A new at-home rehabilitation system that could give stroke survivors greater ability to recover upper limb function has been developed.
The RePlay system uses gamification for patients to use independently to complete appropriate exercises to regain as much function as possible.
The hand-held device uses an integrated accelerometer, gyrometer and force sensor to measure the players’ movements, recording statistics to track progress.
RePlay, devised by a team at The University of Texas at Dallas’ Texas Biomedical Device Center (TxBDC), uses a variety of controllers to test various abilities of stroke rehab patients, including grip strength.
It creates a gameplay environment for rehab exercises in which patients complete games on an Android tablet using a wireless hand-held device or keyboard, or by swiping with their fingers.
The equipment measures force and movement of arms and fingers so that therapists can customise instructions and quantify work and progress. Hand movements are monitored as patients play seven different games, which become more challenging as the patient improves.
The device adds further to remote options available to patients for their neuro-rehab, and adds further evidence to the efficacy of gamified rehab for stroke patients.
“Clinicians can see how many minutes were spent on each game, and that matters a lot,” said Dr Michael Kilgard, interim executive director and chief science officer at TxBDC.
“Physical therapy struggles with the definition of a ‘dose’ of rehab — how much therapy does a patient need? Are we counting in days or hours or sessions? This documents minutes of active engagement. Bringing that data into physical and occupational therapy is significant to us.
“Our participants with stroke and spinal cord injury have now played 19,000 of these games — hundreds upon hundreds of hours — demonstrating that people can use RePlay effectively with only a short learning period and little to no supervision.”
The study of RePlay demonstrated the potential benefits of the system in both supervised and unsupervised settings. Sixteen patients used the system during an initial one-hour office visit, and four of them took the system home.
Participants produced on average 698 discrete movements during the in-office visit, while those who used the system at home produced 1,593 discrete movements per day. The researchers’ baseline expectation was 100 repetitive movements per day.
“When we sent the RePlay system home with a subset of the participants, we did not give them any extra help beyond an occasional phone or Zoom call to see how things were going,” corresponding author Dr David Pruitt said.
“Every day, each participant used the system consistently, following their plan without supervision.”
Upon completion of the at-home phase, all of the participants reported that they would be willing to use the system again in the future.
“As you get stronger, the game raises the difficulty, or you can adjust it yourself. If you can’t do the next level, it backs off next time,” Dr Kilgard said.
“Our participants with stroke and spinal cord injury have now played 19,000 of these games — hundreds upon hundreds of hours — demonstrating that people can use RePlay effectively with only a short learning period and little to no supervision.”
In future studies, the research team plans to test RePlay in tandem with vagus nerve stimulation (VNS).
“Adding the recovery-accelerating power of VNS to RePlay’s engaging, convenient therapy could vastly improve the physical rehabilitation experience for stroke and spinal cord injury patients,” Dr Kilgard said.
“We hope RePlay makes rehabilitation much less cost-prohibitive. Along with time and travel, we believe this system addresses the biggest barriers to achieving the best possible results.”
