Rehabilitation using virtual gaming

Rehabilitation using virtual gaming for Hospital and HOMe-Based Upper-limb exercise post Stroke (RHOMBUS II): a feasibility randomised controlled trial

Many stroke survivors have ongoing problems using their hand and arm post-stroke. Effective rehabilitation of the hand and arm involves lots of practice and repetition. This may be difficult to achieve with limited NHS resources available and can be boring for the stroke survivor to do on their own.

The NeuroPlatform is a non-immersive virtual reality digital platform consisting of an app and a hand controller (NeuroBall), designed for rehabilitation of the hand and arm following stroke.

The device was first tested with 18 stroke survivors at Brunel University. This was followed by another study (RHOMBUS), where the device was used at home by 30 stroke survivors, at least 12 weeks after their stroke. Findings showed the device to be safe, enjoyable and easy to use.

The aim of the RHOMBUS II study is to determine if using the NeuroBall as part of rehabilitation in the early days and weeks following stroke is safe and practical.

What the research involves

We will recruit 24 stroke survivors from the Hillingdon Hospitals' NHS Foundation Trust Acute Stroke Unit and/or the Central North West London NHS Foundation Trust Early Supported Discharge stroke team.

Each stroke survivor will be randomly allocated to either an intervention group or a usual care group. Those in the intervention group will receive and be taught to use the NeuroBall. They will be asked to practice using it daily, in addition to any usual care that is provided through the NHS. Assessments will be completed on entry to the study and repeated after 7 weeks to see if anything has changed.

We will also be asking stroke survivors and the health care professionals working with them, to participate in interviews about the study and how they found using the NeuroBall.

Study collaborators

• Mr Dimitris Athanasiou, Chief Technical Officer, Neurofenix, London
• Dr Karen Baker, Clinical Academic Physiotherapist, Neurofenix, London 
• Dr Carole Pound, Speech & Language Therapist, Visiting Fellow, School of Health and Social Care, Bournemouth University

Publications

• Kilbride C, Scott DJ, Butcher T, et al. Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial. BMJ Open 2018
• Kilbride C, Scott DJ, Butcher T, et al. Rehabilitation via home-based gaming exercise for the upper-limb post stroke (RHOMBUS) 2019 
• Bernhardt J, Hayward K, Dancause N, et al. A stroke recovery trial development framework: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019
• Ward S, Brander, F and Kelly K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry 2019. 
• McLaren R, Signal N, Lord S, et al. The volume and timing of upper limb movement in acute stroke rehabilitation: still room for improvement. Disabil Rehabil 2020; 
• Hordacre B, Austin D, Brown K, et al. Evidence for a Window of Enhanced Plasticity in the Human Motor Cortex Following Ischemic Stroke. Neurorehabil Neural Repair 2021; 
• Borschmann K and Hayward K. Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year, observational study. Physiotherapy 2020; 
• Langhorne P, Coupar F and Pollock A. Motor recovery after stroke: a systematic review. The Lancet Neurology 2009;
• Verbeek JM, van Wegen E, van Peppen R, et al. What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis. PloS one 2014;