Gamified exercise for the distal upper extremity in people with post-stroke hemiparesis: feasibility study on subjective perspectives during daily continuous training

Abstract

Introduction

Dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb. However, rehabilitation exercises tend to be monotonous and require significant motivation to continue, making it difficult to increase the exercise dose. To address this issue, gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements. This study aimed to investigate how subjective perspectives, specifically enjoyability, motivation to continue, and expectancy of effectiveness, change through continuous daily exercise using a developed gamified exercise system.

Materials and Method

Ten people with stroke suffering upper limb dysfunction underwent daily gamified exercise for seven days. The gamified exercise consisted of an electromyography (EMG)-controlled operating system that enabled users to play virtual games using repetitive finger movements. The participants performed conventional self-exercise on the same day as the control exercise, and rated their subjective perspectives on both exercises on a numerical rating scale on each exercise day.

Results

Ratings for enjoyability and motivation to continue consistently showed significantly higher scores for the gamified exercise than for conventional self-exercise on all exercise days. A similar trend was observed in the ratings for the expectancy of effectiveness. No changes over time were found in any of the ratings throughout the exercise period.

Conclusions

Exercise using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements.

KEY MESSAGES

• Although dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb, rehabilitation exercises tend to be monotonous and require significant motivation to continue.

• Gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements.

• Exercises using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements.

Keywords:

• Adherence
• electromyography
• enjoyment
• gamified rehabilitation
• motivation
• stroke

Acknowledgements

We would like to thank Mr. Kosuke Otsubo, a software engineer, and Ms. Yui Minemura and Mr. Shinji Kato, computer graphic designers at SPEED Inc., as well as Mr. Chang Man Kim, an engineer at SMK Corporation, for their invaluable contributions to the development of game elements in our gamified system.

Authors’ contributions

KI, SU, AY, and YO contributed to conception and design of the study. KI collected data and performed the statistical analysis. KI, SU, and AY wrote the first draft of the manuscript. KU, ST, and YO revised the manuscript critically for intellectual content. All authors approved the submitted version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding authors, upon reasonable request.

Additional information

Funding

This work was supported by a grant from the MHLW of Japan based on a funding program on assistive products for the autonomy and independence of persons with disabilities.