Effectiveness of Computer-based Exergaming on Upper Limb Motor Function, Functional Independence, and Quality of Life in Individuals with Spinal Cord Injury: A Randomized Control Trial.

Abstract

Upper limb motor function is one of the most desired abilities of individuals with tetraplegia. Virtual reality-based exergaming is one of the advanced methods of supplementing conventional rehabilitation that enables the user to perform multiple repetitions of meaningful movements due to increased engagement and motivation, but adoption is often limited by high cost of procurement. Due to a large user base of personal computers and smartphones, we tried to check the effectiveness of a novel computer-based exergame that can be administered using a personal computer and a smartphone. The computer is used to display the game, and the smartphone acts as a motion sensor-based controller for providing input to the game. Twenty individuals with spinal cord injury (C6-13, C7-7, AIS A = 14, AIS B = 3, AIS C = 1, AIS D = 2) with a mean age of 30.7 ± 12 years participated in the study. They were randomly allocated to 2 groups. Group A (n = 10) received 30 minutes of computer-based exergaming training 3 times a week for 4 weeks, and Group B (n = 10) received conventional rehabilitation only. Baseline and postintervention assessments were done using the American Spinal Injury Association upper extremity motor score (ASIA-UEMS), Jebsen-Taylor Hand Function Test (JTHFT), Capabilities of Upper Extremity Questionnaire (CUE-Q), Spinal Cord Independence Measure III (SCIM-III), and Spinal Cord Injury Quality of Life (SCI-QOL) by a blinded assessor, and results were analyzed using the IBM SPSS Statistics v30. CUE-Q (P < .001), SCIM III (P < .001), SCI-QOL, and JTHFT lifting light objects and lifting heavy objects tasks in the dominant and nondominant hands and simulated feeding tasks in the dominant hand showed significant difference between the 2 groups. Exploratory analysis confirmed functional gains were independent of baseline severity or injury chronicity. However, no significant differences were seen in the ASIA-UEMS score (P = .060) and the fine motor function tasks of the JTHFT in the dominant and nondominant hands. The results of our study showed that computer-based exergaming is a safe and effective modality beneficial for improving gross upper limb motor function, functional independence, and quality of life in individuals with spinal cord injury as compared to conventional rehabilitation alone. Although, it produces similar results as conventional rehabilitation on upper extremity motor score and fine motor function.