RHOMBUS II: Feasibility of the NeuroBall in Acute Stroke
Research type
Research Study
Full title
Rehabilitation using Virtual Gaming for Hospital and HOMe-Based Upper-limb exercise post Stroke(RHOMBUS II): a feasibility randomised control trial
IRAS ID
282970
Contact name
Cherry B Kilbride
Contact email
Sponsor organisation
Brunel University London
ISRCTN Number
ISRCTN1144009
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Summary of Research
Post -stroke many people experience persistent problems using their arm and hand in everyday activities. Engaging individuals in sufficient practice that makes a difference to their recovery is a challenge given NHS resources, and repetitive exercises are boring. Technology can help achieve sufficient levels of practice through supporting therapy led rehabilitation and self-directed exercise. Research suggests virtual Reality (VR) to be a promising treatment to help arm recovery post stroke; but unfortunately, many VR devices are expensive, and cumbersome.
For the last 3 years, Brunel researchers, stroke survivors and bioengineers have been undertaking a programme of research to develop an innovative, affordable, and portable solution. The VR training device, called the NeuroBall promotes all-in-one arm and hand training through uniquely designed rehabilitation computer games displayed on a tablet computer. The device has been lab tested with 18 stroke survivors, and in a clinical trial with 30 people at least one-year post stroke in their homes for 7 weeks. Results showed the device was safe, enjoyable, easy to use, and participants wished they had used the device earlier in their rehabilitation.
Next, we plan to test the NeuroBall in a randomised controlled trial with 24 stroke survivors who have problems with arm and hand movement. Sixteen people will receive the intervention for 7 weeks, 8 people will continue usual care, starting within the first 6 weeks of stroke when an inpatient on the stroke unit or at home, or both depending on the individual's treatment journey. Measurements will be taken at the start and end of the study. Stroke survivors and health staff will also be invited to be interviewed about taking part in the study. Findings will help the research team assess if a bigger trial across the full stroke pathway is possible and how best to design it.Summary of Results
Stroke survivors can experience persistent arm and hand weakness post-stroke. Intense practice and repetition of movement are key to effective arm and hand rehabilitation. Yet, practice opportunities often fall short of the amount needed to drive recovery of movement in the arm and hand. Technology offers a potential solution to increase practice. The NeuroBall is a portable training device designed by engineers, stroke survivors and therapists for all-in-one arm and hand training through a uniquely designed rehabilitation gaming app, displayed on a tablet computer. This study examined if the device was safe and possible to use and if people liked using it as part of their therapy treatment in the early days and weeks after stroke, both in the stroke unit and at home. This time window early after stroke is important as this is when practice can be at its most effective.
This study took place in the stroke unit at The Hillingdon Hospitals NHS Foundation Trust and in people's home with the early stroke support discharge team in the Central North West London NHS Foundation Trust. Twenty-four participants with new one-sided weakness from stroke and provided informed voluntary consent were recruited to the study and then randomly allocated (by a computer so allocation could not be predicted in advance) to receive either the NeuroBall intervention and usual care (16 stroke survivors) of just usual care (8 stroke survivors). Both groups were in the study for a total of seven weeks, with the intervention group, once trained, using the NeuroBall in addition to their usual treatment. We took measures at the beginning and of the end of the 7 weeks, measures included how much the person's arm and hand could be moved, how much the person could use their arm and hand in everyday activity, any pain, if they were fatigued, and how confident stroke survivors felt about practising alone, satisfaction levels for using the device, and how much practice people did with the NeuroBall.
Twenty-four stroke survivors were recruited, eighteen people completed all stages. Results showed the measures used in the study and described were suitable, and there was minimal missing data (less than 10%). Stroke survivors who used the NeuroBall undertook an additional 13 hours of rehabilitation, completing an average of 15, 133 repetitions with the arm and hand. The average satisfaction score for using the device was 35/40. We also monitored for any side effects or illness that happened during the 7 weeks people were involved in the study; results indicated there no differences between the intervention and usual care groups and that the device was safe to use.
As part of the overall study evaluation we also interviewed stroke survivors (11 who used the NeuroBall and 3 who had their usual care) and 8 members of the healthcare staff about what it was like to take part in the study. An example quote from Participant 023: “…it was nice and easy to do…it is showing what progress I am making each day…I think that’s definitely improved the movement left and right….it is the repetition.â€
In summary, the NeuroBall is safe, enjoyable and easy to use for training the arm and hand both as an inpatient on the stroke unit and early weeks at home.REC name
Wales REC 5
REC reference
20/WA/0347
Date of REC Opinion
21 Dec 2020
REC opinion
Favourable Opinion