Improvement in motor function of the paretic arm after serious games-based training in people with Stroke: a randomized clinical trial

To investigate the changes in speed, accuracy, and motion range of sequential movements performed with the paretic arm (PA) after training based on SG in people with chronic stroke sequelae (PwS). 

A controlled, randomized, single-blind design following CONSORT guidelines was used with 44 participants who had a stroke at least six months prior, divided into two groups: experimental group (EG), which performed one individual training session with seven attempts in four Nintendo Wii® games, and a control group (CG), which received only daily living instructions. The motor demands of the four games mainly involve shoulder and elbow movement at varying speeds, directions, range, and rhythm. The inclusion criteria were: (1) ability to actively perform shoulder and elbow flexion against gravity with a minimum range of 50º with the PA, (2) no dementia (Montreal Cognitive Assessment > 20), and (3) no corrected visual or auditory impairments. Exclusion criteria included (1) aphasia, (2) hemineglect, and (3) shoulder pain or deformities in the PA. The primary outcome was a computerized test to assess the speed and accuracy of sequential movements performed with the PA. The secondary outcome was the shoulder and elbow range of motion, which was measured by goniometry. Assessments were performed before training (BT), immediately after training (AT), 48 hours post-training (48hAT), and seven days post-training (7dAT).

EG and CG had no significant differences in demographic or clinical characteristics at baseline. After training, EG significantly improved all four game scores, which were maintained at 7dAT (p 0.0001). Repeated-measures ANOVA showed a significant interaction between group and assessment points for the speed and accuracy (F(3,117) = 5.12, p 0.002, effect size = 0.91). Tukey-Kramer post-test confirmed the significant improvements in speed and accuracy between BT and AT, 48hAT, and 7dAT, only for EG (p 0.0001). For the secondary outcome, ANOVA also showed a significant interaction between assessment and group for elbow range of motion (F(3,114) = 5.84, p 0.0009, effect size r = 0.94), confirmed by the post-hoc test, which showed significant improvements between BT and AT, 48hAT, 7dAT (p 0.0001), only for EG.

Training based on SG effectively improves the speed, accuracy, and range of motion of the paretic arm in PwS. Further studies should investigate the impact of objective motor function improvements on activity and participation.

These findings underscore the effectiveness of SG training as an approach to enhancing motor function in stroke patients and highlight its practical potential in stroke rehabilitation.