Skip to main content
Top
Published in: Journal of NeuroEngineering and Rehabilitation 1/2014

Open Access 01-12-2014 | Research

Computer game-based upper extremity training in the home environment in stroke persons: a single subject design

Authors: Angelique Slijper, Karin E Svensson, Per Backlund, Henrik Engström, Katharina Stibrant Sunnerhagen

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2014

Login to get access

Abstract

Background

The objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function.

Methods

Twelve subjects with prior stroke were recruited; 11 completed the study.

Design

The study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16–18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon’s signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant.

Results

Six females and five males, participated in the study with an average age of 58 years (range 26–66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study.

Conclusion

The results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.
Literature
1.
go back to reference Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1994,75(4):394-398. 10.1016/0003-9993(94)90161-9CrossRefPubMed Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1994,75(4):394-398. 10.1016/0003-9993(94)90161-9CrossRefPubMed
2.
go back to reference Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ: Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003,34(9):2181-2186. 10.1161/01.STR.0000087172.16305.CDCrossRefPubMed Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ: Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003,34(9):2181-2186. 10.1161/01.STR.0000087172.16305.CDCrossRefPubMed
3.
go back to reference WHO: International Classification of Functioning, Disability and Health: ICF. Geneva: WHO Library Cataloguing-in-Publication Data; 2001. WHO: International Classification of Functioning, Disability and Health: ICF. Geneva: WHO Library Cataloguing-in-Publication Data; 2001.
4.
go back to reference Outpatient Service Trialists: Therapy-based rehabilitation services for stroke patients at home. Cochr Datab Syst Rev 2003., (1): Art. No.: CD002925. doi:10.1002/14651858.CD002925 Outpatient Service Trialists: Therapy-based rehabilitation services for stroke patients at home. Cochr Datab Syst Rev 2003., (1): Art. No.: CD002925. doi:10.1002/14651858.CD002925
5.
go back to reference Finley M, Combs S: User perceptions of gaming interventions for improving upper extremity motor function in persons with chronic stroke. Physiother Theory Pract 2013,29(3):195-201. 10.3109/09593985.2012.717591CrossRefPubMed Finley M, Combs S: User perceptions of gaming interventions for improving upper extremity motor function in persons with chronic stroke. Physiother Theory Pract 2013,29(3):195-201. 10.3109/09593985.2012.717591CrossRefPubMed
6.
go back to reference Wulf G: Self-controlled practice enhances motor learning: implications for physiotherapy. Physiotherapy 2007,93(2):96-101. 10.1016/j.physio.2006.08.005CrossRef Wulf G: Self-controlled practice enhances motor learning: implications for physiotherapy. Physiotherapy 2007,93(2):96-101. 10.1016/j.physio.2006.08.005CrossRef
7.
go back to reference Langhorne P, Coupar F, Pollock A: Motor recovery after stroke: a systematic review. Lancet Neurol 2009,8(8):741-754. 10.1016/S1474-4422(09)70150-4CrossRefPubMed Langhorne P, Coupar F, Pollock A: Motor recovery after stroke: a systematic review. Lancet Neurol 2009,8(8):741-754. 10.1016/S1474-4422(09)70150-4CrossRefPubMed
8.
go back to reference Luft AR, McCombe-Waller S, Whitall J, Forrester LW, Macko R, Sorkin JD, Schulz JB, Goldberg AP, Hanley DF: Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. Jama 2004,292(15):1853-1861. 10.1001/jama.292.15.1853CrossRefPubMedPubMedCentral Luft AR, McCombe-Waller S, Whitall J, Forrester LW, Macko R, Sorkin JD, Schulz JB, Goldberg AP, Hanley DF: Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. Jama 2004,292(15):1853-1861. 10.1001/jama.292.15.1853CrossRefPubMedPubMedCentral
9.
