EFFECT OF GAME-BASED REHABILITATION PROGRAM COMPARED TO TASK-BASED TRAINING ON UPPER LIMB MOTOR FUNCTION IN PEOPLE WITH STROKE: PRELIMINARY FINDINGS

A.S. Ali¹, A. Arumugam², S. Kumaran D.¹

¹Manipal College of Health Professions, Manipal Academy of Higher Education, Department of Physiotherapy, Manipal, India, ²College of Health Sciences, University of Sharjah, Department of Physiotherapy, Sharjah, United Arab Emirates

Background: Game-based rehabilitation is an emerging therapeutic intervention that allows intensive, repetitive, task-based training to improve upper limb (UL) function following stroke. The ArmAble™ is a commercially available, indigenously developed, interactive arm rehabilitation gaming device. Rehabilitation using a commercial gaming system will be motivating, enjoyable, challenging. However, studies investigating the effect of commercially available games that are functionally relevant are scarce.

Purpose: To assess the effect of an intensive, functional, gamified rehabilitation program using the ArmAble™ device in improving UL motor function in people with stroke.

Methods: In this ongoing, single-blinded, randomized clinical trial (CTRI/2020/09/027651), 30 adults (mean age ± SD= 59.2 ±11.2; 70% males) with acute/sub-acute unilateral stroke were randomized to receive an either intensive, functional, gamified training program using the ArmAble™ (n=15) or task-based training (n=15) for 45-60 minutes. In addition, both the groups received conventional therapy for 45-60 minutes/day, 6 days/week for 2 weeks. Outcomes evaluated by a blinded assessor at the baseline and the end of 2-week intervention included the Fugl-Meyer assessment – upper extremity and the action research arm test. Mann-Whitney U test was used to analyse the (skewed) data for all outcomes.

Results: All thirty participants completed the 2-week intervention without any adverse events. The median post-stroke duration was 26 (8.5, 53.8) days. The median baseline Fugl-Meyer assessment – upper extremity score was 26 (13,37.5) in the experimental group and 7.0 (0, 27.5) in the comparator group. The median baseline action research arm test score was 9.0 (0, 26.5) in experimental group and 27.0 (12.5, 44.5) in the comparator group. There was a significant difference in Fugl-Meyer assessment – upper extremity (Median difference [Quartile 1, Quartile 3 (Q1,Q3)] = 9.0 [1.50, 10.5]; p= 0.005) and the action research arm test (Median difference [Q1,Q3]= 6.0 [0,11.0]; p= 0.023) score in the game-based rehabilitation group compared to task-based training group.

Conclusions: Our preliminary findings showed that the game-based rehabilitation with the ArmAble™ could enhance motor and functional recovery of the affected UL as an adjunct to the conventional therapy compared to that of task-based training for stroke survivors.

Implications:​Intensive,functional gamified rehabilitation with the ArmAble™, in addition to the conventional therapy, can be used during the acute and sub-acute stages of stroke to make the therapy more intensive, repetitive, motivating and fun-based, and thereby improving the UL function.

Funding acknowledgements: Industry grant from the BeAble Health Pvt Ltd. (IIT Hyderabad, Telangana, India) and the Society of Indian Physiotherapist [SIP_2021_YR01].

Keywords:
Game-based training
Hemiparesis
Upper extremity

Topics:
Neurology: stroke

Did this work require ethics approval? Yes

Institution: Manipal Academy of Higher Education, Manipal, Karnataka, India

Committee: Institutional Ethics Committee, Kasturba Medical College and Kasturba Hospitals

Ethics number: 328/2020