Prescribed Video Game Treatment to Promote Early Recovery for Hospitalized Stroke Patients: Concepts in Standardized Implementation.

Patients with stroke often have upper limb impairment that impacts function and quality of life. Increased amounts of arm training in the early phase post stroke may reduce impairment of the arm, but are not achieved in standard therapy. Video Gaming Technology (VGT) has been shown to improve activity, participation, and function, and could be a unique and engaging strategy for training the arm in high doses when delivered during critical periods and within the standard of care. This paper describes a standardized approach to implementing prescribed VGT for patients hospitalized with acute stroke stratified by level of impairment. This is a description of a novel methodology used with adult patients hospitalized with acute stroke and upper extremity impairment in the stroke unit or the acute inpatient rehabilitation facility. The gaming protocol and stratification model utilize strategies for matching patient-specific impairments to an assigned VGT intervention to optimize engagement and accelerate recovery. In addition, a unique 'Stopping Criteria' is described that helps clinicians administer safe game play with acute populations at a goal dose of up to 60 min of time on task (TOT) arm movement. Response is measured to track safe completion of the protocol and response to treatment, including outcomes like change in Upper Extremity Fugl-Meyer (FMUE) from baseline to final evaluation. Preliminary results indicate that VGT is feasible and safe in acute stroke patients when adhering to this standardized method.