Self-Directed Upper Extremity Gaming in Inpatients With Stroke

Self-Directed Upper Extremity Gaming in Inpatients With Stroke: A Feasibility Study

STRIVE uses a camera mounted on the in-room TV and a connected laptop to track arm and hand movements during gameplay via markerless motion capture. No controllers or wearable sensors are required, and patients initiate a session with a single button on the TV remote. Games target clinically relevant movements such as reaching and grasping, with difficulty adapting to the user.

This is a prospective, single-arm feasibility study using a four-phase co-design protocol adapted from Clanchy et al. Phase 1 (n=20): inpatient stroke survivors complete one supervised session; think-aloud methods capture usability barriers. Phase 2: a multidisciplinary translation team rates issues on clinical significance and technical feasibility. Phase 3: prioritized issues are translated into design changes, producing STRIVEv2, with each change traceable to a user-identified barrier. Phase 4 (n=20): a separate group uses STRIVEv2 over three or more consecutive daily sessions under naturalistic conditions to evaluate usability readiness.

An occupational therapist sets up equipment, calibrates, and runs a supervised practice session so participants can start, pause, and stop safely. Sessions occur only when participants are awake, alert, and medically stable. The system logs only de-identified session metadata (timestamps, duration, active play time, task attempts and completions, game scores). No video, audio, or images are recorded.

Inclusion Criteria:

• admitted for IP stroke rehabilitation ARAT >5 and <40 at enrollment
• sufficient cognition and vision to follow simple instructions
• medically stable for independent seated or supine UE activity

Exclusion Criteria:

• severe neglect that prevents task engagement
• significant aphasia that prevents understanding of instructions
• medical contraindications to unsupervised UE activity as determined by the treating team