernicke en el paciente alcohólico. Revista Clínica Española, 211(9), 458-463. https://doi.org/10.1016/j.rce.2011.04.001
Chandrakumar, A., Bhardwaj, A., & ‘T Jong, G. W. (2019). Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis. Journal of Basic and Clinical Physiology and Pharmacology, 30(2), 153-162. https://doi.org/10.1515/jbcpp-2018-0075
Dávila-Morán, R. C. (2024). La rehabilitación física y sus avances con realidad virtual: Una revisión sistemática (Physical rehabilitation and its advances with virtual reality: a systematic review). Retos, 60, 467-476. https://doi.org/10.47197/retos.v60.109195
Flansbjer, U.-B., Holmbäck, A. M., Downham, D., Patten, C., & Lexell, J. (2005). Reliability of gait perfor-mance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medi-cine, 37(2), 75-82. https://doi.org/10.1080/16501970410017215
Fu, V., Weatherall, M., & McNaughton, H. (2021). Estimating the minimal clinically important difference for the Physical Component Summary of the Short Form 36 for patients with stroke. Journal of International Medical Research, 49(12), 3000605211067902. https://doi.org/10.1177/03000605211067902
Gerridzen, I. J., Hertogh, C. M. P. M., Depla, M. F., Veenhuizen, R. B., Verschuur, E. M. L., & Joling, K. J. (2018). Neuropsychiatric Symptoms in People With Korsakoff Syndrome and Other Alcohol-Related Cognitive Disorders Living in Specialized Long-Term Care Facilities: Prevalence, Severi-ty, and Associated Caregiver Distress. Journal of the American Medical Directors Association, 19(3), 240-247. https://doi.org/10.1016/j.jamda.2017.09.013
Goldberg, A., Chavis, M., Watkins, J., & Wilson, T. (2012). The five-times-sit-to-stand test: Validity, relia-bility and detectable change in older females. Aging Clinical and Experimental Research, 24(4), 339-344. https://doi.org/10.1007/BF03325265
Habas, E., Farfar, K., Errayes, N., Rayani, A., & Elzouki, A.-N. (2023). Wernicke Encephalopathy: An Up-dated Narrative Review. Saudi Journal of Medicine & Medical Sciences, 11(3), 193-200. https://doi.org/10.4103/sjmms.sjmms_416_22
Hafsteinsdóttir, T. B., Rensink, M., & Schuurmans, M. (2014). Clinimetric Properties of the Timed Up and Go Test for Patients with Stroke: A Systematic Review. Topics in Stroke Rehabilitation, 21(3), 197-210. https://doi.org/10.1310/tsr2103-197
Hedlefs Aguilar, M. I., & Garza Villegas, A. A. (2016). Análisis comparativo de la Escala de Usabilidad del Sistema (EUS) en dos versiones. RECI Revista Iberoamericana de las Ciencias Computacionales e Informática, 5(10), 44. https://doi.org/10.23913/reci.v5i10.48
Kennedy, R. S., Drexler, J., & Kennedy, R. C. (2010). Research in visually induced motion sickness. Ap-plied Ergonomics, 41(4), 494-503. https://doi.org/10.1016/j.apergo.2009.11.006
Kennedy, R. S., Lane, N. E., Berbaum, K. S., & Lilienthal, M. G. (1993). Simulator Sickness Questionnaire: An Enhanced Method for Quantifying Simulator Sickness. The International Journal of Aviation Psychology, 3(3), 203-220. https://doi.org/10.1207/s15327108ijap0303_3
Lee, J. H., Ku, J., Cho, W., Hahn, W. Y., Kim, I. Y., Lee, S.-M., Kang, Y., Kim, D. Y., Yu, T., Wiederhold, B. K., Wiederhold, M. D., & Kim, S. I. (2003). A Virtual Reality System for the Assessment and Rehabili-tation of the Activities of Daily Living. CyberPsychology & Behavior, 6(4), 383-388. https://doi.org/10.1089/109493103322278763
Martín-San Agustín, R., Crisostomo, M. J., Sánchez-Martínez, M. P., & Medina-Mirapeix, F. (2021). Re-sponsiveness and Minimal Clinically Important Difference of the Five Times Sit-to-Stand Test in Patients with Stroke. International Journal of Environmental Research and Public Health, 18(5), 2314. https://doi.org/10.3390/ijerph18052314
Matsushita, T., Nishioka, S., Yamanouchi, A., Okazaki, Y., Oishi, K., Nakashima, R., Tokunaga, Y., & Onizu-ka, S. (2022). Predictive ability of hand-grip strength and muscle mass on functional prognosis in patients rehabilitating from stroke. Nutrition, 102, 111724. https://doi.org/10.1016/j.nut.2022.111724
Mong, Y., Teo, T. W., & Ng, S. S. (2010). 5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity. Archives of Physical Medicine and Rehabilitation, 91(3), 407-413. https://doi.org/10.1016/j.apmr.2009.10.030
