A Resource-Efficient, High-Dose, Gamified Neurorehabilitation Program for Chronic Stroke at Home: Retrospective Real-World Analysis

Abstract

Background: Accumulating evidence and medical guidelines recommend high-dose neurorehabilitation for recovery after stroke. The reality, however, is that most patients receive a fraction of this dose, with therapist availability and costs of delivery being major implementational barriers. Objective: This study aimed to explore a potential solution by conducting a retrospective analysis of a real-world enhanced clinical service that used gamified self-training technologies at home under remote therapist supervision. Methods: Data from 17 patients who completed a 12-18 week full-body, high-dose neurorehabilitation program entirely at home were analyzed. Program delivery relied primarily on patients training independently (asynchronously) with the MindMotion GO (MindMaze) gamified-therapy solution. Accompanying telerehabilitation training sessions with a therapist occurred weekly while therapists used a web application to continuously monitor and manage the program remotely. Effectiveness of the program was assessed through measured active training time, a measure that more closely reflects delivered dosage as opposed to scheduled dose. Patient recovery was evaluated with standardized impairment and functional clinical measures and patient self-reported outcome measures. Finally, a cost model was computed to evaluate the resource efficiency of the program. Results: Patients maintained high training adherence throughout the program and reached an average total active training time of 39.7 (SD 21.4) hours, with the majority delivered asynchronously (mean 82.2%, SD 10.8%). Patients improved in both upper-limb (Fugl-Meyer Upper Extremity, mean 6.4, SD 5.1; P<.001) and gait and balance measures (Functional Gait Assessment, mean 3.1, SD 2.6; P<.001; Berg Balance Scale, mean 6.1, SD 4.4; P<.001). Overall, the program was viewed very favorably among patients who completed a post-program survey, with 73.7% (14/19) of respondents being satisfied or very satisfied, while 63.2% (12/19) of respondents reported subjective improvements in physical abilities. Per-patient therapist costs approximated US $338, representing a resource-efficient alternative to delivering the same dose via one-on-one in-person training sessions (US $1903). Conclusions: This work demonstrates effective high-dose neurorehabilitation delivery via gamified therapy technologies at home. The approach shows that training time can be successfully decoupled from therapist-presence without compromising adherence, outcomes, or patient satisfaction over an extended program period. Given growing concerns over therapist availability and increasing health care costs, this resource-efficient approach can help achieve medical guidelines and complement existing clinic-based approaches.

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