go back to reference Stoykov ME, Lewis GN, Corcos DM: Comparison of bilateral and unilateral training for upper extremity hemiparesis in stroke. Neurorehabil Neural Repair 2009,23(9):945-953. 10.1177/1545968309338190CrossRefPubMed Stoykov ME, Lewis GN, Corcos DM: Comparison of bilateral and unilateral training for upper extremity hemiparesis in stroke. Neurorehabil Neural Repair 2009,23(9):945-953. 10.1177/1545968309338190CrossRefPubMed
10.
go back to reference Whitall J, McCombe Waller S, Silver KH, Macko RF: Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke 2000,31(10):2390-2395. 10.1161/01.STR.31.10.2390CrossRefPubMed Whitall J, McCombe Waller S, Silver KH, Macko RF: Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke 2000,31(10):2390-2395. 10.1161/01.STR.31.10.2390CrossRefPubMed
11.
go back to reference Bach-y-Rita P, Wood S, Leder R, Paredes O, Bahr D, Wicab Bach-y-Rita E, Murillo N: Computer-assisted motivating rehabilitation (CAMR) for institutional, home, and educational late stroke programs. Top Stroke Rehabil 2002,8(4):1-10. 10.1310/HHAD-6TU3-GR8Q-YPVXCrossRefPubMed Bach-y-Rita P, Wood S, Leder R, Paredes O, Bahr D, Wicab Bach-y-Rita E, Murillo N: Computer-assisted motivating rehabilitation (CAMR) for institutional, home, and educational late stroke programs. Top Stroke Rehabil 2002,8(4):1-10. 10.1310/HHAD-6TU3-GR8Q-YPVXCrossRefPubMed
12.
go back to reference Broeren J, Claesson L, Goude D, Rydmark M, Sunnerhagen KS: Virtual rehabilitation in an activity centre for community-dwelling persons with stroke. The possibilities of 3-dimensional computer games. Cerebrovasc Dis 2008,26(3):289-296. 10.1159/000149576CrossRefPubMed Broeren J, Claesson L, Goude D, Rydmark M, Sunnerhagen KS: Virtual rehabilitation in an activity centre for community-dwelling persons with stroke. The possibilities of 3-dimensional computer games. Cerebrovasc Dis 2008,26(3):289-296. 10.1159/000149576CrossRefPubMed
13.
go back to reference Saposnik G, Mamdani M, Bayley M, Thorpe KE, Hall J, Cohen LG, Teasell R: Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the Wii gaming system. Int J Stroke 2010,5(1):47-51. 10.1111/j.1747-4949.2009.00404.xCrossRefPubMed Saposnik G, Mamdani M, Bayley M, Thorpe KE, Hall J, Cohen LG, Teasell R: Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the Wii gaming system. Int J Stroke 2010,5(1):47-51. 10.1111/j.1747-4949.2009.00404.xCrossRefPubMed
14.
go back to reference Saposnik G, Teasell R, Mamdani M, Hall J, McIlroy W, Cheung D, Thorpe KE, Cohen LG, Bayley M: Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke 2010,41(7):1477-1484. 10.1161/STROKEAHA.110.584979CrossRefPubMed Saposnik G, Teasell R, Mamdani M, Hall J, McIlroy W, Cheung D, Thorpe KE, Cohen LG, Bayley M: Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke 2010,41(7):1477-1484. 10.1161/STROKEAHA.110.584979CrossRefPubMed
15.
go back to reference Sweetser P, Weyth P: A model for evaluating player enjoyment in games. ACM Comp Entertain 2005, 3: 1-24.CrossRef Sweetser P, Weyth P: A model for evaluating player enjoyment in games. ACM Comp Entertain 2005, 3: 1-24.CrossRef
16.
go back to reference Zyda M: From visual stimulation for visual games. Computer 2005, 38: 25-32.CrossRef Zyda M: From visual stimulation for visual games. Computer 2005, 38: 25-32.CrossRef
17.
go back to reference LoPiccolo P: Serious games. Computer Graphics World 2004, 27: 4-6. LoPiccolo P: Serious games. Computer Graphics World 2004, 27: 4-6.
18.
go back to reference Legg L, Langhorne P: Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials. Lancet 2004,363(9406):352-356.CrossRefPubMed Legg L, Langhorne P: Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials. Lancet 2004,363(9406):352-356.CrossRefPubMed
19.
go back to reference Duncan P, Richards L, Wallace D, Stoker-Yates J, Pohl P, Luchies C, Ogle A, Studenski S: A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke 1998,29(10):2055-2060. 10.1161/01.STR.29.10.2055CrossRefPubMed Duncan P, Richards L, Wallace D, Stoker-Yates J, Pohl P, Luchies C, Ogle A, Studenski S: A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke 1998,29(10):2055-2060. 10.1161/01.STR.29.10.2055CrossRefPubMed
