Motor-training software on tablets or smartphones (Apps) offer a low-cost, widely-available\nsolution to supplement arm physiotherapy after stroke. We assessed the proportions of\nhemiplegic stroke patients who, with their plegic hand, could meaningfully engage with\nmobile-gaming devices using a range of standard control-methods, as well as by using a\nnovel wireless grip-controller, adapted for neurodisability. We screened all newly-diagnosed\nhemiplegic stroke patients presenting to a stroke centre over 6 months. Subjects\nwere compared on their ability to control a tablet or smartphone cursor using: finger-swipe,\ntap, joystick, screen-tilt, and an adapted handgrip. Cursor control was graded as: no movement\n(0); less than full-range movement (1); full-range movement (2); directed movement\n(3). In total, we screened 345 patients, of which 87 satisfied recruitment criteria and completed\ntesting. The commonest reason for exclusion was cognitive impairment. Using conventional\ncontrols, the proportion of patients able to direct cursor movement was 38ââ?¬â??48%;\nand to move it full-range was 55ââ?¬â??67% (controller comparison: p>0.1). By comparison,\nhandgrip enabled directed control in 75%, and full-range movement in 93% (controller comparison:\np<0.001). This difference between controllers was most apparent amongst\nseverely-disabled subjects, with 0% achieving directed or full-range control with conventional\ncontrols, compared to 58% and 83% achieving these two levels of movement,\nrespectively, with handgrip. In conclusion, hand, or arm, training Apps played on conventional\nmobile devices are likely to be accessible only to mildly-disabled stroke patients.\nTechnological adaptations such as grip-control can enable more severely affected subjects\nto engage with self-training software.
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