Introduction: Balance training combined with virtual reality is recommended for patients after stroke. Off-the-shelf systems or systems developed for rehabilitation can be used. Games on the systems differ in adaptability of speed, amount of feedback, or difficulty, which affects satisfaction, challenge, and quality of movement during gameplay. Purpose: To compare virtual reality balance games on a pressure plate of an off-the-shelf system and a system developed for rehabilitation in patients in the chronic phase after a stroke. Methods: 26 participants were included. In the first part, balance and walking tests were used to assess their abilities (modified miniBESTest, 10MWT and FAC). In the second and third parts, participants played games divided into pairs according to the direction of movement of the center of pressure (COP) they facilitate. Half of the games were on a rehabilitation system (Equio, Kinestica) and the other half on an off-the-shelf system (Nintendo Wii Balance Board with Wii Fit, Nintendo). Participants played self-paced games in one session and game-paced games in the other. The number of repetitions and amplitude of pelvic motion in centimeters (video analysis), perceived exertion (Borg’s perceived exertion rating scale), enjoyment (mPACES), flow (FSSOT), and likeability of the games (rating 1-6) were assessed. The symmetry of weight distribution between lower limbs, limits of stability, and the COP range of motion were measured with a pressure plate. Results: There were no statistically significant differences in patient enjoyment between games (p = 0,271). Statistically significant differences occurred mostly in game-paced games. WBB games facilitated a higher number of repetitions (p < 0,009), a greater range of pelvic motion (p < 0,025) and were perceived as more exerting than the Equio games (p = 0,015). Compared to WBB games, Equio games scored statistically significantly higher in flow state (p = 0,008) and were more likable (Equio: modus 4-6; WBB: modus 1-2). We found no statistically significant differences between game-paced and self-paced games in weight distribution symmetry, limits of stability, and COP range of motion (p > 0,133). Conclusion: The differences between the systems are particularly clear for game-paced games. Game-paced and self-paced games are comparable in terms of facilitation of symmetry of weight distribution, limits of stability, and COP range of motion.
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