Background: Motor disability after stroke is common, with approximately 350,000 stroke survivors (50 percent) losing substantial function of their arms and hands. Loss of hand function makes everyday activities, such as dressing and meal preparation, challenging. Constraint-induced movement therapy (CI therapy) substantially decreases disability after stroke or other neurological insult, but it is available to less than 1 percent of individuals who could benefit from it. Our research group received funding from PCORI pilot projects to develop and test, in collaboration with stakeholders, a novel approach to home-based rehabilitation that utilizes newly developed, inexpensive, and commercially available gaming technology (Microsoft KinectOne) to disseminate CI therapy to underserved individuals. The gaming therapy that our team has developed has been well received by patients across multiple socioeconomic, cultural, and ethnic groups, and has shown promising initial evidence of efficacy.
Objective: The current proposal aims to expand on this previous work by conducting a randomized controlled trial comparing virtual-reality delivery of CI therapy with (1) traditional clinic-based CI therapy of equal total duration, and (2) a control group equating the dose of in-person therapy.
Methods: Individuals (225) with chronic stroke will be randomized to one of four different interventions: (1) traditional CI therapy (35 therapist/client contact hours), (2) therapist-as-consultant virtual-reality CI therapy (5 therapist/client contact hours in the clinic and 30 hours of independent game play at home), (3) telerehabilitation therapist-as-consultant virtual-reality CI therapy (5 therapist/client contact hours via videoconference and 30 hours of independent game play in the home), and (4) 5 hours of standard care. Functional use of the more affected hand and motor speed will be measured before treatment, immediately after treatment, and six months later.
Projected Outcomes: Results of this study will provide information to therapists and patients/families regarding the relative effectiveness of four potential treatment alternatives for chronic hemiparesis. This information will empower informed decision making by educating stakeholders about the relative effectiveness of an "off-the-shelf" tool for self-initiated in-home rehabilitation.
Stakeholder Engagement: An advisory panel of stakeholders advised the research design, aided in the preparation of this grant application, and will advise all phases of the research process. Some members of the core research team are also stakeholders.
Anticipated Impact: If our hypothesis (that the lower-cost gaming therapy will be of comparable effectiveness to CI therapy and more effective than standard occupational therapy) is confirmed, then this work could trigger a paradigmatic shift in approach to rehabilitation—namely, patient-driven use of off-the-shelf technology facilitating more efficient use of therapist expertise.
Gauthier LV, Kane C, Borstad A, et al. Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multicenter comparative effectiveness trial of inhome gamified constraint-induced movement therapy for rehabilitation ofchronic upper extremity hemiparesis. BMC Neurology (2017).