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Enabling stroke survivors with arm disabilities to do more training.

A new study by Imperial College London quantified the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming device. The device called GripAble™ is created by scientists at Imperial College London and clinicians at Imperial College Healthcare NHS Trust.

Stroke often causes paralysis or weakness of one or more of the muscles in your arm or shoulder. The condition has affected over five million people in the UK. Exercise is the only intervention that improves arm function. But, this task-specific exercise is limited by the cost and availability of occupational therapists and physiotherapists.

The GripAble™ device is consists of a lightweight electronic handgrip. The handgrip interacts wirelessly with a standard PC tablet to enable the user to play arm-training games.

It uses a novel mechanism that detects the tiny flicker movements of severely paralyzed patients and channels them into controlling a computer game.

The patient needs to squeeze, turn, or lift the handgrip. It vibrates in response to their performance while playing.

Scientists tested the device in a clinical trial of 30 patients. All participants were provided with the GripAble device and taught to use it in a single training session. The participants were then left to use the device without any supervision over eight days.

They found that the device enabled on average 104 upper limbs (UL) repetitions per day, whereas conventional therapy achieved 15 UL repetitions per day.

Michelle Broderick, lead author of the study and Clinical Research Therapist in Stroke at Imperial College Healthcare NHS Trust, said: “Stroke is a major cause of arm weakness in the UK. It can significantly impact survivors’ lives, making it hard for them to do routine daily tasks, limiting their independence.”

“Previous studies have shown that repetitive exercise is vital for improving arm weakness, but this can be difficult due to resource constraints within healthcare settings, as well as the range of challenges faced by stroke survivors during their recovery, which can limit their ability to initiate or engage in independent exercise or rehabilitation activities.”

“This study is the first to show that a rehabilitation device – GripAble – can achieve significant increases in the amount of exercise patients do compare to supervised therapy. Our findings suggest that a significant proportion of stroke survivors may potentially benefit from GripAble alongside conventional therapy. This could improve patient outcomes as well as easing pressure for the NHS in terms of infrastructure and resources.”

“The next steps to fully determine GripAble’s impact is to assess the technology across a wider section of the population over a longer period.”

Dr. Paul Bentley, a co-author of the study and Clinical Director of the Imperial College Network of Excellence in Rehabilitation Technology at Imperial College London, added: “The findings from this clinical trial provide evidence that GripAble can be adopted to help further support stroke patients with severe arm weakness with their rehabilitation unsupervised.”

“This could have big implications for the NHS, given that recovery from Stroke is strongly influenced by exercise intensity. Patients can use our technology to continue with their physiotherapy outside of standard treatment and help with their recovery. The long-term aim of GripAble is that patients can use it outside of a clinical setting such as in their homes and communities, and we are now working further to assess the device’s impact on clinical outcomes.”

On average, patients used the device for 26 minutes/day to do their UL exercises, in addition to 25 minutes daily conventional UL therapy, therefore doubling total exercise duration to 51 minutes, which is significantly greater than standard care.

After surveying the participants, they also found that 57 percent found the device easy to use and understand, and 63 percent felt it promoted UL recovery.

Journal Reference:
  1. Michelle Broderick et al. Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care. DOI: 10.1177/15459683211041313

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