Background Upper limb functional deficits are common after stroke and result from motor weakness, ataxia, spasticity, spatial neglect, and poor stamina. Past studies employing a range of commercial gaming systems to deliver rehabilitation to stroke patients provided short-term efficacy but have not yet demonstrated whether or not those games are acceptable, that is, motivational, comfortable, and engaging, which are all necessary for potential adoption and use by patients. Objective The goal of the study was to assess the acceptability of a smartphone-based augmented reality game as a means of delivering stroke rehabilitation for patients with upper limb motor function loss. Methods Patients aged 50 to 70 years, all of whom experienced motor deficits after acute ischemic stroke, participated in 3 optional therapy sessions using augmented reality therapeutic gaming over the course of 1 week, targeting deficits in upper extremity strength and range of motion. After completion of the game, we administered a 16-item questionnaire to the patients to assess the game’s acceptability; 8 questions were answered by rating on a scale from 1 (very negative experience) to 5 (very positive experience); 8 questions were qualitative. Results Patients (n=5) completed a total of 23 out of 45 scheduled augmented reality game sessions, with patient fatigue as the primary factor for uncompleted sessions. Each patient consented to 9 potential game sessions and completed a mean of 4.6 (SE 1.3) games. Of the 5 patients, 4 (80%) completed the questionnaire at the end of their final gaming session. Of note, patients were motivated to continue to the end of a given gaming session (mean 4.25, 95% CI 3.31-5.19), to try other game-based therapies (mean 3.75, 95% CI 2.81-4.69), to do another session (mean 3.50, 95% CI 2.93-4.07), and to perform other daily rehabilitation exercises (mean 3.25, 95% CI 2.76-3.74). In addition, participants gave mean scores of 4.00 (95% CI 2.87-5.13) for overall experience; 4.25 (95% CI 3.31-5.19) for comfort; 3.25 (95% CI 2.31-4.19) for finding the study fun, enjoyable, and engaging; and 3.50 (95% CI 2.52-4.48) for believing the technology could help them reach their rehabilitation goals. For each of the 4 patients, their reported scores were statistically significantly higher than those generated by a random sampling of values (patient 1: P=.04; patient 2: P=.04; patient 4: P=.004; patient 5: P=.04). Conclusions Based on the questionnaire scores, the patients with upper limb motor deficits following stroke who participated in our case study found our augmented reality game motivating, comfortable, engaging, and tolerable. Improvements in augmented reality technology motivated by this case study may one day allow patients to work with improved versions of this therapy independently in their own home. We therefore anticipate that smartphone-based augmented reality gaming systems may eventually provide useful postdischarge self-treatment as a supplement to professional therapy for patients with upper limb deficiencies from stroke.

BACKGROUND Upper limb functional deficits are common after stroke and result from motor weakness, ataxia, spasticity, special neglect and poor stamina. Past studies employing a range of commercial gaming systems to deliver rehabilitation to stroke patients provided short-term efficacy, but have not yet demonstrated whether or not those games are acceptable for long-term use, that is, motivational, comfortable, and engaging, all necessary for their long-term adoption and use by patients. OBJECTIVE To assess the acceptability of a cell-phone based augmented reality (AR) game as a means of delivering stroke rehabilitation for patients with upper limb motor function loss. METHODS Five patients ages 50–70, all of whom experienced motor deficits after acute ischemic stroke, participated in three optional therapy sessions using augmented reality therapeutic gaming over the course of one week targeting deficits in upper extremity strength and range of motion. After completion of the game we administered a questionnaire that assessed the game acceptability for the patient. RESULTS Five out of five acute stroke patients completed a total of 23 out of 45 scheduled AR game sessions, with patient fatigue the primary factor for uncompleted sessions. Four out of five patients completed a 16-question questionnaire at the end of their final gaming session with one patient lost to early discharge. An average score of 4.25/5 for motivation to follow the instructions and finish the AR experience to the end of a given gaming session, 3.75/5 for motivation to try other game-based therapies, 3.5/5 for desire to do another session, and 3.25/5 for motivation to perform other exercises in support of their daily rehabilitation. In addition, average scores of 4/5 was given for the overall experience, 4.25/5 for comfort, 3.25/5 for finding the study fun, enjoyable, and/or engaging, and 3.5/5 for believing this technology could help them reach their rehabilitation goals. For each of the four patients, their reported scores were statistically significantly higher in value than that generated by a random sampling of values, with an average of P=.037. CONCLUSIONS Based on the questionnaire scores, patients with upper limb motor deficits following stroke found our AR game motivating, comfortable, engaging and well tolerated. Anticipated improvements in AR technology may allow patients to work with improved versions of the presently tested therapy, independently, in their own home. We therefore anticipate that cell-phone based AR gaming systems may one day provide useful self-treatment of stroke patients with upper limb deficiencies post discharge as a supplement to professional therapy.