VIENNA – A digital handgrip developed by U.K. researchers allowed more patients with arm weakness caused by a stroke to self-rehabilitate than did the use of standard mobile device touch screen controls in a 6-month, single-center survey.
Results showed that almost all patients (94%) could use the novel wireless controller, compared with 56%-62% of patients who could successfully use the gestures that commonly control mobile devices, such as swiping, tilting, or touching a screen.
Courtesy Paul Rinne
This stroke patient is shown using the handgrip.
“Standard mobile gaming technology can be used by the majority of stroke patients with moderate and mild arm weakness” Paul Rinne said at the annual European Stroke Conference. “It could increase the amount of complementary therapy given and hopefully be more economical” than existing technology used in motor rehabilitation programs, he suggested.
The device could bring stroke rehabilitation to the patients’ bedside and allow additional self-therapy, said Mr. Rinne, who is completing his PhD in brain sciences and is a researcher at the Human Robotics Group, Imperial College London, where the handgrip was developed.
Physiotherapist-led physical therapy is one of the main components of poststroke rehabilitation programs and evidence shows that the success of such therapy is greatly influenced by how intensively, long, and often patients perform task-specific exercises (PLoS One 2014;9:e87987). The problem, of course, is having sufficient human and financial resources to maximize potential benefits, Mr. Rinne observed. According to a National Institute for Health and Care Excellence estimate, 55% of stroke patients receive less than 45 minutes of motor rehabilitation exercise per day. Other data suggest that patients do not receive therapy for very long or perform too few repetitions during a session.
Although gaming technology is already being used as an adjunct to traditional physical therapy in some centers, the cost of equipment currently used is often high and it is often geared toward patients with high motor function. It cannot be used by patients at the bedside or at home at the moment, which would help increase the “dose” of treatment. The use of mobile devices is thus gaining interest as a possible alternative means of supplementing current rehabilitation programs, making it both more accessible – around 75% of the general public have access to a mobile device, Mr. Rinne observed – and more engaging or motivating for patients.
Mr. Rinne and coinvestigators surveyed all patients presenting with arm weakness on admission to a large hyper-acute stroke unit over a 6-month period. Of 342 patients who were screened, 89 were included. Reasons for exclusion were cognitive impairment or comorbidities (130 patients), lack of communication or language barrier (36 patients), resolution of arm weakness (34 patients), preexisting arm weakness (24 patients), arm weakness not due to stroke (5 patients), or patient refusal (24 patients).
The mean age of patients who participated was 65 years and 57% were male. The baseline National Institutes of Health Stroke Scale score was 5.8 and the NIHSS Motor subscale score was 1 on a scale of 0 to 4, signifying mild impairment. Other functional measures used were the 66-item Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the 12-item Short-Form Fugl-Meyer (S-FM) scale, and the 14-item Fugl-Meyer Assessment Hand Subscale (FMA-Hand).
During the assessment period, study participants were given a mobile tablet and asked to perform a variety of touch-screen hand movements with their paretic and unaffected arms to move an object on screen. The results were given a movement score, ranging from 0 (no movement) to 3 (full range of movement) and were compared against those obtained by use of a gaming joystick and the digital handgrip developed by the Imperial College London team.
The S-FM was used to divide patients into groups depending on their baseline arm weakness. Patients with severe impairment had lower movement scores in both their paretic and unaffected hands than did those with more moderate or mild impairment. Mr. Rinne noted that there was no difference in the results seen with the conventional controllers, and a similar proportion of patients could swipe, press a button, tilt, or use the joystick successfully.
However, comparing the results obtained with the digital handgrip and mobile tablet, he noted that patients who used the digital handgrip could follow the object on screen much more accurately than when they used a swiping motion on a tablet. Even patients with severe impairment could use the handgrip.
“We found that 89% of our severely weak patients could still interact with these games and perform self-rehabilitation when using our controller,” Mr. Rinne reported. In contrast, no severely impaired patient could perform the screen swipe on a tablet.