Mobile Game Induces Active Engagement on Neuromuscular Electrical Stimulation Training in Patients with Stroke

Abstract

This study aimed to investigate the effectiveness of the mobile game-based neuromuscular electrical stimulation (MG-NMES) with assessing usability issues, such as attention and curiosity, and intrinsically interesting issues, which is necessary for successful poststroke rehabilitation. With the conventional NMES (C-NMES) system, the subjects underwent active repetitive cyclic NMES training. For assessment of usability issues, 20 hemiplegic stroke subjects were randomly divided into two groups. The subjects in the MG-NMES group (n = 9) and C-NMES group (n = 11) underwent 20 minutes of training each day for 5 days. We assessed the subjects' attention, curiosity, and intrinsically interesting issues; and using questionnaires they answered questions regarding their expectations of the training outcome after each training session. We found that the subjects in the MG-NMES group maintained their attention and interest for the 5 days, and their curiosity and expectation of a positive training outcome gradually increased as the training proceeded. In contrast, the C-NMES group reported no change in their attention or curiosity, but it was lower than the subjects in the MG-NMES group. In addition, their interest gradually decreased, which may have reduced their expectations of a positive outcome as the sessions progressed. There were no side effects during the training sessions in either group. The MG-NMES training paradigm developed is a new, readily available, and highly motivating MG-NMES training system. Based on the usability test, the reported advantages of the system were improved attention and flow experience during NMES training.

Getting into a “Flow” state: a systematic review of flow experience in neurological diseases

“…They expect to foster the engagement through the gamification of the therapeutic exercises and at the same time give the therapist the possibility to control and customize the levels of complexity of the rehabilitation training. Seven of the ten included studies measured flow experience in the context of serious games in patients with stroke, PD, MS and/or TBI [42][43][44][45][46][47][48]. Flow experience was mainly assessed in the context of usability studies in newly developed serious game therapy programs for rehabilitation purposes [42,43,45,47].…”

“…Flow experience was mainly assessed in the context of usability studies in newly developed serious game therapy programs for rehabilitation purposes [42,43,45,47]. Our review showed that total flow mean scores between 3.76 and 4.33 points on a 5-point Likert scale were achieved in all studies when serious games were used as physical-therapeutic exercises [42][43][44][45][46] compared to control groups without serious games, these flow mean points reached 3.65-3.76 [44,46]. It turns out that therapeutic interventions with a game-like character stimulate concentration and enjoyment.…”

“…In seven out of the ten studies, as presented in Table 2, serious games were used as therapeutic intervention. The designs of the studies were either pilot and explorative in nature, testing the usability of a new serious game [42,43,45,47] or pilot Randomized Controlled Trials (RCT) evaluating the preliminary efficacy of new games [44,46,48]. Four usability studies measured flow in order to quantify the level of immersion into the gameplay [42,43,45,47].…”

Virtual Reality Gaming Technology for Mental Stimulation and Therapy

“…Data representing physiological responses to being hit and weapon fire such as saturation of blood oxygen, breathing behaviour, heart rate and so on are provided as a feedback for communication with the wearer by means of ARAIG. Jeonghun Ku [5] performed rehabilitation of post-stroke patients by assessment of intrinsically interesting issues, curiosity, attention, usability issues and so on with the help of neuromuscular electrical stimulation (MG-NMES) based mobile games.…”

“…It is essential for stroke affected patients to relearn performing the basic motor activities [5]. Practice and feedback and provided to enable learning and to improve its efficiency.…”