Clinical validation of an individualized auto-adaptative serious game for combined cognitive and upper limb motor robotic rehabilitation after stroke
(2025) Journal of NeuroEngineering and Rehabilitation — Vol. 22, n° 1, p. 1-14 (2025)
Files
Doumasetal-2025-Clinicalvalidationofanindividualizedauto-adaptativeseriousgameforcombinedcognitiveandupp.pdf
Open Access - Adobe PDF
- 1.89 MB
Details
- Authors
- Abstract
- Background Intensive rehabilitation through challenging and individualized tasks are recommended to enhance upper limb recovery after stroke. Robot-assisted therapy (RAT) and serious games could be used to enhance func- tional recovery by providing simultaneous motor and cognitive rehabilitation. Objective The aim of this study is to clinically validate the dynamic difficulty adjustment (DDA) mechanism of ROBiG- AME, a robot serious game designed for simultaneous rehabilitation of motor impairments and hemispatial neglect. Methods A proof of concept, with 24 participants in subacute and chronic stroke, was conducted using a 5-day protocol (two days were dedicated to assessment and three days to consecutive training sessions). Participants performed three consecutive ROBiGAME sessions during which overall task difficulty was determined through simul- taneous DDA of motor and attentional parameters. Relationships between clinical and robotic assessment scores with respective task-difficulty parameters were analyzed using a multivariate regression model and a principal com- ponent analysis. Results Game difficulty rapidly (within approximately thirty minutes) auto-adapted to match individual impairment levels. The relationship between task-difficulty parameters with motor (Fugl Meyer Assessment: r = 0.84 p < 0.05) and with attentional impairments (Bells test total omissions: r = 0.617 p < 0.05) showed that task-difficulty during RAT adapted to each participant’s degree of impairment. Principal component analysis identified two data subsets determining overall task-difficulty, one subset for motor and the other for cognitive functional evaluation scores with respective task-difficulty parameters. Conclusions This proof of concept clinically validated a DDA mechanism and showed how task-difficulty adequately adapted to match individual degrees of impairment during RAT after stroke. ROBiGAME provided simultaneous motor and attentional exercises with parameters determining task-difficulty strongly related with respective clinical and robotic evaluation scores. Individualized levels of game difficulty and rapid adjustment of the system suggest implementation in clinical practice.
- Affiliations
Citations
Doumas, I., Lejeune, T., Edwards, M., Stoquart, G., Vandermeeren, Y., Dehez, B., & Dehem, S. (2025). Clinical validation of an individualized auto-adaptative serious game for combined cognitive and upper limb motor robotic rehabilitation after stroke. Journal of NeuroEngineering and Rehabilitation, 22(1), 1-14. https://doi.org/10.1186/s12984-025-01551-w (Original work published 2025)