Abstract
Motor-training software on tablets or smartphones (Apps) offer a low-cost, widely-available solution to supplement arm physiotherapy after stroke. We assessed the proportions of hemiplegic stroke patients who, with their plegic hand, could meaningfully engage with mobile-gaming devices using a range of standard control-methods, as well as by using a novel wireless grip-controller, adapted for neurodisability. We screened all newly-diagnosed hemiplegic stroke patients presenting to a stroke centre over 6 months. Subjects were compared on their ability to control a tablet or smartphone cursor using: finger-swipe, tap, joystick, screen-tilt, and an adapted handgrip. Cursor control was graded as: no movement (0); less than full-range movement (1); full-range movement (2); directed movement (3). In total, we screened 345 patients, of which 87 satisfied recruitment criteria and completed testing. The commonest reason for exclusion was cognitive impairment. Using conventional controls, the proportion of patients able to direct cursor movement was 38–48%; and to move it full-range was 55–67% (controller comparison: p>0.1). By comparison, handgrip enabled directed control in 75%, and full-range movement in 93% (controller comparison: p<0.001). This difference between controllers was most apparent amongst severely-disabled subjects, with 0% achieving directed or full-range control with conventional controls, compared to 58% and 83% achieving these two levels of movement, respectively, with handgrip. In conclusion, hand, or arm, training Apps played on conventional mobile devices are likely to be accessible only to mildly-disabled stroke patients. Technological adaptations such as grip-control can enable more severely affected subjects to engage with self-training software.
Highlights
The most important intervention shown to improve physical function after stroke is repetitive, task-directed exercises, supervised by a physiotherapist, with higher intensity leading to faster and greater recovery[1]
Increasing numbers of motor-training Apps for mobile devices have been commercialised in recent years, and clinical trials are under way[8, 9]
The first part of our study indicates that standard use of everyday mobile devices for arm physical therapy in stroke, is likely to be limited
Summary
The most important intervention shown to improve physical function after stroke is repetitive, task-directed exercises, supervised by a physiotherapist, with higher intensity leading to faster and greater recovery[1]. An alternative approach to self-rehabilitation, are medical applications (Apps), or gaming software, run on mobile media devices e.g. tablets or smartphones[6, 7] Because such devices are low-cost ($200–500), and ubiquitous, they have the potential to democratize computerized-physiotherapy, especially in under-resourced settings, e.g. chronically-disabled in the community. Their portability enables home use, while their employment of motivational gaming strategies can potentiate high-intensity motor practice. Increasing numbers of motor-training Apps for mobile devices have been commercialised in recent years, and clinical trials are under way[8, 9] Since these devices are designed for able-person use, it is questionable as to how well disabled people can access them, and engage meaningfully and repeatedly with rehabilitation software
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