Gamification of Upper Limb Virtual Rehabilitation in Post Stroke Elderly Using SilverTune- A Multi-sensory Tactile Musical Assistive System

Gamification of virtual rehabilitation devices gained rapid interest in the last two decades. Its popularity and use in remote telehealth and rehabilitation have gained more importance and application with the current COVID-19 pandemic situation. The benefits of gamification and the use of virtual reality (VR) games in rehabilitation therapy and telerehabilitation have been particularly well demonstrated in post-stroke patients. In this study, we present our pilot study using a game-based therapy approaches for the upper limb (UL) rehabilitation in elderly post-stroke patients in Singapore. The aim of the study is to develop a smart multi-sensory musical assistive system, called SilverTune, to promote the rehabilitation outcomes of elderly post-stroke patients. The SilverTune is like a musical instrument which is highly adaptable to provide six types of music audios and play interactions to cater for various elderly's preferences and therapeutic movement requirements. SilverTune can also quantitatively record therapeutic data, analyze performance in real time, and give multi-modal feedback to both elderly and therapist. It is designed to produce a variety of digital audios like drum, saxophone, bell, harp, etc. via changing the shape and the interaction behaviours of the users. A SilverTune mobile app was developed as a companion mobile app for SilverTune music therapy. The app can play the digital contents, which is activated by SilverTune. Furthermore, the app can record user's profile and the data input from SilverTune for future analysis by the therapist. Two games were developed to play using SilverTune device. The first is a horse racing game where the horse moves around a racetrack. The second is a table tennis game whereby the table tennis ball is required to be served across the net to gain points. The horse racing game facilitated shoulder flexion and extension, whereas the table tennis game facilitated shoulder horizontal abduction and adduction. If the movement of the SilverTunes device is detected by the accelerometer, the horse or bat will run or swing forward. If no movement is detected, then the horse or bat will be stationary. Participants' self-perceived level of performance and satisfaction were shown to have significant improvements after the intervention phase. Particpants were also assessed before and after interventions using Fugl Meyer Assessment-Upper Extremity (FMA-UE), Canadian Occupational Performance Measure (COPM) scores with improvements in passive joint motion. Post-intervention questionnaire found that many participants liked SilverTune games due to its novelty, audio/visual effects and that it helped them to stay focused during therapy. SilverTune can be potentially used as a telerehabilitation tool for the current COVID-19 pandemic situation to support a safe high-quality care at a reduced cost.