Game-Based Stroke Rehab From Home On Par with Clinic

Read the comment before you start asking your doctor about this. 

Game-Based Stroke Rehab From Home On Par with Clinic

Arm motor function recovery was noninferior in randomized trial

• by Crystal Phend, Senior Associate Editor, MedPage Today February 10, 2019

HONOLULU -- Arm exercises erase post-stroke deficits just as well when administered through home-based telemedicine as in the office, a randomized trial showed.
Improvement in arm motor function on the Fugl-Meyer scale was 7.86 points with telerehab versus 8.36 points at day 30, which met noninferiority criteria, Steven Cramer, MD, of the University of California Irvine, reported here at the International Stroke Conference (ISC).
Arm recovery exceeded the minimal clinically important difference in both groups and didn't differ between rehab strategies by aphasia status.
"What we're trying to do with home-based telehealth does not compete with or replace traditional rehab medicine. It is expanding tools," Cramer said.
ISC session moderator Louise McCullough, MD, PhD, of the University of Texas Health Science Center at Houston, agreed but noted some advantages to rehab from home.
"If we can optimize it... there could be huge cost savings," she said in an interview, "and especially for people in rural areas, like lots of Texas does not have access to rehab. It might be 2 hours away. This gives more options for people."
The NIH StrokeNet trial included 124 adults who were 4 to 36 weeks post-ischemic or hemorrhagic stroke and had a baseline arm motor Fugl-Meyer score of 22 to 56 on the 66-point scale.
Treatment consisted of 36 sessions (18 supervised) of 70 minutes each, over 6-8 weeks. Intensity, duration, and frequency of therapy were matched between groups. Participants were randomized to therapy at home via telemedicine or in a traditional clinic setting with the same Accelerated Skill Acquisition program (impairment focused, task specific, and with intensive engagement).
McCullough praised the focused study design.
"I think the rehab field is really emerging and they're taking it very scientifically now -- things like dose that they may not have thought about, frequency. There probably is still a lot to learn," she told MedPage Today.
Telerehab patients started their supervised sessions with a video conference where they worked with the therapist.
For the 15 minutes of the session that was functional training, the in-clinic group got functional tasks whereas the home-based group got functional games. "This is not your father's Wii game," Cramer noted. The games could be set to emphasize targets in specific parts of the visual field and could vary in speed, range of motion, target size, and cognitive demand. Input devices to play the games ranged from a squeezing device to a "whack-a-mole" mallet and a gun.
Stroke knowledge gained was likewise similar between groups, although patients liked in-clinic therapy significantly better as measured by activity-inherent motivation.
Patients' preference to go to clinic appears to be because of that live social interaction. McCullough noted. "We now know social isolation is very common. But if you have low vision or you live alone, it's really difficult to get to clinic. So now we have to get it so the preference is to do it at home."
"I think that social interaction is going to be really important to fold into our telemedicine and telehealth platforms for whatever disease," she added.

Cramer disclosed relevant relationships with TRCare, MicroTransponder, Dart Neuroscience, Neurolutions, Regenera, Abbvie, and SanBio.
McCullough disclosed no relevant relationships with industry.

• Primary Source

  International Stroke Conference

  Source Reference: Cramer SC, et al "Telerehabilitation in the Home versus Therapy In-Clinic for Patients With Stroke" ISC 2019; Abstract LB23.

February 11, 2019

— Carole Lewis

This is quite a title. As a PT and editor of an international journal on rehabilitation I find this offensive. First of all this is only a conference submission and has not been peer reviewed. Second, one of the authors has a financial interest in showing positive results for this product. I would seriously question if this is as effective as noted. Finally, the Fugl-Myer is not a functional outcomes tool. There are many other functional outcomes tools that are better for the upper extremity than this. In addition, what about the all important lower extremities?
This is a good idea but how about using it for an adjunct or more extensive rehabilitation? Studies are pretty clear that the more the patient gets the better they do and with the restrictions on therapists time this might be great for patients that are discharged or can tolerate more time in the day.
We as a country need to figure out the best ways to get the most appropriate care to our patients who have strokes and not jump on eye catching titles with little evidence that demean the current therapies that provide proven benefits.