Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial

Abstract

IntroductionEffective interventions to promote upper-limb recovery poststroke are characterised by intensive and repetitive movements. However, the repetitive nature of practice may adversely impact on adherence. Therefore, the development of rehabilitation devices that can be used safely and easily at home, and are motivating, enjoyable and affordable is essential to the health and well-being of stroke survivors.The Neurofenix platform is a non-immersive virtual reality device for poststroke upper-limb rehabilitation. The platform uses a hand controller (a NeuroBall) or arm bands (NeuroBands) that facilitate upper-limb exercise via games displayed on a tablet. The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial aims to determine the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper-limb poststroke.Methods and analysisThirty people poststroke will be provided with a Neurofenix platform, consisting of a NeuroBall or NeuroBands (dependent on impairment level), seven specially designed games, a tablet and handbook to independently exercise their upper limb for 7 weeks. Training commences with a home visit from a research therapist to teach the participant how to safely use the device. Outcomes assessed at baseline and 8 weeks and 12 weeks are gross level of disability, pain, objectively measured arm function and impairment, self-reported arm function, passive range of movement, spasticity, fatigue, participation, quality of life (QOL) and health service use. A parallel process evaluation will assess feasibility, acceptability and safety of the intervention through assessment of fidelity to the intervention measured objectively through the Neurofenix platform, a postintervention questionnaire and semistructured interviews exploring participants’ experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on QOL and resource use.Ethics and disseminationEthics approval granted from Brunel University London (10249-MHR-Mar/2018-12322-2). Trial results will be submitted for publication in journals, presented at national and international conferences and distributed to people with stroke.Trial registration numberISRCTN60291412; Pre-results.

Enhancing Upper Limb Rehabilitation of Stroke Patients With Virtual Reality: A Mini Review

“…Self-administered treatment at home, through technology-based training and conventional exercises, has been previously found to be accepted by chronic stroke patients (Nijenhuis et al, 2017). A few VR systems have been specifically designed for home-based use like the Neurofenix platform (Kilbride et al, 2018), aiming to encourage stroke patients to exercise independently at home, in their environment, and with minimal therapist supervision. Feasibility studies reported that patients, trained at their own home during 4 weeks, have gained significant improvements in bilateral upper limb function, grasp strength and motor control (Burdea et al, 2019;Thielbar et al, 2020).…”

Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial

“…Stroke Alliance for Europe states that "every 20 s, someone in Europe has a stroke", while in the United States, "someone has a stroke every 40 s" a leading cause of significant long-term disabilities [1,2]. used, for medical purposes, in the motor rehabilitation of post-stroke patients [17,18]. Previous research on NIVR and immersive VR-based activities suggests that these interventions improve upper extremity rehabilitation after a stroke by providing motivating environments, stimulating extrinsic feedback, or simulating gameplay to facilitate recovery.…”

“…Over the past ten years, research and literature reviews regarding the use of VR in post-stroke recovery have been homogeneous. Many approaches have focused on the use of VR as adjunct therapy alongside standard physiotherapy, and in some studies, non-dedicated VR technologies have been used, for medical purposes, in the motor rehabilitation of post-stroke patients [ 17 , 18 ]. Previous research on NIVR and immersive VR-based activities suggests that these interventions improve upper extremity rehabilitation after a stroke by providing motivating environments, stimulating extrinsic feedback, or simulating gameplay to facilitate recovery.…”

Effectiveness of a home-based exercise program among patients with lower limb spasticity post-stroke: A randomized controlled trial

“…Home-based rehabilitation programs, which are safe, inexpensive, and easy-to-implement, have been developed for stroke rehabilitation using different technologies [15]. Randomized trials have evaluated whether nurse-led, home-based rehabilitation programs, such as home-based physical activity incentive and education programs [16], and home-based gaming exercises [17], can positively influence recovery after stroke. Home-based hand rehabilitation has been shown to significantly increase the selfreported function and quality of movement of the impaired hand after chronic stroke [18].…”