Democratizing Neurorehabilitation: How Accessible are Low-Cost Mobile-Gaming Technologies for Self-Rehabilitation of Arm Disability in Stroke?

Motor-training software on tablets or smartphones (Apps) offer a low-cost, widely-available solution to supplement arm physiotherapy after stroke. We assessed the proportions of hemiplegic stroke patients who, with their plegic hand, could meaningfully engage with mobile-gaming devices using a range of standard control-methods, as well as by using a novel wireless grip-controller, adapted for neurodisability. We screened all newly-diagnosed hemiplegic stroke patients presenting to a stroke centre over 6 months. Subjects were compared on their ability to control a tablet or smartphone cursor using: finger-swipe, tap, joystick, screen-tilt, and an adapted handgrip. Cursor control was graded as: no movement (0); less than full-range movement (1); full-range movement (2); directed movement (3). In total, we screened 345 patients, of which 87 satisfied recruitment criteria and completed testing. The commonest reason for exclusion was cognitive impairment. Using conventional controls, the proportion of patients able to direct cursor movement was 38–48%; and to move it full-range was 55–67% (controller comparison: p>0.1). By comparison, handgrip enabled directed control in 75%, and full-range movement in 93% (controller comparison: p平板电脑或智能手机上的运动训练软件（Apps）可为卒中后手臂康复治疗提供一种低成本、可及性广的辅助解决方案。我们评估了偏瘫卒中患者使用患手，通过一系列标准控制方式，以及一款专为神经障碍人群适配的新型无线握力控制器，能够有效参与移动游戏设备交互的比例。我们筛选了6个月内就诊于某卒中中心的所有新诊断偏瘫卒中患者。对受试者使用以下方式控制平板电脑或智能手机光标时的能力进行对比：手指滑动、点击、摇杆、屏幕倾斜，以及适配型握力装置。光标控制能力被划分为如下等级：无移动（0级）、活动范围未达全范围（1级）、全范围移动（2级）、定向移动（3级）。本研究共筛选345例患者，其中87例符合入组标准并完成测试。最常见的排除原因为认知功能障碍。使用常规控制方式时，能够实现光标定向移动的患者占比为38%~48%；能够实现全范围移动的患者占比为55%~67%（各控制器间对比：p>0.1）。相较而言，使用握力控制器时，75%的患者可实现定向控制，93%的患者可实现全范围移动（各控制器间对比：p