Using Game-based Telerehabilitation to Improve Access to Treatment for Persons with Brain Injury in a Community Clinic Setting

Research Objectives: To assess the feasibility of using R3THA, a personalized system that employs affordable and versatile rehabilitation technologies designed to improve upper extremity functionality, in a community-based telerehabilitation setting, in a hybrid model integrating traditional therapeutic exercises with engaging exergames.

Design: The study was a single-site, interventional, non-comparative trial involving three stroke survivors. It included six sessions of upper extremity training using R3THA. Screening, clinical and kinematics assessments were conducted at community based clinic before and after the study.

Setting: Intervention procedures involved an initial in-person evaluation, a home visit for setup and training, six telerehabilitation sessions combining traditional occupational therapy and R3THA, and a final discharge evaluation.

Participants: Recruitment was facilitated through the Rutgers SLP community clinic via clinician referrals. The inclusion criteria targeted individuals aged 18 to 80 with adequate mobility in shoulder, elbow, wrist, and hand joints to engage in exergames, a Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score of 21 or above, and participants must receive pro-bono services from the clinic. Four potential participants were screened, with one not meeting the motor criteria, resulting in three participants completing the study.

Interventions: Four participants completed six telerehabilitation sessions, each lasting 30 minutes to 1 hour, depending on participant tolerance, technical issues, and standby support availability.

Main Outcome Measures: The study utilized several outcome measures, including The System Usability Survey (SUS), R3THA Kinematic Assessments of Hand and Arm Function (R3THA-AP), and The Wolf Motor Function Test (WMFT).

Results: SUS results varied, with usability scores ranging from below average ( < 68) to above average (>68). Semi-structured interviews (SSIs) indicated unanimous agreement among participants regarding the necessity of standby caregiver assistance during sessions. Both participants and caregivers emphasized the crucial role of therapist support in facilitating effective gameplay. Despite cognitive impairments, one participant successfully engaged with the game, underscoring R3THA's feasibility for users with limited cognitive abilities. Motor outcomes, including improvements in WMFT and R3THA-AP, varied among participants.

Conclusions: Overall, all participants indicated that R3THA is a viable option for telerehabilitation, provided there is proper setup, caregiver support, reliable Wi-Fi, and remote assistance from therapists. Interestingly, while age seemed to influence interest in continued use—particularly among younger adults—personal preferences and habituation appeared to be more significant factors. Furthermore, individuals with brain injuries from economically disadvantaged communities could engage in game-based telerehabilitation with remote clinician support.

Author(s) Disclosures: Qinyin Qiu, Amanda Gross, Ashley Mont, and Mee Eriksson are co-founders of NeurtoTechR3, inc., a company designed and developed R3THA.