[BOOK] Chapter 4: The Design Process and Usability Assessment of an Exergame System to Facilitate Strength for Task Training for Lower Limb Stroke Rehabilitation

Abstract

Successful stroke rehabilitation relies on early, long-term, repetitive and intensive treatment, which is rarely adhered to by patients. Exergames can increase patients’ engagement with their therapy. Marketed exergaming systems for lower limb rehabilitation are hard to find and, none yet, facilitate Strength for Task Training (STT), a novel physiotherapeutic method for stroke rehabilitation. STT involves performing brief but intensive strength training (priming) prior to task-specific training to promote neural plasticity and maximize the gains in locomotor ability. This research investigates how the design of an exergame system (game and game controller) for lower limb stroke rehabilitation can facilitate unsupervised STT and therefore allow stroke patients to care for their own health. The findings suggest that specific elements of STT can be incorporated in an exergame system. Barriers to use can be reduced through considering the diverse physiological and cognitive abilities of patients and aesthetic consideration can help create a meaningful system than promotes its use in the home. The semantics of form and movement play an essential role for stroke patients to be able to carry out their exercises.

1. Background

With over 15 million cases worldwide every year [1], strokes are a leading cause of serious long-term disability [2, 3]. Up to 75% of people affected by stroke have lower limb mobility limitations [3, 4], including hemiplegia (muscle paralysis) or hemiparesis (muscle weakness) down one side of the body [5]. The World Health Organization (WHO) has highlighted the need for home health care that calls for rehabilitative devices, self-monitoring tools and self-management skills [6].

Success for stroke rehabilitation relies on early, intensive, long term repetitive treatment to regain motor control [5, 7] by learning to use existing redundant neural pathways [8]. However, although abundantly prescribed by clinicians, as little as 31% of patients perform these exercises correctly and consistently, often due to their monotonous nature [9].

Recent studies show that systems of rehabilitative devices with incorporated digital games for exercising (exergames) improve patient engagement with their home-based therapies. This has promoted beneficial patient outcomes for different long-term conditions, including upper limb stroke rehabilitation [5, 10, 11], and more effective recovery [12]. While there exist systems designed for upper-limb stroke rehabilitation [5, 13, 14] and for improving gait and balance [15–17], only one was found targeted specifically towards lower limb stroke rehabilitation [18].[…]

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