Moraes, T. M., Zaninotto, A. L., Neville, I. S., Hayashi, C. Y., & Paiva, W. S. (2021). Immersive virtual reali-ty in patients with moderate and severe traumatic brain injury: A feasibility study. Health and Technology, 11(5), 1035-1044. https://doi.org/10.1007/s12553-021-00582-2
Onishi, H., Uchida, N., Itami, K., Sato, M., Tamura, S., Kurosaki, A., & Ishida, M. (2020). Subclinical thia-mine deficiency: What is the most appropriate method of diagnosis and treatment? Palliative and Supportive Care, 18(5), 614-616. https://doi.org/10.1017/S147895152000098X
Oudman, E., Kruisselbrink, J., & Noback, I. (2023). Virtual Reality in Korsakoff’s Syndrome. Interna-tional Journal of Research Publication and Reviews, 04(02), 691-694. https://doi.org/10.55248/gengpi.2023.42004
Oudman, E., Oey, M. J., Batjes, D., Van Dam, M., Van Dorp, M., Postma, A., & Wijnia, J. W. (2022). Wer-nicke-Korsakoff syndrome diagnostics and rehabilitation in the post-acute phase. Addiction Neuroscience, 4, 100043. https://doi.org/10.1016/j.addicn.2022.100043
Oudman, E., Wijnia, J. W., Oey, M. J., Van Dam, M., & Postma, A. (2021). Wernicke-Korsakoff syndrome despite no alcohol abuse: A summary of systematic reports. Journal of the Neurological Scienc-es, 426, 117482. https://doi.org/10.1016/j.jns.2021.117482
Pietrzak, E., Pullman, S., & McGuire, A. (2014). Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. Games for Health Journal, 3(4), 202-214. https://doi.org/10.1089/g4h.2014.0013
Podsiadlo, D., & Richardson, S. (1991). The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons. Journal of the American Geriatrics Society, 39(2), 142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
Prats-Bisbe, A., López-Carballo, J., García-Molina, A., Leno-Colorado, D., García-Rudolph, A., Opisso, E., & Jané, R. (2024). Virtual Reality–Based Neurorehabilitation Support Tool for People With Cog-nitive Impairments Resulting From an Acquired Brain Injury: Usability and Feasibility Study. JMIR Neurotechnology, 3, e50538. https://doi.org/10.2196/50538
Rodríguez-Fuentes, G., Campo-Prieto, P., & Cancela-Carral, J. M. (2025). Immersive Virtual Reality as Physical and Cognitive Therapy in Acquired Brain Injury: TEVI-DCA Program. Electronics, 14(6), 1204. https://doi.org/10.3390/electronics14061204
Sanvisens, A., Zuluaga, P., Fuster, D., Rivas, I., Tor, J., Marcos, M., Chamorro, A. J., & Muga, R. (2017). Long-Term Mortality of Patients with an Alcohol-Related Wernicke–Korsakoff Syndrome. Alco-hol and Alcoholism, 52(4), 466-471. https://doi.org/10.1093/alcalc/agx013
Scalzo, S. J., Bowden, S. C., Ambrose, M. L., Whelan, G., & Cook, M. J. (2015). Wernicke-Korsakoff syn-drome not related to alcohol use: A systematic review. Journal of Neurology, Neurosurgery & Psychiatry, jnnp-2014-309598. https://doi.org/10.1136/jnnp-2014-309598
Sierra Gordillo, Y., Martínez Casas, O. Y., & Cárdenas Medina, C. A. (2025). Manifestaciones neurológicas del alcoholismo crónico. Acta Neurológica Colombiana, 41(2), e1883. https://doi.org/10.22379/anc.v41i2.1883
Tinetti, M. E., Franklin Williams, T., & Mayewski, R. (1986). Fall risk index for elderly patients based on number of chronic disabilities. The American Journal of Medicine, 80(3), 429-434. https://doi.org/10.1016/0002-9343(86)90717-5
Uygur, M., Barone, D. A., Dankel, S. J., & DeStefano, N. (2022). Isometric tests to evaluate upper and lower extremity functioning in people with multiple sclerosis: Reliability and validity. Multiple Sclerosis and Related Disorders, 63, 103817. https://doi.org/10.1016/j.msard.2022.103817
Van Dam, M. J., Van Meijel, B., Postma, A., & Oudman, E. (2020). Health problems and care needs in patients with Korsakoff’s syndrome: A systematic review. Journal of Psychiatric and Mental Health Nursing, 27(4), 460-481. https://doi.org/10.1111/jpm.12587
Wang, C.-Y., & Chen, L.-Y. (2010). Grip strength in older adults: Test-retest reliability and cutoff for sub-jective weakness of using the hands in heavy tasks. Archives of Physical Medicine and Rehabili-tation, 91(11), 1747-1751. https://doi.org/10.1016/j.apmr.2010.07.225
Wijnia, J. W. (2022). A Clinician’s View of Wernicke-Korsakoff Syndrome. Journal of Clinical Medicine, 11(22), 6755. https://doi.org/10.3390/jcm11226755
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