A resource efficient, high-dose neurorehabilitation program for chronic stroke at home

Accumulating evidence and medical guidelines recommend high-dose neurorehabilitation for recovery after stroke. Unfortunately, most patients receive a fraction of this dose, with therapist availability and costs of delivery being major implementational barriers. To explore a potential solution, we conducted a retrospective analysis of a real-world enhanced clinical service that used gamified self-training technologies at home under remote therapist supervision. Data from 17 patients who completed a 12-18 week full-body, high-dose neurorehabilitation program entirely at home were analyzed. Program delivery relied on patients independently training (asynchronously) with the MindMotion GO gamified-therapy solution. Accompanying telerehabilitation sessions with a therapist occurred weekly while therapists used a web application to monitor and manage the program remotely. Patients maintained high training adherence throughout and reached an average total Active Training Time--a measure more closely reflecting delivered versus scheduled dose--of 39.7{+/-}21.4 hours, with the majority (82.2{+/-}10.8%) delivered asynchronously. Patients improved in both upper-limb (Fugl-Meyer, +6.4{+/-}5.1; p<0.01) and gait and balance measures (Functional Gait Assessment, +3.1{+/-}2.6; p<0.01; Berg Balance Scale, +6.1{+/-}4.4; p<0.01). Most experienced subjective improvements in physical abilities and overall satisfaction. Per-patient therapist costs approximated 338 USD, representing a resource-efficient alternative to delivering the same dose in-person (1903 USD). This work demonstrates effective high-dose neurorehabilitation delivery via gamified therapy technologies at home and shows that training time can be successfully decoupled from therapist-presence without compromising adherence, outcomes, or patient satisfaction. 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.