A combination of playing a specially-designed video game and having regular telemedicine visits can help people who have had a stroke recover function in their affected limbs just as well as traditional physical therapy.

According to a new study, the at-home game can be more cost-effective and convenient for stroke patients, but can also complement standard rehab.1

An added benefit of the video game? Patients like playing it.

 Why Do Strokes Happen?

How Strokes Affect Mobility

Many people who have a stroke lose some function on the affected side of their body. For example, a person may lose motor skills in one arm, which limits their ability to do tasks in their day-to-day lives and stay independent.

Some people can get those skills back through intensive physical therapy that’s done at a clinic or health care facility.

However, this type of therapy can take a long time and be expensive since health insurance may put limits on coverage.

Stroke rehabilitation at a clinic can also be challenging to access for people who live in rural areas and those who lack transportation.

 What to Expect from Stroke Rehabilitation

Recovery Rapids

A team of researchers has come up with an innovative way to help stroke patients at home through telemedicine and video gaming.

Lynne Gauthier, PhD, a creator of Recovery Rapids and founder of Games that Move You, told Verywell that the game was specifically designed for stroke patients.

Gauthier, who is also an associate professor of Physical Therapy and Kinesiology at the University of Massachusetts Lowell, said that the game has players paddling down a river in a kayak, which requires them to use the arm affected by the stroke.

The patient plays the game while in front of a home computer. A Microsoft Kinect camera plugs into the computer facing the patient and replicates the patient’s movements in the game environment.

As they’re maneuvering the kayak, the player is met with challenges such as having to avoid rocks or bat away obstacles as they travel down the river.

Players can also play mini-games, such as a card game where they must flip over cards using their affected arm.

Gaming can be done in the person’s home, and they don’t have to come into the clinic for therapy.

— CAROLEE J. WINSTEIN, PHD, PT

What makes the game specifically helpful for stroke patients is that it’s programmed to ignore movements made by the stronger side of their body.

“We want to get people to really engage with the weaker side of their body and reinforce that movement to help them translate that movement into their everyday lives,” said Gauthier.

 Can Video Games Help COVID Brain Fog?

The Study

To see how effective Recovery Rapids could be, the researchers enrolled 167 patients at five sites who were at least six months past their stroke. All the participants had mild to moderate loss of ability in one of their arms.

Of the patients the researchers identified, 150 finished the treatment, and 115 completed the follow-up.

What the Researchers Did

The patients were randomly assigned to four groups for a three-week period:

The first group (self-gaming) received five hours of traditional physical therapy intervention that focused on helping them make behavioral changes. They also played the game at home on their own.

The second group (tele-gaming) had five hours of behavioral therapy and gaming at home plus telemedicine visits that focused on behavior.

The third group (traditional care) received five hours of traditional physical rehabilitation that focused on motor skills. 

The fourth group (constraint-induced) received 35 hours of constraint-induced movement therapy, which traditionally involves putting a restraint on the limb that was not affected by the stroke, forcing the patient to use the affected limb.

 An Overview of Stroke Treatments

The Results

The researchers used several measurements of motor improvement to see how well the patients were able to use the arm that had been affected by the stroke.

They found that the self-gaming group and the tele-gaming group both had meaningful gains in motor activity in their arm—in fact, they were better than those seen in the traditional group.

The tele-gaming group had gains similar to those seen in the constraint-induced group; however, self-gaming was not as effective as the constraint-induced therapy.

Six months later, most of the patients seemed to have retained the gains they made in treatment.

 How PT's Use Games to Make Therapy Fun

Physical Therapists as Player Two

Previous research has explored how video games designed for patients to play in clinics helped them with rehabilitation, but the Recovery Rapids study was the first to look at patients gaming at home.2

Therapists are the ideal person to be an agent for behavior change, which is a very important part of the intervention.

— LYNNE GAUTHIER, PHD

According to Gauthier, the game is not intended to replace physical therapists; rather, it’s designed to work with them while at the same time reducing the need for patients to visit a clinic for in-person therapy.

“The patient was the driver of their own treatment and engaged independently in motor practice through to technology,” said Gauthier. “Then, they periodically met with a therapist and the therapist served as more of a coach.”

Gauthier emphasized that “it’s still very important to have the therapists involved in the process so that the person gets some guidance. Therapists are the ideal person to be an agent for behavior change, which is a very important part of the intervention.”

What Is Behavioral Therapy for Stroke Patients?

Behavioral therapy looks at a patient’s daily life and how losing the use of an arm has affected their ability to do their activities.

Patients who played Recovery Rapids improved more because their physical therapists were able to guide them through making changes in their behavior that would help them increase their use of the affected arm.

Gauthier said that “most people follow through with the program at home. They’re motivated to do it—the game keeps them engaged.”

 Using VR Headsets In Physical Therapy

Helping More Patients Play—and Heal

Carolee J. Winstein, PhD, PT, a spokesperson for the American Stroke Association and a professor of biokinesiology and physical therapy at the University of Southern California, told Verywell that Recovery Rapids is “very motivating.”

Winstein, who was not involved in the study, said that Recovery Rapids is “much more engaging than standard therapy—which can be relatively boring. The gaming can be done in the person’s home, and they don’t have to come into the clinic for therapy.”

While at-home gaming might be more accessible than leaving home for therapy, there are still a few adjustments that need to be made to the setup.

Gauthier said that at the moment, games like Recovery Rapids require a gaming computer—a more powerful machine than what most people have at home.

To make it accessible to more patients, Gauthier said that the next step in developing the game will be to move it to smartphones and tablets.

Winstein said that another way to increase accessibility would be making the game playable for people who have lost some cognitive ability after a stroke.