Safety, feasibility, acceptability and preliminary effects of the Neurofenix platform for Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): results of a feasibility intervention study

Abstract

ObjectivesTo investigate the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper limb (UL).DesignA non-randomised intervention design with a parallel process evaluation.SettingParticipants’ homes, South-East England.ParticipantsThirty adults (≥18 years), minimum 12-week poststroke, not receiving UL rehabilitation, scoring 9–25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate.InterventionsParticipants were trained to use the platform, followed by 1 week of graded game-play exposure and 6-week training, aiming for a minimum 45 min, 5 days/week.OutcomesSafety was determined by assessing pain and poststroke fatigue at 8 and 12 weeks, and adverse events (AEs). Impairment, activity and participation outcomes were measured. Intervention feasibility was determined by the amount of specialist training and support required to complete the intervention, time and days spent training, and number of UL movements performed. Acceptability was assessed by a satisfaction questionnaire and semistructured interviews.ResultsParticipants (14 women; mean (SD) age 60.0 (11.3) years) were a median of 4.9 years poststroke (minimum-maximum: 1–28 years). Twenty-seven participants completed the intervention. The odds of having shoulder pain were lower at 8 weeks (OR 0.45, 95% CI 0.24 to 0.83, p=0.010) and 12 weeks (OR 0.46, 95% CI 0.25 to 0.86, p=0.014) compared with baseline. Fugl-Meyer upper extremity, Motor Activity Log and passive range of movement improved. No other gains were recorded. Poststroke fatigue did not change. Thirty mild and short-term AEs and one serious (unrelated) AE were reported by 19 participants. Participants trained with the platform for a median of 17.4 hours over 7 weeks (minimum-maximum: 0.3–46.9 hours), equating to a median of 149 min per week. The median satisfaction score was 36 out of 40.ConclusionThe Neurofenix platform is a safe, feasible and well accepted way to support UL training for people at least three months poststroke.Trial registration numberISRCTN60291412.

The use of home-based digital technology to support post-stroke upper limb rehabilitation: A scoping review

“…A total of 45 studies 15,17–21,23,26–29,33,35,36,40,42,43,45,46,49,52–56,61–66,68,69,71,72,74,77–79,82–85,89,91 deployed games for home-based upper limb rehabilitation following stroke. Of these, 15 articles 15,18,20,28,29,33,35,42,45,46,56,72,82,84,91 found a VR game to be a feasible, well-received, and safe intervention to use at home for people with chronic hemiparesis following stroke. These studies also demonstrated a positive impact of VR games on improving arm functioning and the number of reaching movements achieved.…”

“…Twenty-two studies 12,14,20,21,24,25,30,34,37,48,50,51,60,61,67,73–75,80,86,91,94 used a mobile technology or a mobile application as part of their intervention for home-based upper limb rehabilitation with stroke patients. Mobile technology had been used more frequently by stroke patients for information searching, and reminders in comparison to non-stroke participants.…”

“…More than 1/3 of the articles included have used or created VR or virtual environment as part of their intervention. 12,15,18,20,28,29,33,35,36,38,40,42,[45][46][47]51,56,58,69,72,78,79,82,84,89,91 VR enables the provision of rehabilitation offering rich experience and credibility in alternative environments such as at home. This minimizes auditory and visual distractions that possibly can happen in communal health care settings.…”

“…Patients have shown a high level of adherence, 97.8%, to gamificationmediated rehabilitative exercises. 101 This review identified 45,15,[17][18][19][20][21]23,[26][27][28][29]33,35,36,40,42,43,45,46,49,[52][53][54][55][56][61][62][63][64][65][66]68,69,71,72,74,[77][78][79][82][83][84][85]89,91 studies in which various types of digital games had been deployed as part of the intervention for homebased post-stroke upper limb rehabilitation. These games were augmented with/without virtual/immersive reality, and played via computer, mobile phone, and other digital devices and the participants were able to engage in rehabilitation activities based upon gamification within the home setting.…”

“…92 This emerging technology is widely being integrated in various medical fields. 93 Twenty-six articles 12,15,18,20,28,29,33,35,36,38,40,42,[45][46][47]51,56,58,69,72,78,79,82,84,89,91 used or created a VR intervention or a virtual environment for home-based upper limb rehabilitation after stroke.…”