Game-based rehabilitation improves upper limb movement capacity compared to task-based training in people post-stroke: Kinematic analyses from the EnteRtain randomized clinical trial

BACKGROUND AND AIMS: Although many gaming systems for early stroke rehabilitation capture kinematic data, studies on upper limb (UL) movement capacity analysis after virtual reality (VR)-based gaming interventions remain limited. This study is a secondary analysis of the EnteRtain randomized clinical trial and aims to examine the effects of gamified rehabilitation using a low-cost arm rehabilitation system compared to task-based training on UL movement capacity in individuals with acute or sub-acute stroke. METHODS: This secondary analysis used data from a randomized, multicenter, single-blind clinical trial involving 120 participants (91 males) with unilateral stroke and an UL Brunnstrom motor recovery stage ≥ 1 to ≤ 5, recruited from four centers across India. Participants received either gamified training with the ArmAble™ device (experimental group; n = 64) or task-based training (control group; n = 56), alongside conventional therapy for two hours/day, six days/week, over two weeks, followed by four weeks of home-based UL rehabilitation. Movement capacity outcomes (reach distance, time, and movement velocity) were assessed by blinded evaluators at two and six weeks and analyzed using a linear mixed-effects regression model. RESULTS: At six weeks, the experimental group demonstrated significantly greater improvements compared to control group in movement velocity for reaches to both near [mean difference (95% CI): -2.8 (-5.0, -0.75); p = 0.008] and far targets [-2.7 (-4.9, -0.51); p = 0.016]. No significant differences were however observed at two weeks. Changes in reach distance and movement time were not statistically significant between the groups at any time point. CONCLUSION: Gamified rehabilitation with the ArmAble™ device enhanced UL movement velocity at six-week compared to task-based training in individuals recovering from acute/sub-acute stroke. These findings support the use of ArmAble™ both as an engaging therapeutic tool and as a quantitative assessment platform for evaluating UL function post-stroke.