Utilizing Gaming Mechanics to Optimize Telerehabilitation Adherence in Persons With Stroke

1. Purpose/Specific Aims The overarching aim of this study is to provide a mechanism for patients to engage in progressive motor practice for a meaningful time period. The investigator's aim to improve on the positive outcomes demonstrated in patients in the chronic phase and the pilot work being done on patients in the acute in-patient phase post stroke to determine whether functional recovery can be further improved using a home based system.

Aim 1: Evaluate compliance with Home-Telerehabilitation simulated hand/arm gaming activities and two computer game groups, one with motivation enhanced: Home Training Motivation Enhanced (HTme) simulations and one with non-enhanced simulations: Home Training Unenhanced (HTu) versions. Hypothesis: Participants in the HTme group will show significant compliance as compared to the control group (HTu).

Aim 2: Evaluate the effectiveness of motivation enhanced HTme home-based virtually simulated hand/arm gaming activities for individuals with stroke as compared to a program unenhanced HTu versions of the same simulations. Hypothesis: Participants completing HTme training will exhibit significantly improved clinical, kinematic and neurophysiological outcomes as compared to the control group (HTu).

Aim 3: Evaluate the impact of the motivation enhancements designed into computer games to provide a more enjoyable training experience. Hypothesis: Enjoyment of the games will be a more valid predictor of compliance than personal factors. 2. Background and Significance Studies have shown that sustained hand rehabilitation training is important for continuous improvement and maintenance of function following a stroke. It is unimaginably difficult to pursue education, employment and community participation without being able to independently use one's hands. The primary goal of this study is to test an exciting new technology that can be easily used in the home for long-term hand and upper extremity training. Recovery of hand function post brain injury is particularly recalcitrant to currently available interventions. To date, the best efforts of groups studying traditionally presented as well as technology-based therapeutic interventions for the hemiplegic hand and arm have produced measurable changes in motor function and motor control but fall far short of major reductions in disability.

If the amount of therapy is critical to rehabilitation, our current institutional limitations undermine the probabilities for successful outcomes. After discharge from the inpatient stay, access to rehabilitation therapy can be difficult for some patients. This is due in part to inadequate insurance, lack of transportation, and the patient's dependence on their caregiver. Having access to long-term rehabilitation training anywhere and at any time is necessary for sub-acute and chronic patients to continuously improve their functional abilities. 3. Research Design and Methods This study will be a single blind randomized controlled trial. Subjects will be blinded to the purpose of the study. All outcome measures will be performed by a therapist blinded to group assignment. A controlled trial will be utilized to determine the additive effect of presenting rehabilitation activities in a virtual environment as compared to standard upper extremity exercise. The investigators will randomize subjects to treatment and control groups using a computerized random number generator.