Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial

Background: Few rehabilitation methods have proven their efficacy in increasing sensori-motor recovery and/or function of the upper limb (UL) after stroke. Video games (VGs) are promising tools in this indication. Objective: To compare UL rehabilitation by using VGs and conventional rehabilitation (CR) in patients with sub-acute stroke. Design: Single-blind, multicentric trial, with central randomization and stratification by center. Setting: Physical and rehabilitation medicine departments of 2 university hospitals. Participants: Adults within 3 months after a first vascular cerebral accident, with UL Fugl Meyer Score (UL-FMS) < 30/66 and without major cognitive impairment. Intervention: A 45-min additional session of conventional occupational therapy (OT) or a VG-based OT session as add-on therapy to usual rehabilitation programs, 5 days/week for 6 weeks. Main Outcome Measures: Primary outcome: UL-FMS. Secondary outcome: Box and Block Test (BBT), Wolf Motor Function test (WMFT), Motor Activity Log (MAL), Barthel Index and quality of life (SF-36). Results: We included 51 patients (20 women) at a mean (SD) of 27.2 (19.4) days post-stroke (mean age 58 years [range 24-83]), 26 in the CR group and 25 in the VG group (23 in each group at 6-month follow-up). The mean duration of the additional rehabilitation session was similar in both groups: 29.3 (4.3) vs 28.0 (4.4) min in CR and VG groups. Shoulder pain occurred in 4 patients in the VG group versus 7 in the CR group. At day 45, gain in UL-FMS did not significantly differ between the groups (CR mean 17.8 [14.6] vs VG 24.1 [14.8]; P = 0.10), whereas gain in BBT was doubled in the VG group (CR 7.4 [12.2] vs VG 15.7 [16.3]; P = 0.02). At 6-month follow-up, the study was inconclusive about between-group differences in UL-FMS, BBT and other criteria. Post-hoc analysis showed that gains in UL-FMS or BBT were significantly higher in the VG than CR group for patients included within 30 days post-stroke. Conclusion: In general, we cannot conclude that video gaming and conventional OT led to different longterm sensorimotor recovery of the UL after sub-acute stroke. However, when applied within the first month after stroke, video gaming was more efficient than conventional rehabilitation on both sensorimotor recovery and gross grasping function. (C) 2019 Elsevier Masson SAS. All rights reserved.