New Study Demonstrates Rehabilitation can be Effectively Managed at Home
By Karen Angelo
A new at-home rehabilitation gaming system that simulates a kayaking adventure, combined with therapist counseling on everyday tasks, can help stroke patients regain strength and mobility, according to a study led by Assoc. Prof. Lynne Gauthier of the Department of Physical Therapy and Kinesiology.
This new approach improves motor skills by about 20%, as much as traditional therapy can, but also improves arm use during daily activities by 50%, according to the new study, recently published in EClinicalMedicine.
Improvements made in traditional therapy rarely translate to better function outside the clinic, but this new at-home treatment approach fixes that, according to Gauthier.
“Instead of therapists spending time on exercises that can be done independently, we found that arm use improves most when therapists use their limited time with the patient to coach them through everyday living tasks, such as dressing, mowing the lawn and using a keyboard or mouse,” says Gauthier. “Unlike the traditional approach to care, this new model creates lasting change in how well patients use the weaker side of their body during their daily activities. We are also seeing these changes years after their stroke, showing that effective therapies can be a game-changer and that it is never too late to keep improving.”
Funded by the Patient-Centered Outcomes Research Institute, an independent nonprofit based in Washington, D.C., the study involved people affected by stroke who had some upper movement in their arms. The researchers compared groups who received traditional in-clinic motor therapy with those who used the gaming system independently at home and received behavioral intervention from their therapist, including coaching on how to use the weaker side of the body more often for tasks such as eating and dressing.
Using the power of artificial intelligence and sensors, the therapeutic game simulates a patient’s movements in a kayak navigating rapids. The patient travels along a river, avoiding obstacles, dodging rapids and solving puzzles. The software gauges the patient’s ability so that it can continue to challenge them independently at home with exercises at the right level of difficulty.
“We found that patients feel empowered and have fun using the game, which motivates them to keep gaming and getting stronger,” says Gauthier, who created the gaming program with a software developer.
Nancy Strahl, a stroke survivor who participated in the trial, agrees.
“I loved the avatar kayaker and the challenge of gaming to get to the next level of play,” says Strahl. “It did not feel like rehab. The game was difficult at first, but as my arm and hand got stronger, the game adapted to my increase in movement and strength.”
The therapeutic game can provide access to care to more people who suffer neurological damage, says Gauthier, since some people recovering from a stroke stop their rehabilitation early on because their insurance runs out or they can’t get to appointments.
Strahl, who lives in a rural area in Oregon, appreciates that she was able to do the exercises from her home on her own schedule.
“I was happier and much more motivated,” she says. “I also consulted with a therapist to get ideas on how to break down difficult daily movements into tiny steps and help track progress. I felt I gained at least 85% improvement over six weeks.”
Gauthier stresses that technology alone cannot change stroke victims’ behaviors without the intervention of physical and occupational therapists, social workers and psychologists to also change victims’ habits.
“Therapists can help patients break actions into small steps, encourage patients to use their weaker arm, set goals and problem-solve,” she says.
Kristina Kelly, a neurological physical therapist who worked on the study, says that the dual-care approach is effective with patients.
“The neurological connections between muscles and the brain can improve with combined motor training and daily behavioral changes,” says Kelly, a physical therapist and clinical educator in the Department of Neurology at Ohio State University’s Wexner Medical Center. “Many patients three or five years after a stroke may give up and decline. This model has shown that it can help improve performance of daily tasks and activities long after the initial stroke.”
Therapists talk to patients about their typical day, including issues with changing position like getting out of bed or rising from a chair, as well as dressing, bathing and eating. Together, they come up with solutions that include how to incorporate the weaker side into these tasks. They may also set new goals such as grocery shopping, doing laundry, preparing food, participating in hobbies and caring for pets.
“The gaming intervention that we have researched can help transform clinical care, improve access and free up therapist time for behavioral intervention,” says Gauthier. “Our goal is to get the word out so that more therapists can start to adopt this method to give their patients effective and accessible treatment options.”