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Stopped due to futility considerations:
Sample size calculations have assumed smaller effect sizes than considered relevant now.
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| Name | Class |
|---|---|
| University of Zurich | OTHER |
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This study investigates the use of motivating/rewarding features in a computer based arm rehabilitation program. Half of the subjects will take part, besides receiving standard therapy, in a computer based program delivering a game like scenario with visual effects and monetary rewards in case of successful level completion, while the other half will take part in a similar program without visual effects or the possibility to earn money.
Rewards not only increase motivation to train, but have also been shown to influence motor skill learning via activation of dopaminergic brain structures. In goal oriented tasks, receiving information about goal achievement has a rewarding value, which is further increased if performance has monetary consequences. Computer games often strengthen this kind of information by presenting explosions and other salient stimuli when a goal is achieved (e.g. a target has been reached). The current study investigates the outcome of an arm rehabilitation program, based on such a computer game delivered in two versions. Stroke patients are asked to use their impaired arms to perform goal oriented movements. Movements are translated into movements of a virtual arm on a computer screen. Goals are "meteors", threatening to destroy a planet on which they fall, if not caught by the virtual arm. One version of the computer game delivers state of the art graphics including a number of visual effects and, if the planet was protected successfully, information about a monetary reward, whereas the other version of the program delivers schematic graphic objects only. Training time and intensity are kept constant and outcome measures, including standard clinical motor assessments, are compared between the groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| high incentive | Experimental | game version including visual effects and monetary rewards |
|
| low incentive | Active Comparator | game version without visual effects or monetary rewards |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| high incentive | Behavioral | Subjects are required to use their arms in order to control a virtual arm on a computer screen to prevent meteors from destroying a planet. The game includes visual effects and monetary rewards. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in ArmeoSenso - hand workspace | The subject moves the affected arm as far as possible in all directions while sitting in a gaming position. Movement range is recorded. | Assessed for each training visit (i.e., 15 visits over 3 weeks between day 2 and day 22): Main outcome is the change in hand workspace over the training intervention. |
| Measure | Description | Time Frame |
|---|---|---|
| Motivation questionnaire | Measures motivation to train. | Assessed for each training visit (i.e., 15 visits over 3 weeks between day 2 and day 22) |
| Wolf Motor Function Test | Quantifies upper extremity motor ability through timed and functional tasks. |
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Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Andreas Luft, Prof. | University of Zurich, University Hospital Zurich | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cereneo, Center For Rehabilitation and Neurology | Vitznau | Canton of Lucerne | 6354 | Switzerland | ||
| Klinik Adelheid |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34937456 | Derived | Widmer M, Held JPO, Wittmann F, Valladares B, Lambercy O, Sturzenegger C, Palla A, Lutz K, Luft AR. Reward During Arm Training Improves Impairment and Activity After Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair. 2022 Feb;36(2):140-150. doi: 10.1177/15459683211062898. Epub 2021 Dec 22. | |
| 29197412 | Derived |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| low incentive | Behavioral | Subjects are required to use their arms in order to control a virtual "hand" on a computer screen to prevent objects from reaching the bottom. The game does not include visual effects or monetary rewards. |
|
| Baseline (day 1), post-training (day 23 ± 5 days) and 3 months post-training (day 113 ± 7 days); training lasts for 3 weeks (15 visits, one per workday) |
| Fugl-Meyer Assessment Upper Extremity | Measures motor impairment. | Baseline (day 1), post-training (day 23 ± 5 days) and 3 months post-training (day 113 ± 7 days); training lasts for 3 weeks (15 visits, one per workday) |
| Box and Blocks Test | Measures gross manual dexterity. | Baseline (day 1), post-training (day 23 ± 5 days) and 3 months post-training (day 113 ± 7 days); training lasts for 3 weeks (15 visits, one per workday) |
| ArmeoSenso: pointing task | Goal is to reach targets in the transversal plane in front of the subject: number of targets and time. | Assessed for each training visit (i.e., 15 visits over 3 weeks between day 2 and day 22) |
| Motor Activity Log 14 (MAL-14) | Self-reported movement ability. | Baseline (day 1), post-training (day 23 ± 5 days) and 3 months post-training (day 113 ± 7 days); training lasts for 3 weeks (15 visits, one per workday) |
| Barthel Index | Measure of independence in daily living. | Baseline (day 1), post-training (day 23 ± 5 days) and 3 months post-training (day 113 ± 7 days); training lasts for 3 weeks (15 visits, one per workday) |
| NIHSS | Measure of stroke severity. | Baseline (day 1), post-training (day 23 ± 5 days) and 3 months post-training (day 113 ± 7 days); training lasts for 3 weeks (15 visits, one per workday) |
| Unterägeri |
| Canton of Zug |
| 6314 |
| Switzerland |
| Zuercher Reha Zentrum Wald | Wald | Switzerland |
| Widmer M, Held JP, Wittmann F, Lambercy O, Lutz K, Luft AR. Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: study protocol for a randomized controlled trial. Trials. 2017 Dec 2;18(1):580. doi: 10.1186/s13063-017-2328-2. |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |