Feasibility of and Adherence to a Home-Based Video Game Rehabilitation Protocol

PURPOSE: Stroke is a leading cause of chronic disability which often leaves survivors with a loss of functional movements. Research has shown that high repetitions of specific movements are required for motor recovery, and frequently, therapists provide patients with home-based exercises to fulfill this high repetition demand. Studies have shown that patients do not always adhere to these programs for various reasons. Duck Duck Punch (DDP) is a Kinect-based post-stroke rehabilitation game designed to promote high repetitions of specific movements through a game scenario. The purpose of this study is to evaluate the feasibility and adherence of a home-based DDP protocol. We hypothesized that it would be feasible and that participants would adhere to this protocol.

DESIGN: This study is a subset of data from a larger parent study supported by an NIH SBIR Phase II grant. Participants were included if they had experienced a unilateral ischemic or hemorrhagic stroke between 3 months and 7 years prior, aged 21-90 years, and had a caregiver or friend willing to assist with set-up and operation of the game. They were excluded if there was anything (e.g. pain, severe ROM limitations, cognitive or visual impairments) that would affect their ability to reach during the intervention.

METHOD: 66 community-dwelling participants were randomized to play DDP or a commercially available computer game (Microsoft Kinect Target Shoot, KTS) in their homes 60 minutes a day, 3 times per week, for 6 weeks. Adherence data were collected on number of days played, minutes played, and the average minutes per session. Adherence data were compared between games (DDP or KTS), as well as to the instructed dose. A focus group was also held to assess feasibility of set-up and home use with participants or caregivers.

RESULTS: DDP is feasible for patients to use in the home setting. Patients demonstrated statistically significant higher adherence to DDP home program compared to KTS, shown by more days played (15.55 vs. 9.83), more minutes played per session (37.33 vs. 20.26), and more total minutes played (906.79 vs. 420.33).

CONCLUSION: The data suggest that DDP is feasible as a self-directed in-home therapy program, and that patients were able to adhere to dose instructions. This may have implications for the use of DDP in a variety of settings (e.g. home, hospital) as an option for self-directed therapy outside of traditional therapy hours.

References

Benjamin EJ, Blaha MJ, Chiuve SE, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e229-e445.

Langhorne, P., Coupar, F., & Pollock, A. (2009). Motor recovery after stroke: a systematic review. The Lancet. Neurology, 8(8), 741-754. doi:10.1016/S1474-4422(09)70150-4

Birkenmeier, R. L., Prager, E. M., & Lang, C. E. (2010). Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: A proof-of-concept study. Neurorehabilitation and Neural Repair, 24(7), 620-635.

Miller, K. K., Porter, R. E., DeBaun-Sprague, E., Van Puymbroeck, M., & Schmid, A. A. (2017). Exercise after Stroke: Patient Adherence and Beliefs after Discharge from Rehabilitation. Topics in Stroke Rehabilitation, 24(2), 142-148. doi:10.1080/10749357.2016.1200292