A flipped model of care for stroke rehab, in which therapist time is focused on behavioral intervention and motor practice is self-managed through video games, produced greater gains in quality of everyday arm use compared with traditional therapist-led motor rehabilitation. Researchers published their findings in EClinicalMedicine.

“As the ultimate goal of rehabilitation is to increase functional use of the paretic arm and hand, there appears to be a marked disconnect between the techniques that can best accomplish this goal and current rehabilitation practice,” wrote lead author Lynne V. Gauthier, PhD, of the University of Massachusetts, Lowell, and coauthors. “The model of game-based self-management tested here can effectively expand use of behavioral techniques by freeing up therapist time that is normally dedicated to supervised motor practice.”

The 5-site trial randomly assigned community-dwelling adults with post-stroke mild/moderate upper extremity hemiparesis to 1 of 4 interventions over a 3-week period: (1) 5 hours of behaviorally focused intervention plus gaming self-management (self-gaming); (2) the self-gaming intervention with additional, though brief, behaviorally focused telerehab (telegaming); (3) 5 hours of traditional motor-focused rehab; or (4) 35 hours of constraint-induced movement therapy. Some 90% of 167 participants who began treatment completed treatment, and 69% completed follow-up.

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Gains on the Motor Activity Log Quality of Movement (MAL), a measure of everyday arm use, were clinically meaningful with both the telegaming and self-gaming interventions, according to the study. MAL scores were 1.0 point higher with telegaming and 0.8 points higher with self-gaming than with traditional care. Compared with constraint-induced movement therapy, self-gaming was less effective (-0.4 points) but telegaming was not less effective (-0.2 points). Six months after the intervention, retention of MAL gains was 57% across all groups.

Gains on the Wolf Motor Function Test, which assessed motor speed/function, were clinically meaningful and similar across all groups, researchers reported. Six-month retention was 92%.

“[A] self-management approach that employs brief telehealth behavioral consultation produces outcomes similar to in-clinic constraint-induced movement therapy, but requires just one-fifth as much therapist time,” researchers wrote. “Results of this pragmatic trial support the need for a marked shift towards prioritizing behavioral intervention during neurologic motor rehabilitation, as upper limb motor practice can be effectively self-managed at home.”

Reference

Gauthier LV, Nichols-Larsen DS, Uswatte G, et al. Video game rehabilitation for outpatient stroke (VIGoROUS): a multi-site randomized controlled trial of in-home, self-managed, upper-extremity therapy. EClinicalMedicine. Published online December 16, 2021. doi: 10.1016/j.eclinm.2021.101239