Abstract
Background & purpose
Activity-based neuroplasticity and re-organization leads to motor learning via replicating real-life movements. Increased repetition of such movements has growing evidence over last few decades. In particular, computer-game-based rehabilitation is found to be effective, feasible and acceptable for post-stroke upper limb deficits. Our study aims to evaluate the feasibility and effectiveness of 12 weeks of computer-game-based rehabilitation platform (GRP) on fine and gross motor skills post-stroke in India.
Methods
Through this trial we will study the effect of adjunctive in-hospital GRP (using a motion-sensing airmouse with off-the-shelf computer games) in 80 persons with subacute stroke, for reduction of post-stroke upper limb deficits in a single-centre prospective Randomized Open, Blinded End- point trial when compared to conventional therapy alone.
Results
We intend to evaluate between-group differences using Wolf Motor Function test, Stroke Specific Quality of Life, and GRP assessment tool. Feasibility will be assessed via recruitment rates, adherence to intervention periods, drop-out rate and qualitative findings of patient experience with the intervention.
Conclusion
The CARE FOR U trial is designed to test the feasibility and effectiveness of a computer-game based rehabilitation platform in treating upper limb deficits after stroke. In case of positive findings GRP can be widely applicable for stroke populations needing intensive and regular therapy with supervision.
Introduction & rationale
Over the last few decades, there has been an increase in stroke burden globally. Global burden of disease (GBD) 2016 reports 80.1 million prevalent cases of stroke globally. and 116.4 million disability adjusted life years.1 Asia accounts for almost two-thirds of the world’s stroke incidences.2
A significant proportion of individuals with stroke have long term residual disability3 and three-fourths of Indian stroke survivors are left with moderate to severe disabilities.4 Loss of arm function with stroke can impact a person’s ability to participate in home life, work and can reduce quality of life. Upper limb (UL) impairments are seen in 80% of stroke survivors and only 5–20% have complete functional recovery.5–7 with residual spasticity in 46% of cases5 and only 20.7% of stroke survivors returning to work by 2 years post-stroke (with half having changed their job).8 Early and targeted rehabilitation for UL deficits post-stroke is therefore crucial.9
Current evidence-based approaches used in rehabilitation of UL function after stroke emphasize that intensity, volume of training and task-specificity are pivotal.5 One such approach, the constraint-induced movement therapy, established strongly to be effective in rehabilitation of UL deficits, requires constraint of the unaffected limb and performance of repetitive functional training of upper extremity. This constraint can be applied for up to 60–90% of waking hours10,11 Questions arise on the ability of patients to adhere to such therapy regimes which are tedious and may lead to poor adherence in those with low motivation12 which is essential for improved compliance and adherence to rehabilitation regimes for individuals with UL deficits.13–15
Activity-based neuroplasticity and re-organization leading to motor learning by replicating real-life movements and repetition has growing evidence over last few decades.16,17 Virtual reality has been proven to improve UL function and ADLs when used as an adjunct to usual care (probably by increasing the duration of overall therapy).18 Such a mode of therapy has frequently been applied via the use of commercial gaming consoles like the Sony Playstation, Nintendo Wii and Microsoft Kinect. However VR based therapy has its cons: lack of computer skills of therapists, support infrastructure, initial investment, inadequate communication infrastructure in case of telerehabilitation and questionable long lasting effects.18,19 Studies also provide an increasing evidence for use of gaming technology in stroke rehabilitation of UE.20,21 Computer based systems may allow less dependence on rehabilitation personnel, improved standardization of rehabilitation protocols, increased intensity and frequency of activities and creative treatment delivery.22 A structured game-based rehabilitation protocol could effectively improve post-stroke upper limb function15,23,24 and is reported to be feasible, well-accepted by patient population with no adverse effects.21
Our study will therefore investigate the feasibility and effectiveness of a simplified in-hospital upper-limb rehabilitation program using off-the-shelf computer-games and a miniature wireless motion detecting mouse (Airmouse™) mounted on various objects to replicate activities of daily living (ADLs) for those with subacute stroke. We hypothesize that adjunctive Computer game-based rehabilitation platform for post-stroke upper extremity fine and gross motor deficits, will be feasible and effective in treating UL deficits due to stroke when compared to conventional therapy alone in the subacute phase.
Methods
CARE FOR U
A computer-game-based rehabilitation platform (GRP) previously developed for assessment and rehabilitation of UL functions of individuals with stroke and cerebral palsy will be used in this trial for those with stroke.25,26 This GRP includes three main components:
- A miniature wireless inertia-based motion-detecting mouse which translates movements performed to the motion of a computer cursor: Airmouse™ (Figure 1). When mounted on objects, the mouse is used to control the motion of the cursor/game paddle. The Airmouse™ can be mounted on a varied range of objects of differing physical properties (weight, texture, shape, size) that create diverse functional demands allowing for practice of manual dexterity, precision and power grasps.
TBI Rehabilitation 