You may have been shocked when I said in my last article that computer games can make a big difference in stroke recovery. A game hits all the 5 key criteria that we understand as being important for helping the brain re-organise itself after an injury. Plus rehab should be FUN. In fact, it seems recovery is better when it is.
Researchers have been testing different types of video gaming based on what we think helps with neuroplasticity. It takes a lot of trial and error to get something that's right – but back in 2005, a clever research scientist from New Zealand did something that seemed ordinary at the time but that could change the future of stroke rehabilitation. He'd been building exercise equipment for paraplegics, when he got the idea of taping a computer joystick upside down on the ceiling, and hanging a sling from it so that a disabled arm could move the joystick. Different versions developed from there using sawn-crutches for handlebars and lengths of 50mm plumbing pipe – but it worked! Patients who used the system reported that they were moving their arms more and looking forward to playing the games.
His name is Marcus King. And these days, his system is made of hospital-grade plastics, a wireless movement sensor which the stroke person uses for playing rehabilitation games, and it goes by the name Able-X. I've been using it for some time now to work with stroke people and to measure its potential for helping the recovery process. It ticks all the boxes that neuroplasticity theory supports:
a. high frequency repetition of movement
b. rewards and encouragement built-in
c. progressive levels of difficulty appropriate to stroke
d. decision-making as part of the exercise
e. easy for a stroke person to use alone
For a couple of years I've been helping Marcus to research how much the Able-X helps some people with their stroke recovery. It has also gone through clinical trials at the Otago University School of Physiotherapy.
As physiotherapists we measure statistical things like how far you can raise an arm, how strong you are and how well you coordinate your movement. But we also look at functional things like whether you can dress yourself or concentrate enough to finish a task, or how to ease pain in less active joints. I've had patients using the Able-X whose lives have improved in each of those simple but important ways.
For one of my patients, the day he could use his affected hand to open the door and carry his lunch on a tray out into the sunshine and eat it independently was a special milestone. That may sound small. But to a stroke person, it can mean the world. What was perhaps even more significant was something we can't measure – but we can see it, and that's how his self-esteem and self-confidence returned after this moment. His family said “It was like having him back again.”
The sense of autonomy and achievement also makes a big difference to carers. You can get a virtuous cycle, where using the computer system is motivational enough to get a stroke person through the repetitions needed to make real, usable progress. And then success builds self-esteem and more motivation. It'd be great to be able to measure the weight that's lifted from a carer's shoulders each time their loved one makes a small gain or develops new independence.
Most of these cases involve people who are months or years post-stroke.
As with everything to do with stroke, no one size fits everyone, so Able-X won't be appropriate for everyone. To use it, you need to be able to lift the stroke-affected arm at least a little, and different people get different benefits.
There's another device that helps with more severe impairment, and I'll cover that next time.
