Stroke Patients Benefit from At-Home Therapy Video Game Trial Based at UAB

REACT Pilot Award-winner Gittendra Uswatte PhD, professor in the College of Arts and Sciences’ Department of Psychology and associate director of the CI Therapy Research Group and Taub Therapy Clinic, has developed a video game that allows stroke patients to practice Constraint-Induced Movement therapy. 

Constraint-Induced Movement therapy is a behavioral approach to the rehabilitation of movement and speech after brain injury developed at the University of Alabama at Birmingham. It is now being used in a video game version called Recovery Rapids through an ongoing clinical trial.

CI therapy, created by the research group led by Ed Taub, Ph.D., allows patients to learn to improve speech and movement of the parts of their bodies affected by stroke and other types of brain injuries. By encouraging regular use of the the impaired function and limiting other ways to accomplish daily activities, the patient’s brain rewires itself to regain a higher level of function.

These therapies have proved to significantly improve the quality of movement and the amount of use of the more-affected arm or leg for common daily living activities in most patients who have been treated. Significant improvements have also been observed in patients treated for difficulty with speech.

“We know from several randomized controlled trials that patients with stroke, like the individuals who will participate in this trial, obtain large improvements in the use of their stroke affected arm in everyday life after CI therapy when it is delivered face-to-face in the clinic,” said Gitendra Uswatte, Ph.D., professor in the College of Arts and Sciences’ Department of Psychology and associate director of the CI Therapy Research Group and Taub Therapy Clinic. “Patients who did not use that arm to carry out activities like eating, combing your hair, and picking up a telephone begin to do so after in-clinic CI therapy.”

The video game therapy allows patients to receive treatment from home, while still benefiting from the innovative CI therapy techniques and therapist interaction.

“Given the lower cost and increase in access to treatment made possible by the virtual reality version of CI therapy, the virtual reality version will represent an advance for patients even if the treatment gains are only two-thirds to half as large as for the in-clinic version of CI therapy,” Uswatte said.

Recovery Rapids can be played on a home video game system that is supplied by the study. The treatment and testing that will be done at the University of Alabama at Birmingham is part of a multi-site clinical trial directed by Lynne Gauthier, Ph.D., assistant professor of Physical Medicine and Rehabilitation at The Ohio State University, whose research group designed the game.

Jeremy Reynolds, above, participates in the at-home video game therapy to treat his stroke-affected hand. The game, Recovery Rapids, places the user in a kayak traveling down the river to complete activities such as paddling and reaching for fruit with the more affected hand.

The game contains tasks designed to exercise a variety of arm movements and automatically progresses with the play increasing in difficulty as the patient improves. Patients virtually kayak down a river using the game system and perform tasks that will force them to exercise their affected body part, avoiding use of the opposite limb completely. While playing the game, patients encounter tasks such as paddling, reaching for fruit on trees, avoiding rocks and fishing.

The game is also customizable to the patient’s needs. For example, if a patient has more trouble with hand activities, the game can be customized to present more hand tasks.

Uswatte is a 2017 REACT Pilot Award recipient for similar work using CI therapy, "Priming the Brain for Rehabilitation: Brain Stimulation Followed by Constraint-Induced Movement Therapy in Adults with Sever Arm Paresis after Stroke." 

Stroke patients who are interested in participating in the Recovery Rapids trial are encouraged to contact (205) 934-9768.

Eligible patients are those who are more than six months after a stroke, can partially open and close the hand, and have some movement of the wrist, elbow and shoulder. Eligible patients will be randomized to standard CI therapy, home-based gaming CI therapy, or standard physical therapy. Treatment will be at no cost to the patient.

Read the full UAB News story here and watch a participant playing the game.
Learn more about the clinical trial using the Recovery Rapids game.
Learn more about REACT Pilot Awards.