Functional Viability Duck Duck Punch
Condition: Rehabilitation; Recovery of Function; Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      This study has 2 parts: In one part of this study, people with stroke will either play a
      custom designed computer game for stroke rehabilitation called Duck Duck Punch or an off the
      shelf computer game with their weaker arm 3 times per week for 6 weeks. Evaluations will
      determine whether or not one computer game improved arm movement more than the other. In the
      second part of the study, people with stroke, caregivers of people with stroke and stroke
      rehabilitation therapists will meet in several focus groups to design a useful and
      informative Duck Duck Punch performance report.
    

Detailed description: 
      Stroke is a problem nationally, but especially in the southeastern USA, a region known as the
      "stroke belt" where stroke incidence is high and age of stroke onset is low. The vast
      majority, >75%, of stroke survivors experience paresis of one arm/hand that does not resolve
      acutely. Long-term arm movement impairment restricts independence with self-care and
      vocational activities, increases caregiver burden and reduces quality of life. Although
      rehabilitation improves outcomes, systematic financial pressures increasingly limit its
      duration. Unfortunately, this is happening at a time when strong evidence is emerging that
      traditional therapy programs do not provide adequate amounts of movement practice needed for
      motor recovery. Thus, there is a need for innovative technology to augment traditional stroke
      rehabilitation programs in a way that can provide the necessary movement practice within the
      constraints of current rehabilitation practice.

      To meet this need, the Principal Investigators developed a prototype Kinect-based post-stroke
      rehabilitation game called Duck Duck Punch (DDP). While maintaining the appeal of a game, DDP
      has a therapeutic focus because its unique design elicits an arm motor recovery process
      consistent with evidence-based stroke rehabilitation principles. The player moves his/her
      physical arm to control an avatar arm to reach and "punch" virtual ducks. Custom features
      allow tailoring of game difficulty to match a player's impairment level so that the player
      seeks to accomplish optimally challenging movement goals. By design, the avatar does not
      respond to atypical arm motions, which encourages the player to trial and error a variety of
      motions until implicitly learning the more normal strategy. Thus, unlike most commercially
      available "off the shelf" games, success requires "therapist approved" healthy arm motions.
      Success motivates continued game play for extended practice of healthy motions. Therapists
      can integrate DDP into in-clinic or in-home therapies for additional quasi-supervised
      movement practice and receive a performance report that quantifies and monitors progress
      toward recovery goals. Further development of this report will enable its integration into a
      billable rehabilitation program.

      The Investigators licensed DDP and formed a company, Recovr, which has received investment
      funding for initial start-up and market research. Of note, DDP has also received FDA 510(k)
      Clearance to "support physical rehabilitation of adults in the clinic and at home via
      performance of therapist-assigned reach exercises for the upper extremities." In a funded
      NIH/NIGMS pilot project, the investigators established the technical merit and feasibility of
      DDP as a tool to augment inpatient, outpatient and home-based stroke rehabilitation by
      increasing therapist- and patient-directed movement practice opportunities. Very promising
      results motivated the current project that seeks to test the functional viability of DDP and
      determine its commercial potential.
    

Intervention name(s): Duck Duck Punch Play; Commercially Available Game Play
Intervention type(s): Device; Behavioral
Intervention description(s): The behavioral intervention will include playing a hands-free video game custom designed for stroke survivors.; The behavioral intervention will include playing a hands-free video game available off-the-shelf.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Stroke survivors will either play a custom designed computer game for stroke rehabilitation called Duck Duck Punch or an off the shelf computer game with their weaker arm 3 times per week for 6 weeks. Evaluations will determine whether or not one computer game improved arm movement more than the other.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Video Games