20.
go back to reference Duncan P, Studenski S, Richards L, Gollub S, Lai SM, Reker D, Perera S, Yates J, Koch V, Rigler S, Johnson D: Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke 2003,34(9):2173-2180. 10.1161/01.STR.0000083699.95351.F2CrossRefPubMed Duncan P, Studenski S, Richards L, Gollub S, Lai SM, Reker D, Perera S, Yates J, Koch V, Rigler S, Johnson D: Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke 2003,34(9):2173-2180. 10.1161/01.STR.0000083699.95351.F2CrossRefPubMed
21.
go back to reference Legg L, Langhorne P: Therapy-based rehabilitation for stroke patients living at home. Stroke 2004,35(4):1022. 10.1161/01.STR.0000121043.21973.9FCrossRefPubMed Legg L, Langhorne P: Therapy-based rehabilitation for stroke patients living at home. Stroke 2004,35(4):1022. 10.1161/01.STR.0000121043.21973.9FCrossRefPubMed
22.
go back to reference Backlund P, Alklind Taylor A-S, Engström H, Johannesson M, Lebram M, Poucette J, Slijper A, Svensson K, Sunnerhagen K: Evaluation of usefulness of the Elinor console for home-based stroke rehabilitation. In IEE Third International Conference on Games and Virtual Worlds for Serious Applications: 2011. Athens: IEEE; 2011:98-103.CrossRef Backlund P, Alklind Taylor A-S, Engström H, Johannesson M, Lebram M, Poucette J, Slijper A, Svensson K, Sunnerhagen K: Evaluation of usefulness of the Elinor console for home-based stroke rehabilitation. In IEE Third International Conference on Games and Virtual Worlds for Serious Applications: 2011. Athens: IEEE; 2011:98-103.CrossRef
23.
go back to reference Zhan S, Ottenbacher KJ: Single subject research designs for disability research. Disabil Rehabil 2001,23(1):1-8. 10.1080/09638280150211202CrossRefPubMed Zhan S, Ottenbacher KJ: Single subject research designs for disability research. Disabil Rehabil 2001,23(1):1-8. 10.1080/09638280150211202CrossRefPubMed
24.
go back to reference Lyden P, Lu M, Jackson C, Marler J, Kothari R, Brott T, Zivin J: Underlying structure of the national institutes of health stroke scale: results of a factor analysis. NINDS tPA stroke trial investigators. Stroke 1999,30(11):2347-2354. 10.1161/01.STR.30.11.2347CrossRefPubMed Lyden P, Lu M, Jackson C, Marler J, Kothari R, Brott T, Zivin J: Underlying structure of the national institutes of health stroke scale: results of a factor analysis. NINDS tPA stroke trial investigators. Stroke 1999,30(11):2347-2354. 10.1161/01.STR.30.11.2347CrossRefPubMed
25.
go back to reference Nordenskiold UM, Grimby G: Grip force in patients with rheumatoid arthritis and fibromyalgia and in healthy subjects. A study with the Grippit instrument. Scand J Rheumatol 1993,22(1):14-19. 10.3109/03009749309095105CrossRefPubMed Nordenskiold UM, Grimby G: Grip force in patients with rheumatoid arthritis and fibromyalgia and in healthy subjects. A study with the Grippit instrument. Scand J Rheumatol 1993,22(1):14-19. 10.3109/03009749309095105CrossRefPubMed
26.
go back to reference Hammer A, Lindmark B: Test-retest intra-rater reliability of grip force in patients with stroke. J Rehabil Med 2003,35(4):189-194. 10.1080/16501970306132CrossRefPubMed Hammer A, Lindmark B: Test-retest intra-rater reliability of grip force in patients with stroke. J Rehabil Med 2003,35(4):189-194. 10.1080/16501970306132CrossRefPubMed
27.
go back to reference Lagerstrom C, Nordgren B: On the reliability and usefulness of methods for grip strength measurement [published erratum appears in Scand J Rehabil Med 1998 Sep;30(3):192]. Scand J Rehabil Med 1998,30(2):113-119. 10.1080/003655098444228CrossRefPubMed Lagerstrom C, Nordgren B: On the reliability and usefulness of methods for grip strength measurement [published erratum appears in Scand J Rehabil Med 1998 Sep;30(3):192]. Scand J Rehabil Med 1998,30(2):113-119. 10.1080/003655098444228CrossRefPubMed
28.
go back to reference Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S: The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1975,7(1)):13-31.PubMed Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S: The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1975,7(1)):13-31.PubMed
