Effects of a Computerised Exercise System on Functionality of the Arm,Cognition and Quality of Life in Stroke Patients
Condition: Stroke; Neuronal Plasticity; Hemiplegia
MeSH terms: Stroke; Hemiplegia
Study type: Interventional

Summary: 
      Stroke occurs as a result of blood vessels of the brain becoming blocked or bleeding which in
      turn can result in loss of function in the limbs. Rehabilitation of patients following stroke
      includes repetitive, task based exercises to help regain normal limb function. Developments
      in stroke rehabilitation have resulted in more and more therapeutic options being available
      for inclusion in the treatment plan of stroke patients. The benefits of computerised task
      based arm and hand rehabilitation exercises in stroke rehabilitation are well known. Computer
      based rehabilitation supports the stroke patient in performing high intensity, multiple
      repetition exercises and in doing so encourages the regeneration of brain cells. In addition,
      it is believed that the stimulating environment provided by computerised exercise programs
      encourages the ability to problem solve and perform tasks. However, the effects of such
      computer based treatments on cognition have rarely been studied.

      In Turkey to date there are no community based, task specific computerised exercise
      programmes available to stroke sufferers. Such systems may provide inpatient and community
      based stroke sufferers with a practical and economical therapeutic option as a part of stroke
      rehabilitation. Moreover, this may provide the patient with a mode of ongoing, long term
      therapeutic exercise and maintenance of skills acquired in the hospital rehabilitation period
      shortly after stroke.

      The aim of this study was to investigate the benefits of computer based, task specific
      exercises when compared to conventional rehabilitation alone on arm and hand function,
      quality of life and cognition in stroke patients.
    

Detailed description: 
      In developed countries only 5-10% of chronic stroke patients receive an active rehabilitation
      program. In Turkey, there is no community based rehabilitation program available to stroke
      patients in the subacute - chronic phase of the disease, even though it is known that
      functional gain can continue in this part of the disease when supported by an adequate
      rehabilitation program. Equally, functional gain can be lost over time if appropriate
      physical therapy is discontinued.

      Recent Advances in technology have allowed for the development of new approaches in stroke
      rehabilitation. Computer based treatment options include virtual reality (VR), robotic
      training and computer based task specific games. Computer based rehabilitation can encourage
      patients in performing high intensity, repetitive exercises which in turn aids
      neuroplasticity; the benefits of such treatments in upper extremity rehabilitation following
      stroke have been established. It is also believed that the stimulating environment provided
      by computed based exercises can enhance the development of problem solving and functionality
      in stroke patients. However, the effects of such technology on cognitive function in stroke
      patients has not been established in the literature. The disadvantages of VR and robotic
      training is that the necessary hard and software is often expensive and use of the machinery
      requires special training. Therefore, these options are often unavailable in rehabilitation
      centres. Contrary to this, computerized task specific gaming systems can be more economical
      and practical for both therapist and patient and can be used in the home environment without
      the necessity of direct supervision of a physiatrist.

      A review by Johansson et al. on home computer based task specific gaming exercises in stroke
      patients concluded that patients enjoyed the treatment but determining the benefits of
      treatment require further randomized control studies of better quality to be conducted. A
      pilot study based on a six week computer based task specific gaming exercise program in
      chronic stroke patients resulted in an improvement in learnt tasks and clinical evaluation.

      Rejoyce (Rehabilitation Joystick for Computerized Exercise), is a computer game based task
      specific exercise system developed by Rehabtronics Inc. for use as part of the treatment of
      stroke and spinal cord injury patients. Rejoyce aims to improve upper extremity and hand
      function by encouraging neuroplasticity through repeated task specific games.

      The aim of this study was to study the effects of computer game based task specific exercise
      system on upper extremity and hand function as well as cognitive function and quality of life
      compared to conventional rehabilitation in stroke patients.

      Patients who have developed a stroke in the past year and who have been admitted to our
      Physical and Rehabilitation Medicine (PRM) Department in Turkey for stroke rehabilitation
      will be included in the study. The total number of patients to be included in the study to
      obtain a study power of 80% and 5% type I error is thirty.
    

Intervention name(s): Rejoyce (Rehabilitation Joystick for Computerized Exercise); Conventional physical therapy; Occupational therapy
Intervention type(s): Device; Other; Other
Intervention description(s): Rejoyce (Rehabilitation Joystick for Computerized Exercise), is a computer game based task specific exercise system developed by Rehabtronics Inc. for use as part of the treatment of stroke and spinal cord injury patients. Rejoyce aims to improve upper extremity and hand function by encouraging neuroplasticity through repeated task specific games.; A physical therapy session customised to the patient's needs overseen by a physical medicine and rehabilitation specialist and conducted by a physiotherapist which includes range of motion, neurophysiological and strengthening exercises, balance and coordination training and walking exercises.; Task based exercises overseen by a physical medicine and rehabilitation specialist and conducted by an occupational therapist aimed at improving upper arm dexterity, coordination and strength.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients will be randomized into one of two groups (fifteen patients in each group) using the Random Allocation Software. All patients will receive a one hourly 'one-on-one' session of physiotherapy five days a week to a total of twenty hours (four weeks) which includes strengthening, balance and walking exercises. In addition to this, one group will receive half and hour of conventional occupational therapy which includes task based exercises aimed at improving upper arm dexterity, coordination and strength seven days a week to a total of twenty eight hours (four weeks), whereas patients in the other group will receive half an hour of Rejoyce computerized exercise to a total of twenty eight hours (four weeks).
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: stroke; neuronal plasticity; cognition; hemiplegia; Remote rehabilitation