Neurogame Therapy as an Upper Extremity Home Program for Persons After Stroke: A Preliminary Mixed Methods Investigation

Abstract

This preliminary study was designed to evaluate the effectiveness and acceptability of Neurogame Therapy (NGT), an innovative application of surface electromyography (sEMG) with a computer game, as a home program for persons after stroke. A concurrent mixed-methods design was used. A repeated measures design tested the quantitative outcomes such as sEMG, kinematics, and activity measures including the Wolf Motor Function Test and the Chedoke Arm and Hand Activity Inventory. Nested one-on-one interviews were completed to gather information on home exercise programs in general, functional use of the upper extremity, and the acceptability of NGT. Nine participants completed the quantitative portion of the study and ten completed the qualitative portion. A statistically significant change was found across the intervention period on one of the surface electromyography outcomes, however no changes were found in kinematic and activity outcomes. The qualitative interviews provided in depth information on upper extremity functional use in daily activities and home programs, as well as, information on the acceptability of NGT. Most participants found NGT to be motivating and while most reported no dramatic changes in their upper extremity use, some did report small changes in movement of the affected limb or an increased awareness and desire to use the limb. Participants also identified ways to improve NGT including more time with the system and increased clarity in the interface. The combined results suggest that NGT requires further study and may benefit from the inclusion of a functional activity component that would assist in generalizing changes at the sEMG level to the functional level. This preliminary investigation suggests that NGT is motivating for adults after stroke and acts primarily at the level of sEMG, at this time. Future studies could investigate: (1) adding a functional activity component to the program (2) the use of NGT with persons in the acute phase of stroke recovery and (3) the nature of home exercise from the perspective of therapists and caregiver.