Participant Adherence to a Video Game-Based Tele-rehabilitation Program : A Mixed-Methods Case Series

In this chapter, the experiences of four subjects from a larger trial of video game-based hand and arm rehabilitation for stroke survivors are discussed. We will outline the barriers to participation and adherence to home programs for persons with stroke and relate them to the use of previously developed New Jersey Institute of Technology Home Virtual Rehabilitation System (NJIT-HoVRS), developed to address these barriers. Next we discuss describe the experiences of participants. The four subjects represent the highest and lowest levels of adherence in their protocol groups. Interestingly, more commonalities are observed between the two higher adhering and the two lower adhering subjects than there are when comparing subjects across the two protocols utilized in the study. Age, computer literacy and previous experience with computer games did not have a consistent impact on adherence in these subjects. Moreover, all four subjects demonstrated “clinically significant improvements” in motor function, but only one expressed satisfaction with the outcome. This initial examination suggests that maximizing adherence across a broad sample of subjects might not be achieved an intervention that addresses a set of diagnosis- or population-specific barriers to participation.