29.
go back to reference Lin JH, Hsu MJ, Sheu CF, Wu TS, Lin RT, Chen CH, Hsieh CL: Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke. Phys Ther 2009,89(8):840-850. 10.2522/ptj.20080285CrossRefPubMed Lin JH, Hsu MJ, Sheu CF, Wu TS, Lin RT, Chen CH, Hsieh CL: Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke. Phys Ther 2009,89(8):840-850. 10.2522/ptj.20080285CrossRefPubMed
30.
go back to reference Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G: Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer test, action research arm test and Box and block test: a multicentre study. Clin Rehabil 2005,19(4):404-411. 10.1191/0269215505cr832oaCrossRefPubMed Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G: Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer test, action research arm test and Box and block test: a multicentre study. Clin Rehabil 2005,19(4):404-411. 10.1191/0269215505cr832oaCrossRefPubMed
31.
go back to reference Yozbatiran N, Der-Yeghiaian L, Cramer SC: A standardized approach to performing the action research arm test. Neurorehabil Neural Repair 2008,22(1):78-90.CrossRefPubMed Yozbatiran N, Der-Yeghiaian L, Cramer SC: A standardized approach to performing the action research arm test. Neurorehabil Neural Repair 2008,22(1):78-90.CrossRefPubMed
32.
go back to reference Penta M, Tesio L, Arnould C, Zancan A, Thonnard JL: The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke 2001,32(7):1627-1634. 10.1161/01.STR.32.7.1627CrossRefPubMed Penta M, Tesio L, Arnould C, Zancan A, Thonnard JL: The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke 2001,32(7):1627-1634. 10.1161/01.STR.32.7.1627CrossRefPubMed
33.
go back to reference Ekstrand E, Lindgren I, Lexell J, Brogardh C: Test-retest reliability of the ABILHAND questionnaire in persons with chronic stroke. PM R 2013. doi: 10.1016/j.pmrj.2013.09.015. [Epub ahead of print] Ekstrand E, Lindgren I, Lexell J, Brogardh C: Test-retest reliability of the ABILHAND questionnaire in persons with chronic stroke. PM R 2013. doi: 10.1016/j.pmrj.2013.09.015. [Epub ahead of print]
34.
go back to reference Wang TN, Lin KC, Wu CY, Chung CY, Pei YC, Teng YK: Validity, responsiveness, and clinically important difference of the ABILHAND questionnaire in patients with stroke. Arch Phys Med Rehabil 2011,92(7):1086-1091. 10.1016/j.apmr.2011.01.020CrossRefPubMed Wang TN, Lin KC, Wu CY, Chung CY, Pei YC, Teng YK: Validity, responsiveness, and clinically important difference of the ABILHAND questionnaire in patients with stroke. Arch Phys Med Rehabil 2011,92(7):1086-1091. 10.1016/j.apmr.2011.01.020CrossRefPubMed
35.
go back to reference Gustafsson S, Sunnerhagen K, Dahlin-Ivanoff S: Occupational therapist’s and patients’ perception of ABILHAND, a new assessment tool for measuring manual ability. Scand J Occup Ther 2004, 11: 107-117. 10.1080/11038120410020692CrossRef Gustafsson S, Sunnerhagen K, Dahlin-Ivanoff S: Occupational therapist’s and patients’ perception of ABILHAND, a new assessment tool for measuring manual ability. Scand J Occup Ther 2004, 11: 107-117. 10.1080/11038120410020692CrossRef
36.
go back to reference Gladstone DJ, Danells CJ, Black SE: The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002,16(3):232-240. 10.1177/154596802401105171CrossRefPubMed Gladstone DJ, Danells CJ, Black SE: The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002,16(3):232-240. 10.1177/154596802401105171CrossRefPubMed
37.
go back to reference Sampson M, Shau YW, King MJ: Bilateral upper limb trainer with virtual reality for post-stroke rehabilitation: case series report. Disabil Rehabil Assist Technol 2012,7(1):55-62. 10.3109/17483107.2011.562959CrossRefPubMed Sampson M, Shau YW, King MJ: Bilateral upper limb trainer with virtual reality for post-stroke rehabilitation: case series report. Disabil Rehabil Assist Technol 2012,7(1):55-62. 10.3109/17483107.2011.562959CrossRefPubMed
38.
