Understanding upper extremity home programs and the use of gaming technology for persons after stroke

doi:10.1016/j.dhjo.2015.03.007

Disability and Health Journal

Volume 8, Issue 4, October 2015, Pages 507-513

https://doi.org/10.1016/j.dhjo.2015.03.007 Get rights and content

Abstract

Background

Many persons post-stroke continue to have difficulty using their more involved upper extremity and home programs may be poorly adhered to limiting the amount of practice an individual receives. More information on the experience of traditional home program and the acceptability of a novel home intervention was sought.

Objective

To qualitatively describe 1) upper extremity use at home, 2) previous home exercise or activity programs, and 3) the acceptability of a novel upper extremity home program, NeuroGame Therapy (NGT), that combines surface electromyography (sEMG) biofeedback and a commercial computer game.

Methods

A purposeful sample of ten persons with moderate to severe upper extremity motor impairment used the NGT intervention in their home for four weeks and completed nested (pre and post) one-on-one interviews. Written transcripts from the interviews were coded and themes were identified to address stated objectives.

Results

Participants reported that while use of their upper extremity in daily activities was recommended it occurred infrequently. Most participants described previous home programs as being non-specific, were often not carried out as recommended or were self-modified. Participants found NGT to be engaging and motivating, but reported minimal changes in the functional uses of their upper extremity.

Conclusion

These findings suggest that after stroke upper extremity use may be infrequent and home program approaches could be re-examined. NGT was reported to be an acceptable home intervention, but it will require further development and study to understand its value and role in post-stroke rehabilitation.

Section snippets

Design

This initial study of NGT was designed to collect both quantitative and qualitative data on the effectiveness and acceptability of this home approach for adults post-stroke. The quantitative study used a repeated measures design (A1, A2, B1, A3; A = Assessment, B = Intervention) and results are reported in a separate paper.³⁰ A qualitative descriptive approach as described by Sandelowski31, 32 was used to answer questions on the nature of home programs and the acceptability of NGT. This method

Pre-intervention interview

Participants had been asked to describe how they used their affected arm/hand in daily activities in order to understand their functional ability. Two themes emerged regarding upper extremity use in daily activities: 1) that it was infrequent; and 2) that participants felt they should be doing more. Nine participants were able to name at least one functional activity in which they tried to use the affected limb, such as turning on and off light switches or incorporating the affected limb into

Discussion

Key findings highlight the difficulties and opportunities in augmenting or improving home programs in general and the uses of NGT specifically. Participants were able to identify activities during which they used their affected upper extremity, but reported that these activities occurred infrequently and were challenging. Participants described that they should be trying to use their arm more everyday. But they were provided with home programs that they often recalled as non-specific

Conclusion

Adult participants with hemiparesis following stroke were interviewed about home exercise/activity programs in general and the use of NGT specifically. They reported difficulty using their hemiparetic upper extremity for functional activity, but understood that using their affected upper extremity was an important part of continuing motor recovery. Most participants had been provided with a home exercise program in the past, but had difficulty recalling details about it, performing it

Acknowledgment

Jill Jandreau, MS, PT was one of the designated interviewers who contributed to data collection.

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: Presentation of this Material: The contents of this paper were presented October 19th to the first author's doctoral committee and the general public as part of a dissertation defense. Material was also presented to the University of North Carolina faculty and students of the Occupational Therapy and Occupational Science Division and Duquesne University staff as part of a job talk. A proposal for a poster for the American Occupational Therapy Association Conference has been accepted for the 2015 conference.

: Funding: The project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1RR025014, the Bayley Family Foundation and, and a Washington Research Foundation gift to the Center for Sensorimotor Neural Engineering (CNSE), a National Science Foundation Engineering Research Center (EEC-1028725). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies including NIH and NSF.

: Conflicts of interest: Authors Sarah McCoy and Chet Moritz had a potential intellectual property interest in the reported work, which was managed by the University of Washington. The source of the conflict has been dissolved.

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Research PaperUnderstanding upper extremity home programs and the use of gaming technology for persons after stroke

Abstract

Background

Objective

Methods

Results

Conclusion

Section snippets

Design

Pre-intervention interview

Discussion

Conclusion

Acknowledgment

PM R

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Heart disease and stroke statistics—2012 update a report from the American Heart Association

Circulation

Gender differences in stroke incidence and poststroke disability in the Framingham Heart Study

Stroke

Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage

J Speech Lang Hear Res

Constraint-induced movement therapy for upper extremities in stroke patients

Cochrane Database Syst Rev

Robot-assisted therapy for long-term upper-limb impairment after stroke

N Engl J Med

Impact of EMG-triggered neuromuscular stimulation of the wrist and finger extensors of the paretic hand after stroke: a systematic review of the literature

Clin Rehabil

Simultaneous bilateral training for improving arm function after stroke

Cochrane Database Syst Rev

Is health-related-quality of life of stroke patients influenced by neurological impairments at one year after stroke?

Eur J Phys Rehabil Med

Outpatient rehabilitation among stroke survivors – 21 states and the District of Columbia, 2005

MMWR Morb Mortal Wkly Rep

Occupational Therapy for Physical Dysfunction

Motor control: Translating Research into Clinical Practice

Occupational Therapy Essentials for Clinical Competence

Neurological Rehabilitation

Effects of a community-based intensive motor training program combined with early supported discharge after treatment in a comprehensive stroke unit: a randomized, controlled trial

Stroke

Research Paper
Understanding upper extremity home programs and the use of gaming technology for persons after stroke