ArmeoSenso - Reward

ArmeoSenso - Rewarding vs. Non-rewarding Therapy of Patients With Arm Impairments Based on Wearable Movement Sensors

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.

Inclusion Criteria:

• stroke survivor (max. 100 days post-stroke)
• upper extremity motor deficits
• patient can lift the paretic arm against gravity
• patient can move the hand at least 20x20 cm in a horizontal plane
• patient is able and willing to participate
• patient has signed informed consent

Exclusion Criteria:

• severe aphasia (impairing verbal instructions)
• severe dementia (impairing the capability to understand instructions)
• severe depression (impairing motivation to train)
• relevant (in the judgement of the investigator) impairment of visual perception, (impairing perception of goals and feedback on the computer screen)