BackgroundThe objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function.MethodsTwelve subjects with prior stroke were recruited; 11 completed the study.DesignThe study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16–18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon’s signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant.ResultsSix females and five males, participated in the study with an average age of 58 years (range 26–66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study.ConclusionThe results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.

Objective. The aim was to compare walking with an individually designed dynamic hinged ankle foot orthosis (DAFO) and a standard carbon composite ankle foot orthosis (C-AFO). Methods. Twelve participants, mean age 56 years (range 26–72), with hemiparesis due to stroke were included in the study. During the six-minute walk test (6MW), walking velocity, the Physiological Cost Index (PCI), and the degree of experienced exertion were measured with a DAFO and C-AFO, respectively, followed by a Stairs Test velocity and perceived confidence was rated. Results. The mean differences in favor for the DAFO were in 6MW 24.3 m (95% confidence interval [CI] 4.90, 43.76), PCI −0.09 beats/m (95% CI −0.27, 0.95), velocity 0.04 m/s (95% CI −0.01, 0.097), and in the Stairs Test −11.8 s (95% CI −19.05, −4.48). All participants except one perceived the degree of experienced exertion lower and felt more confident when walking with the DAFO. Conclusions. Wearing a DAFO resulted in longer walking distance and faster stair climbing compared to walking with a C-AFO. Eleven of twelve participants felt more confident with the DAFO, which may be more important than speed and distance and the most important reason for prescribing an AFO.

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