Study: Video Game Therapy May Help Patients Recover From a Stroke at Home

Home-based video game therapy shows similar outcomes to in-person therapy and provides a far more convenient treatment option for patients.

hands hold a gamepad in front of TV with brain inside in on a blue background
Alex Sandoval

Playing video games may have far more value than simply providing entertainment. For some stroke patients, home-based video game therapy may be just as effective as other popular forms of in-person physical therapy, according to new research.

The findings, according to the study published in eClinicalMedicine, are important in light of access barriers patients may face attending in-person treatment. The study results also show that patients who engage in video game therapy require just one-fifth as much therapist time, which study authors said has important ramifications for therapists, allowing them to redirect time toward other patient interventions.

"The game itself acts as a virtual therapist because it's progressing the difficulty based on what the person can do. So just like a therapist would say, 'Okay, you're able to reach here now we're gonna move the object further away,' the game essentially does the same thing," Lynne V. Gauthier, PhD, director of the Neurorecovery and Brain Imaging Laboratory and associate professor at the University of Massachusetts, Lowell, who led the study told "The game is automatically capturing their movements as they're playing and using that to decide on what bigger movement they need to accomplish next."

Video Game Impact on Stroke Rehabilitation

For the study, researchers focused on assessing the everyday arm use and motor speed function of post-stroke adults immediately before and immediately after treatment, as well as six months after treatment had completed.

Of the 193 participants enrolled in the study, 167 started treatment, 150 (90%) completed that treatment, and 115 (69%) completed treatment and follow-up. All patients, who were recruited between 2016 and 2018, had experienced mild to moderate impacts to their upper extremities.

Study participants received one of four different types of post-stroke intervention over a three week timeframe:

  • 5 hours of behaviorally-focused intervention plus gaming self-management (self-gaming)
  • The same as above with additional behaviorally-focused tele-rehabilitation (tele-gaming)
  • 5 hours of traditional motor-focused rehabilitation
  • 35 hours of constraint-induced therapy in which therapists deliver both behavioral treatment and motor practice

The study found that the "flipped model of care" through which therapist time is focused on behavioral interventions, and motor activities are entirely self-managed by patients via video game activities "proved safe, feasible, and was preferred by client."

What's more, when video game therapy was combined with twice-weekly tele-rehabilitation behavioral consults the results were even more promising, according to the study, which found that this approach "was more successful at promoting and maintaining improved quality of...arm use during daily activities."

"In this new model of care, therapist time is primarily dedicated to behavioral interventions targeting arm use, which can be carried out through tele-rehabilitation to improve access," the study said. "Self-managed intensive motor practice occurs in-home through rehabilitation gaming technology that progresses difficulty, provides immediate feedback, and tracks progress."

Video Game Therapy, Explained

The video game that was utilized for rehabilitation, Recovery Rapids, relies upon a motion sensor and real life movement in order to initiate the movement of a character in the game. As part of the system, a camera-based sensor captures the patient's movements and a game character mirrors those movements.

"For example, players are in a kayak and they're trying to get down the river while navigating through obstacles," Dr. Gauthier said. "To move forward, they need to move their arms side to side to create a paddling movement to move the kayak in the direction they want to go."

The game also provides feedback about whether the patient is doing the movement correctly. If the patient is not doing the movement to the best of their ability, their game character is not moving. Additional challenges within the game include crashing into a bush and moving the video game character's arms into a grab, grasp, and release in an effort to collect as much food as possible

"These are many activities people working on motor function would do in a clinic, but we just put it into a game-based program," Dr. Gauthier says.

Patients use the video game for several hours a day to improve their arm movement and also periodically check in with a therapist via telehealth.

"The goal is to put people in charge of their health and wellness instead of thinking of themselves as a patient who is having something done to them," Dr. Gauthier said.

Current Stroke Rehabilitation Strategies

One of the most widely researched forms of outpatient physical therapy for stroke patients who are not completely paralyzed is constraint-induced movement therapy (CIMT). This type of therapy, which was also used in the control group for the video game therapy comparison, was developed to overcome upper limb impairments after stroke. CIMT relies upon forced use of an affected arm for several hours of exercise while restraining the less affected arm, according to the American Heart Association.

Dr. Gauthier said constraint therapy is very effective in translating the results of in-person therapy to the use of your arms in everyday life. However, she pointed out that there are downsides to constraint-induced movement therapy including the time involved for the therapists who must work with patients, and access to therapy for people who live too far from a clinic or do not live near a specialist at all. Half of the people undergoing stroke recovery do not have regular access to therapy, Dr. Gauthier said.

The study itself outlines barriers to treatment even further noting that they include: "geographic location (e.g., rural disparities), travel-burden, insurance restrictions, and the time cost of delivering both behavioral and motor intervention."

Insurance coverage in particular plays a role in the type of therapy a patient is offered and how much treatment the patient is able to receive.

"Insurance typically only covers about 10 hours of therapy per patient. So people are stuck in this kind of revolving door, they get 10 hours of therapy, then they're discharged. Then they have to figure it out on their own for a while," Dr. Gauthier explained. "When the new year comes around, they may get more coverage, but it's very disjointed care and there's really not enough emphasis on that translation aspect."

What's more, said Dr. Gauthier, because the therapists have such a limited amount of time, it's hard for them to pack everything into just 10 hours.

The Future of Video Game Therapy

The Recovery Rapids video game used in the study is commercially available, though it currently requires specialized hardware to install it. Dr. Gauthier said her team is working to make the game accessible on cell phones and tablets by the end of the year.

Once downloaded, the game can be set up in about 30 seconds, Dr. Gauthier said, adding that researchers did not encounter many technological challenges among older patients who may be less familiar with using computer games.

Igor Rybinnik, MD, a neurologist with Robert Wood Johnson University Hospital's Comprehensive Stroke Center, told, that he is hopeful such therapy will be more widely used and available in the coming years.

"Hopefully over the next five to 10 years, a lot of this gamification of rehab will enter patient homes and it's as simple as plugging it into your TV, instead of traveling to a facility to get this kind of therapy," Dr. Rybinnik said.

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