The effect of graded motor imagery and nintendo wii- based biofeedback techniques on rotator cuff pathologies

The aim of our study was to investigate the effects of graded motor imagery (GMI) added to conventional therapy and Nintendo Wii-based biofeedback training (NWT) added to conventional therapy, compared to conventional exercise therapy alone, on pain, range of motion, kinesiophobia, and function in patients with rotator cuff injury. Thirty-six volunteers aged 18–65 years, with symptoms lasting for at least 3 months, without any additional pathology in the same shoulder, and who had not received any physiotherapy and rehabilitation program in the last 3 months, were included in the study. Participants were randomly assigned to 3 groups. Group 1 received a conventional exercise program, Group 2 received a conventional exercise program plus graded motor imagery training, and Group 3 received a conventional exercise program plus Nintendo Wii-based biofeedback therapy, applied in a clinical setting for 6 weeks, 3 days per week, with all treatment sessions lasting 30–45 minutes. Participants were evaluated twice, before treatment and after treatment (6 weeks). Pain severity was assessed with the Visual Analog Scale (VAS), joint range of motion (shoulder flexion, extension, abduction, internal rotation, and external rotation) with a goniometer, laterality ability with the shoulder version of the Recognise™ application developed by the Neuro Orthopaedic Institute (NOI), kinesiophobia with the Tampa Scale of Kinesiophobia, and upper extremity performance with the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Treatment satisfaction was evaluated at the end of the program with the Global Rating of Change Scale. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) Version 20.0. No significant differences were found between the groups in terms of demographic and clinical characteristics, except for laterality basic test accuracy percentage values (p>0.05). The results of the study showed that after treatment, pain severity decreased and range of motion, functional level, and laterality ability increased in all groups (p<0.05). When groups were compared, GMI training was found to be statistically superior in reducing activity-related pain (p=0.029), improving laterality recognition accuracy (p=0.001), and increasing range of motion (p=0.011), while NWT training was found to be superior in reducing night pain (p=0.008) and improving functional level (p=0.038) (p<0.05). In conclusion, both GMI and NWT training were found to be effective methods for improving functional status, gaining range of motion, and controlling pain in patients with rotator cuff injury.