Dr. Sheree McCormick, Manchester Metropolitan University
A pilot study of a tablet-based app for rehabilitation of the upper limb following stroke
Stroke is an increasingly common and highly debilitating illness with many patients (41-45%) experiencing movement problems that limit their activities of daily living. This often results in long-term dependence at a considerable cost to primary carers and the NHS. In acute rehabilitation clinicians may focus on a patient’s mobility, rather than upper limb movement, to prepare the patient for discharge. While this approach has merit, it may limit the activities the patient is able to perform once at home. Indeed, some individuals affected by stroke report that current upper limb therapy does not meet their needs. It is crucial, therefore, to optimise upper limb movement recovery if quality of life for stroke individuals is to be maintained. This project will investigate a novel ‘mental practice’ approach for stroke individuals with motor weakness. Delivered via a tablet-based app, our new technique, Action Simulation Therapy (AST), aims to improve the recovery of the upper limb and offers long term rehabilitation in the home setting. The technique involves stroke individuals watching videos of upper limb actions and imagining themselves performing the action at the same time. Immediately afterwards they practice the action using the same objects. Imagining making movements whilst watching the same movement, and then practicing the movements reinforces the brain’s attempts to ‘rewire’ the neural connections that have been damaged by the stroke. This approach has been suggested to be better than physical therapy alone. In this project we want to investigate whether AST can be delivered effectively via a tablet-based app. For stroke individuals this could mean that they have access to semi-supported therapeutic care for an extended period of time. In addition, they will have greater control of their rehabilitation. We will test whether the therapy programme: (i) improves the performance of upper limb actions of daily life; (ii) is acceptable to stroke individuals and their support team; (iii) is adhered to by stroke individuals; and (iv) contributes to general wellbeing. The results will inform researchers and clinicians as to how stroke individuals could take greater control of their therapy, the volume of self-directed therapy stroke individuals typically choose to undertake, and the extent of change in outcome measures. The results will be used to support applications for further substantial funding if proof of principle has been established.