Usability of Videogame-Based Dexterity Training in the Early Rehabilitation Phase of Stroke Patients: A Pilot Study

Abstract

BackgroundApproximately 70–80% of stroke survivors have limited activities of daily living, mainly due to dexterous problems. Videogame-based training (VBT) along with virtual reality seems to be beneficial to train upper limb function.ObjectiveTo evaluate the usability of VBT using the Leap Motion Controller (LMC) to train fine manual dexterity in the early rehabilitation phase of stroke patients as an add-on to conventional therapy. Additionally, this study aimed to estimate the feasibility and potential efficacy of the VBT.MethodsDuring 3 months, 64 stroke patients were screened for eligibility, 13 stroke patients were included (4 women and 9 men; age range: 24–91 years; mean time post stroke: 28.2 days).InterventionNine sessions of 30 min VBT, three times per week as an add-on to conventional therapy with stroke inpatients.Outcome measuresPrimary outcome was the usability of the system measured with the System Usability Scale. Secondary outcomes concerning feasibility were the compliance rate calculated from the total time spent on the intervention (TT) compared to planned time, the opinion of participants via open-end questions, and the level of active participation measured with the Pittsburgh Rehabilitation Participation Scale. Regarding the potential efficacy secondary outcomes were: functional dexterity measured with the Nine Hole Peg Test (NHPT), subjective dexterity measured with the Dexterity Questionnaire 24, grip strength measured with the Jamar dynamometer, and motor impairment of the upper limb measured with the Fugl-Meyer Upper Extremity (FM-UE) scale.ResultsPrimarily, the usability of the system was good to excellent. The patient’s perception of usability remained stable over a mean period of 3 weeks of VBT. Secondly, the compliance rate was good, and the level of active participation varied between good and very good. The opinion of the participants revealed that despite individual differences, the overall impression of the therapy and device was good. Patients showed significant improvements in hand dexterity. No changes were found in motor impairment of the upper limb (FM-UE) during intervention.ConclusionVBT using LMC is a usable rehabilitation tool to train dexterity in the early rehabilitation phase of stroke inpatients.

Usability Issues of Clinical and Research Applications of Virtual Reality in Older People: A Systematic Review

“…), ranging from one to 36 sessions spread over the course of 1 single day to 4 years; indeed, usability along with effectiveness of training was tested for three , four Rebsamen et al, 2019;van Beek et al, 2019), six , eight , and 12 weeks Desteghe et al, 2017), and three and 4 years . Exergames (i.e., serious games used for balance and fall risk training) were used in most of the motor training Schwenk et al, 2014;Wüest et al, 2014;Kiselev et al, 2015;Sáenz-de-Urturi et al, 2015;Shubert et al, 2015;Brox et al, 2017;Trombetta et al, 2017;Money et al, 2019;Rebsamen et al, 2019;van Beek et al, 2019), physiotherapy exercise in others Im et al, 2015), cognitive-physical dual-task in Pedroli et al (2018), neuropsychological testing in three studies Corno et al, 2014;Plechatá et al, 2019;Valladares-Rodriguez et al, 2019), gesture therapy in Morán et al (2015) and Vanbellingen et al (2017), and psychosocial support/educational in four studies Castilla et al, 2013;Cook and Winkler, 2016;Desteghe et al, 2017).…”

“…Importantly, some studies adopted technological theoretical frameworks adapted for older people, such as the senior UCD or the senior citizens' acceptance of information systems (SCAIS) Nikitina et al, 2018). However, several studies did not report a theoretical model to design their systems Castilla et al, 2013;Corno et al, 2014;Schwenk et al, 2014;Im et al, 2015;Shubert et al, 2015;Desteghe et al, 2017;Trombetta et al, 2017;Vanbellingen et al, 2017;Plechatá et al, 2019;van Beek et al, 2019). Concerning the assessment of usability of VR systems, a wide range of quantitative and qualitative methods have been used (see Table 1 for specific information and Figures 5-7 for models and methods overviews).…”

“…Concerning quantitative data, system usability scale (SUS) Sáenz-de-Urturi et al, 2015;Shubert et al, 2015;Vanbellingen et al, 2017;Nikitina et al, 2018;Pedroli et al, 2018;Money et al, 2019;Rebsamen et al, 2019;van Beek et al, 2019), TAM-based questionnaires Wüest et al, 2014;Morán et al, 2015;Cook and Winkler, 2016;Rebsamen et al, 2019;Valladares-Rodriguez et al, 2019), UX questionnaires Sáenzde-Urturi et al, 2015;Brox et al, 2017;Desteghe et al, 2017;Rebsamen et al, 2019), UCD-based questionnaire , flow of experience scale , other usability questionnaires Epelde et al, 2014;Trombetta et al, 2017;Plechatá et al, 2019;Valladares-Rodriguez et al, 2019), adherence or motivation to training questionnaires Desteghe et al, 2017;Vanbellingen et al, 2017;Nikitina et al, 2018;Rebsamen et al, 2019;van Beek et al, 2019) or with VR data Kiselev et al, 2015;Desteghe et al, 2017;Vanbellingen et al, 2017;Nikitina et al, 2018;Rebsamen et al, 2019;van Beek et al, 2019), cybersickness assessment Im et al, 2015;Plechatá et al, 2019), technology expertise Rebsamen et al, 2019;Valladares-Rodriguez et al, 2019), and video analysis were used. Regarding qual...…”

Available Therapeutics after a Stroke: Current and Promising Options

“…Physical rehabilitation must start early, if possible, during the first week poststroke [96], because there is an intensification in neuroplasticity during the early stages [91], employing different mechanisms such as the axon regeneration [88], and the higher expression of growth-promoting genes, such as GAP-43. This lesioninduced plasticity that happens during the first days post-stroke [90,97,98] reportedly lasts around 6 months after stroke [4,91,95,97].…”

“…Videogame-or virtual reality-based (VRb) therapies have been under study for upper extremity functional recovery in acute and subacute or chronic patients [91,96,99,102]; the rationale for such approaches is that they promote motor learning and repetitive, intense movements, and in the specific case of virtual reality, the patient is exposed to interactive visual, auditive, and proprioceptive feedback [91,102]. Different videogame and VRb therapies have reported improvements in fine dexterity, grip strength [96], and grasp force [99] in upper extremities, and, activities of daily living [91] and cognition [102] in young and elderly patients after several weeks of rehabilitation. Better results have been observed when combined with conventional therapy, although it is still not known whether it enhances or speeds up recovery [91].…”