Therapeutic Device Uses Video Game To Help Stroke Patients Regain Arm Mobility
April 30th, 2019 By: JobsTherapy.com Content Staff
Can playing a video game help stroke patients regain function in their arms even after years of immobility? According to a study published March 19 in the journal Neurorehabilitation and Neural Repair, the answer appears to be yes, potentially giving health-care professionals an invaluable tool in helping these patients feel like their old selves.
Many stroke survivors are unable to straighten their arms fully at the elbow because the muscles act against each other, a condition known as abnormal co-activation or abnormal coupling, according to News Medical, a website monitoring news in the fields of health and life sciences.
To address this issue, scientists at Northwestern Medical University created a customized video game and a device to play it on called a myoelectric computer interface. The study’s 32 participants were severely impaired, and most could only slightly move their arm and extend their elbow. All of the patients had suffered their stroke at least six months before the study, and the average patient was more than six years removed from his stroke, according to News Medical.
After undergoing rehabilitation with the video game, most patients experienced less arm stiffness and were able to straighten their arms by an average of 11 degrees more than before the therapy, News Medical reported. They also had retained their improved arm function when reevaluated a month afterward.
"Classically, in patients that far out from a stroke, we don't typically expect to see any improvements, but we saw modest yet significant improvement in these patients," the study’s senior author, Dr. Marc Slutzky, told News Medical. "We gamified the therapy into an '80s-style video game. It's rather basic graphics by today's standards, but it's entertaining enough."
Slutzky, associate professor of neurology and physiology at the Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurologist, told News Medical that his research team has partnered with a company to create a wearable version of the device to study at-home use by patients. The device communicates wirelessly with a laptop or tablet, and a future version hopefully will be completely wireless, Slutzky told News Medical. His team recently began studying the use of this device in hospitalized stroke patients, sometimes beginning within a week of their stroke.
"The beauty of this is even if the benefit doesn't persist for months or years, patients with a wearable device could do a 'tune-up' session every couple weeks, months or whenever they need it," Slutzky told the website. "Long term, I envision having flexible, fully wireless electrodes that an occupational therapist could quickly apply in their office, and patients could go home and train by themselves."
To identify which muscles were abnormally coupled, study participants tried to extend their arms to reach items while the scientists recorded the electrical activity in eight of their arm muscles using electrodes placed on the skin. As an example, the biceps and anterior deltoid muscles often activated together in stroke participants even though they shouldn't, News Medical reported.
Next, to retrain the muscles to move normally, participants used their electrical muscle activity to control a cursor in the customized video game. The two abnormally coupled muscles moved the cursor either horizontally or vertically in accordance with the electrical muscle activity (called electromyogram, or EMG). For instance, if the biceps contracted in isolation, the cursor would move up. If the anterior muscles contracted in isolation, the cursor would move to the side. But if the muscles would contract together, the cursor would move diagonally, News Medical reported.
The goal was for participants to move the cursor only vertically or horizontally and not diagonally so that they could hit targets in the video game. When participants learned to decouple the abnormally coupled muscles, they got a higher score, according to News Medical.
Only about 30 percent of U.S. stroke patients get physical therapy following their initial in-patient rehabilitation stay, often because their impairment is too severe to benefit from standard therapy, it costs too much or they live too far from a therapist, News Medical reported. If further developed, this video game-led tool could drastically increase stroke patients’ access to physical therapy. And it could help many stroke patients whose inability to straighten their arm limits the benefit of typical task-based stroke-rehabilitation therapies, such as training on bathing, getting dressed and eating.
"We're still in the very early stages, but I'm hopeful this may be an effective new type of stroke therapy," Slutzky told News Medical. "The goal is to one day let patients buy the training device inexpensively, potentially without even needing insurance, and use it wirelessly in their home."
The device requires only a small amount of muscle activation, which is ideal for severely impaired stroke patients who typically aren’t able to move enough to begin standard physical therapy. It also gives feedback to the patient if she is activating her muscles properly, News Medical reported.
"We learn how to move by trial and error," Slutzky told the website. "If you don't have any feedback about the errors, it's hard to learn to improve movement. This task provides patients with clear feedback about their muscle activation."