Background: Self-led therapy has the potential to extend rehabilitation and enhance recovery after stroke. Evolving technology can add support and structure to this approach. Our objective was to develop and evaluate the See, Imagine, Move; Upper Limb Action Therapy (SIMULATe) application; an iPad-based, cognitive and physical training intervention focused on (re)learning activities of daily living after stroke.
Method: The SIMULATe application was developed using a user-centered approach (ISO 9241-210). The therapy exploits the putative human mirror neuron system to enhance physical practice and positive affect. To evaluate SIMULATe, community dwelling stroke survivors (N=13) between 3 months and 5 years after stroke entered a single group trial. Participants accessed SIMULATe via an iPadTM and observed, imagined and physically practiced functional activities for up to 90 minutes a day for 18 consecutive days. Primary outcome measures included: adherence; retention; usability (System Usability Scale; SUS); and adverse effects. Secondary measures (pre- and post-test) included: the Action Research Arm Test (ARAT); 9 Hole Peg Test (9HPT); Grip Strength (GS); and the Positive and Negative Affect Scale (PANAS). Where appropriate, results are reported as median scores (IQR).
Results: The intervention was feasible. There was >80% retention, participants completed >33% of the maximum target time, the usability (SUS: 0-100) was 91.2 (87.5 - 92.5) and no adverse effects were reported. ARAT scores (0-57) increased from 43.0 (39.5-54.0) to 45.0 (39.0-53.0); GS (N=11*) increased from 28.3 (26.0-44.3) to 35.7 (30.2 - 49.2); 9HPT (N=7*) decreased from 81.1 (38.2-132.83) to 39.9 (33.51-55.7); Positive Affect (10-50; N=10*) increased from 34.2 (29.5-38.0) to 36.0 (32.5-47) and Negative Affect (10-50; N=10*) decreased from 22.0 (13.2-29.2) to 16.5 (11.5-23.25). *Some participants could not complete all measures.
Conclusion: Technology-dependent, self-led therapy appears to be feasible, safe and acceptable to stroke survivors. Further development and investigation in a randomized controlled trial with a usual care comparator is warranted.