Research Report
Population: Both
Alexandra L Borstad, PhD, PT, NCS, Assistant Professor, The Ohio State University borstad.2@osu.edu
Linda Lowes, PhD, PT, Researcher, Nationwide Childrens Hospital linda.lowes@nationwidechildrens.org
Lise Worthen-Chaudhari, MFA, MS, CCRC, Research Assistant Professor, The Ohio State University worthen-chaudhari.1@osu.edu
David Maung, MS, PhD, Computer Science, The Ohio State University maung.4@buckeyemail.osu.edu
Lynne Gauthier, PhD, Assistant Professor, The Ohio State University lynne.gauthier@osumc.edu
Keywords: Participation, Stroke, Gaming, Upper Extremity Performance
Purpose/Hypothesis: Constraint-induced movement therapy (CI therapy) is an effective treatment for the improvement of upper extremity function in individuals with hemiparesis, yet many individuals lack access to CI therapy or any outpatient rehabilitation. The purpose of this research was to 1) develop an affordable home-based model of constraint-induced movement therapy in which motor practice is delivered through a custom 3D video game and 2) establish the feasibility and initial efficacy of this intervention.
Subjects: Seventeen community-dwelling individuals with hemiparesis as a result of chronic stroke, with mild to moderate deficits in upper extremity function provide written consent and participated in this IRB approved study. Participant mean (SD) age was 49 (20) years and they averaged 37 (19) months post-stroke.
Materials/Methods: A custom 3D video game for upper extremity rehabilitation was developed using the Microsoft Kinect®. CI therapy was delivered using a home-based therapist-as-consultant model. Twice weekly in-home consultations by a PT were provided throughout the two-week intervention. Participants were encouraged to play the game for a target of 30 hours. Game content emphasized high-repetition, and self-assessment of daily arm use through a gamified Motor Activity Log. Participants agreed to wear a restraint mitt on the less affected hand for 10 hours per day to promote use of the more affected hand for daily activities. Motor function was assessed by blinded testers immediately prior to and following treatment via the Wolf Motor Function Test (WMFT). Arm use was assessed via tri-axial accelerometry (ratio of more-affected to less-affected arm accelerometer counts). Other measures included the Patient Health Questionnaire and the Brief Kinesthesia Test.
Results: Participants played for an average of 17.4 (8) hours, accumulating an average of 31,256 movement repetitions detected by the Kinect. Mitt use averaged 50 hours. Dose was consistent per time played as evidenced by the correlation between hours played and movement repetitions (r=0.77, p=0.001). As a whole, participants showed clinically meaningful improvements in motor function (WMFT rate #/minute = 5.9). Eleven individuals scored above the 80th percentile of WMFT changes reported by Taub and colleagues. Nine individuals demonstrated increased arm use based on accelerometry. There was no significant relationship found between depression and duration of game play. No relationship was observed between improvement on the WMFT and duration of game play, number of motor repetitions, kinesthetic impairment, handedness, or hemisphere affected.
Conclusions: This in-home therapist-as-consultant model of CI therapy is feasible, delivers a high dose and had initial efficacy in this pilot study. The potential exists to further quantify dose, and change in motor performance using kinematic data captured via the Kinect. Randomized comparative-effectiveness trials are needed to further define role for this technology.
Citation:
Borstad, Alexandra L, PhD, PT, NCS; Lowes, Linda , PhD, PT; Worthen-Chaudhari, Lise , MFA, MS, CCRC; Maung, David , MS, PhD; Gauthier, Lynne V., PhD. Hemiparetic Upper Extremity Performance Improves Following Video Game Delivery of Constraint-Induced Movement Therapy.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/019_borstad-et-al/