go back to reference Yong Joo L, Soon Yin T, Xu D, Thia E, Pei Fen C, Kuah CW, Kong KH: A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. J Rehabil Med 2010,42(5):437-441. 10.2340/16501977-0528CrossRefPubMed Yong Joo L, Soon Yin T, Xu D, Thia E, Pei Fen C, Kuah CW, Kong KH: A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. J Rehabil Med 2010,42(5):437-441. 10.2340/16501977-0528CrossRefPubMed
39.
go back to reference Lang CE, Wagner JM, Dromerick AW, Edwards DF: Measurement of upper-extremity function early after stroke: properties of the action research arm test. Arch Phys Med Rehabil 2006,87(12):1605-1610. 10.1016/j.apmr.2006.09.003CrossRefPubMed Lang CE, Wagner JM, Dromerick AW, Edwards DF: Measurement of upper-extremity function early after stroke: properties of the action research arm test. Arch Phys Med Rehabil 2006,87(12):1605-1610. 10.1016/j.apmr.2006.09.003CrossRefPubMed
40.
go back to reference van der Lee JH, Beckerman H, Lankhorst GJ, Bouter LM: The responsiveness of the action research Arm test and the Fugl-Meyer assessment scale in chronic stroke patients. J Rehabil Med 2001,33(3):110-113. 10.1080/165019701750165916CrossRefPubMed van der Lee JH, Beckerman H, Lankhorst GJ, Bouter LM: The responsiveness of the action research Arm test and the Fugl-Meyer assessment scale in chronic stroke patients. J Rehabil Med 2001,33(3):110-113. 10.1080/165019701750165916CrossRefPubMed
41.
go back to reference Michielsen ME, de Niet M, Ribbers GM, Stam HJ, Bussmann JB: Evidence of a logarithmic relationship between motor capacity and actual performance in daily life of the paretic arm following stroke. J Rehabil Med 2009,41(5):327-331. 10.2340/16501977-0351CrossRefPubMed Michielsen ME, de Niet M, Ribbers GM, Stam HJ, Bussmann JB: Evidence of a logarithmic relationship between motor capacity and actual performance in daily life of the paretic arm following stroke. J Rehabil Med 2009,41(5):327-331. 10.2340/16501977-0351CrossRefPubMed
42.
go back to reference Alklind Taylor A-S, Backlund P, Engström H, Johannesson M, Lebram M: Gamers agains all odds. In Proceedings of Edutainment 2009. Banff: Springer-Verlag Berlin and Heidelberg GmbH & Co; 2009. Alklind Taylor A-S, Backlund P, Engström H, Johannesson M, Lebram M: Gamers agains all odds. In Proceedings of Edutainment 2009. Banff: Springer-Verlag Berlin and Heidelberg GmbH & Co; 2009.
43.
go back to reference Bovolenta F, Goldoni M, Clerici P, Agosti M, Franceschini M: Robot therapy for functional recovery of the upper limbs: a pilot study on patients after stroke. J Rehabil Med 2009,41(12):971-975. 10.2340/16501977-0402CrossRefPubMed Bovolenta F, Goldoni M, Clerici P, Agosti M, Franceschini M: Robot therapy for functional recovery of the upper limbs: a pilot study on patients after stroke. J Rehabil Med 2009,41(12):971-975. 10.2340/16501977-0402CrossRefPubMed
44.
go back to reference Ashford S, Slade M, Malaprade F, Turner-Stokes L: Evaluation of functional outcome measures for the hemiparetic upper limb: a systematic review. J Rehabil Med 2008,40(10):787-795. 10.2340/16501977-0276CrossRefPubMed Ashford S, Slade M, Malaprade F, Turner-Stokes L: Evaluation of functional outcome measures for the hemiparetic upper limb: a systematic review. J Rehabil Med 2008,40(10):787-795. 10.2340/16501977-0276CrossRefPubMed
45.
go back to reference Baker K, Cano SJ, Playford ED: Outcome measurement in stroke: a scale selection strategy. Stroke 2011,42(6):1787-1794. 10.1161/STROKEAHA.110.608505CrossRefPubMed Baker K, Cano SJ, Playford ED: Outcome measurement in stroke: a scale selection strategy. Stroke 2011,42(6):1787-1794. 10.1161/STROKEAHA.110.608505CrossRefPubMed
Metadata
Title
Computer game-based upper extremity training in the home environment in stroke persons: a single subject design
Authors
Angelique Slijper
Karin E Svensson
Per Backlund
Henrik Engström
Katharina Stibrant Sunnerhagen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2014
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-11-35

Other articles of this Issue 1/2014

Journal of NeuroEngineering and Rehabilitation 1/2014 Go to the issue