Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

Abstract

Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

Consideration-of-concept of EvolvRehab-Body for upper limb virtual rehabilitation at home for people late after stroke

“…Notable is the number of repetitions of prescribed exercise that were performed by participants. This is higher than has been reported for routine therapy [3,4,35] and supports earlier findings that VR has the potential to increase intensity of therapy [32,36]. Whether this range of repetitions is the optimal therapeutic dose requires further study especially as it cannot been assumed that higher doses always produce better outcomes [37] although intensity is needed to drive neoplastic changes [1].…”

Feasibility of a combined intermittent theta-burst stimulation and video game-based dexterity training in Parkinson’s disease

“…So, adding tactile pressure feedback could further trigger motor learning during exergaming, as suggested before [17]. A recently developed device, called GripAble [18] may provide this kind of feedback. The GripAble is an exergaming device consisting of a handheld flexible sensor system.…”

Effectiveness of using reward strategies combined with transcranial direct current stimulation (RstDCS) on motivation in chronic stroke patients with upper limb disorders: study protocol for a randomized controlled trial

“…Therefore, it is necessary to encourage patients to exercise for a longer time and increase the number of exercise repetitions 4 . However, the shortage of rehabilitation resources and the high cost of medical treatment mean that most patients do not receive the amount of treatment they should receive under the supervision of therapists during their brief stay in the hospital, let alone the time to return home 5 .…”

“…Therefore, it is necessary to encourage patients to exercise for a longer time and increase the number of exercise repetitions 4 . However, the shortage of rehabilitation resources and the high cost of medical treatment mean that most patients do not receive the amount of treatment they should receive under the supervision of therapists during their brief stay in the hospital, let alone the time to return home 5 . The key to solve this problem is for patients to have positive motivation for rehabilitation in order to improve the efficiency of rehabilitation training so that rehabilitation services can be more sufficiently utilized 6 .…”