Based on our results during the last 25 years, we are developing late stroke computer-assisted motivating rehabilitation (CAMR) for the upper extremity. Evidence has been accumulating that functional gains are possible even many years after the damage. However, postacute rehabilitation must be motivating and related to real-life functional activities, or it may fail to enlist active participation. With CAMR programs, such as briefly reported here, instead of exercise, the patient is engaged in a game (e.g., ping-pong); instead of concentrating on the specific movements, he/she is concentrating on the game and the movements become subconscious. Patients, even those who initially consider that they cannot accomplish the task, show interest and improvement, and functional recovery appears to be extended beyond the specific movements that are being practiced. CAMR is also suitable for late functional reorganization programs in an educational model.

Stroke-induced hemiparesis is a debilitating impairment that compromises ability to perform many activities of daily living (ADLs). Many new therapies for hemiparesis, although intriguing, require exceptional patient motivation and/or may be difficult to implement in some clinical situations. This brief report revisits a motivating, game-based rehabilitation modality reported nearly three decades ago that has heretofore been ignored. Pilot data, examining the feasibility and efficacy of the device, are presented.

IntroductionThe Royal Marines provide the lead Service for UK Defence Mountain and Cold Weather Warfare capability. This is the first prospective study addressing musculoskeletal injury rates sustained during Cold Weather Warfare training, with the aim of informing injury mitigation interventions and assist military medical planning with respect to delivering primary care rehabilitation in theatre.MethodsAll musculoskeletal injuries were surveyed by the Forward Rehabilitation Team (Nov 2019–Mar 2020) during a Cold Weather Deployment to Norway (Ex CETUS 2019/20). The frequency, nature of injury (new or recurrent), onset (sudden or gradual), cause, location and exercise/treatment outcome were recorded.ResultsEleven per cent (n=136 cases) of the deployed population (n=1179) reported a musculoskeletal injury, which were mainly ‘new’ (62%), and with a ‘sudden’ onset (64%). Injury rate was 17.8 injuries per 10 000 personnel days. The majority of injuries occurred due to military training (88%), specifically during ski-related (61%) and load carriage (10%) activities.The average Service Person treated by the Forward Rehabilitation Team improved from ‘injured with restricted duties’ to ‘fully fit’, and with an improvement in their self-reported Musculoskeletal Health Questionnaire from 33 to 45 over an average of two rehabilitation sessions. One hundred and seventeen Service Personnel were able to continue on Ex CETUS with rehabilitation in theatre, thus negating the requirement for aeromedical evacuation for continuation of rehabilitation in the UK. Nineteen patients were unable to continue their Cold Weather Deployment due to the nature of their musculoskeletal injury and returned to the UK for continued care in firm base rehabilitation centres.ConclusionThis study identifies the nature, causation and injury location. It demonstrates the effectiveness of in-theatre rehabilitation and the ability to treat patients when deployed. Recommendations are presented to support strategies to mitigate musculoskeletal injury risk during future Cold Weather Warfare deployments to Norway.

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