UPPER LIMB MOVEMENT CAPACITY FOLLOWING A GAME-BASED REHABILITATION PROGRAM COMPARED TO TASK-BASED TRAINING POST-STROKE: PRELIMINARY FINDINGS

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

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

Background: Stroke Recovery and Rehabilitation Roundtable recommends objective measurement of quality of upper limb motor performance using technological tools to help differentiate restitution from compensation strategies post-stroke. Commonly used clinical outcome measures are unable to objectively measure upper limb movement capacity. The ArmAble^TM is an interactive gaming technology which is capable of measuring the movement capacity in terms of distance, time and velocity of movement. Studies assessing the movement capacity following a game-based rehabilitation on upper limb function are scarce.

Purpose: To assess upper limb movement capacity following a game-based rehabilitation program compared to task-based training post-stroke.

Methods: In this on-going, 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 either an intensive, functional, gamified training program using the ArmAble™ (n = 15) or task-based training (n = 15) in addition to a conventional therapy for 2 hours/day, 6 days/week for 2 weeks. Kinematic (movement capacity) analysis was done using an assessment game, in which a target (indicated by a circle) will appear at a 30-cm radius (near target) of the computer screen of the ArmAble™. Assessment was done unilaterally with their affected limb. Movement capacity such as distance, time and velocity were measured at the baseline and end of 2-week intervention by a blinded outcome assessor. Mann-Whitney U test was used to analyse the skewed data.

Results: All participants in both groups completed the assigned interventions without any adverse effects. Between-group analysis showed a significant difference in the velocity (Median difference (MD) [Q1, Q3] = 3.49 [-3.67, 14.2]; p= 0.026) in the game-based rehabilitation group compared to the task-based training group. However, no significant difference was observed for distance (MD [Q1, Q3] = 0.720 [-3.26, 14.7]; p=0.256) and time (MD [Q1, Q3]= 1.10 [-0.395, 1.42]; p= 0.077) variables. Ten participants in the experimental group could not fully perform the baseline/pre-intervention assessment because of severe upper limb weakness but six of them improved and completed the post-intervention assessment. Five participants in the comparator group were able to neither fully perform pre-intervention nor post-intervention assessment.

Conclusions: Upper limb movement capacity, as assessed using a novel assessment game, is found to improve following a game-based rehabilitation program with the ArmAble™ compared to task-based training, in addition to a conventional therapy, in people with stroke.

Implications: Movement capacity analysis measured with the ArmAble™ could be used as a routine outcome measure to assess the functional status of the affected upper limb in people with stroke.

Funding acknowledgements: This study is partially funded by BeAble Health Pvt Ltd. (IIT Hyderabad, Telangana, India) and Society of Indian Physiotherapists

Keywords:
Movement capacity assessment
Upper extremity
Game-based training

Topics:
Neurology: stroke
Disability & rehabilitation
Innovative technology: information management, big data and artificial intelligence

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: IEC - 328/ 2020