Abstract
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<0.001). This
difference between controllers was most apparent amongst
severely-disabled subjects, with 0% achieving directed or full-range
control with conventional controls, compared to 58% and 83% achieving
these two levels of movement, respectively, with handgrip. In
conclusion, hand, or arm, training Apps played on conventional mobile
devices are likely to be accessible only to mildly-disabled stroke
patients. Technological adaptations such as grip-control can enable more
severely affected subjects to engage with self-training software.
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