Improving motor function after chronic stroke by interactive gaming with a redesigned MR‑compatible hand training device

Abstract

New rehabilitation strategies enabled by technological developments are challenging the prevailing concept of there being a limited window for functional recovery after stroke. In this study, we examined the utility of a robot-assisted therapy used in combination with a serious game as a rehabilitation and motor assessment tool in patients with chronic stroke. We evaluated 928 game rounds from 386 training sessions of 8 patients who had suffered an ischemic stroke affecting middle cerebral artery territory that incurred at least 6 months prior. Motor function was assessed with clinical motor scales, including the Fugl-Meyer upper extremity (FM UE) scale, Action Research Arm Test, Modified Ashworth scale and the Box and Blocks test. Robotic device output measures (mean force, force-position correlation) and serious game score elements (collisions, rewards and total score) were calculated. A total of 2 patients exhibited a marginal improvement after a 10-week training protocol according to the FM UE scale and an additional patient exhibited a significant improvement according to Box and Blocks test. Motor scales showed strong associations of robotic device parameters and game metrics with clinical motor scale scores, with the strongest correlations observed for the mean force (0.677<Ρ<0.869), followed by the number of collisions (-0.670<Ρ<-0.585). Linear regression analysis showed that these indices were independent predictors of motor scale scores. In conclusion, a robotic device linked to a serious game can be used by patients with chronic stroke and induce at least some clinical improvements in motor performance. Robotic device output parameters and game score elements associate strongly with clinical motor scales and have the potential to be used as predictors in models of rehabilitation progress.

An analysis of clinical outcomes and essential parameters for designing effective games for upper limb rehabilitation: A scoping review

“…Most of the games were designed using Unity software ( n = 6) 18,20,23,25,29,30 . Unreal Engine 4.20, 3ds Max, Substance Designer, 21 Blender, 26 and Microsoft Visual C++ 32 were other software used to design rehabilitation games. Some studies also used pre‐designed games ( n = 4) 22,27,28,35 …”

“…According to Figure 2, games was used to six categories of diseases or complications leading to upper limb disabilities. Games were mostly used to rehabilitate upper limb disabilities caused by strokes ( n = 12) 17–19,22,24–26,31,32,35–37 and cerebral palsy ( n = 5) 23,27,29,30,33 . The frequencies and percentages of other diseases and injuries leading to upper limb disabilities are shown in Figure 2.…”

“…Robots (n = 3) 17,23,34 and smart wearables (n = 3) 26,28,32 were two types of technology that were used for the rehabilitation of upper limb disabilities along with games. Moreover, seven studies 18,20,24,26,31,33,35 provided their rehabilitation services as telerehabilitation.…”

The role of ventral tegmental area in chronic stroke rehabilitation: an exploratory study

“…Patients were supervised at home while receiving training with the third-generation Magnetic Resonance Compatible Hand-Induced RObotic Device (“MR_CHIROD”) ( 21 ), which was coupled with an interactive computer game as described in detail elsewhere ( 22 ). Each patient underwent training for 45 min per day, 3 days per week, over a period of 10 weeks.…”