Piloting an immersive treatment room to promote early therapeutic activity after stroke

From the 2023 HVPA National Conference

Amelia Tenberg MSN (Johns Hopkins School of Medicine), Sandra Deluzio MS (The Johns Hopkins Hospital), Kelly Jordan MS, Elizabeth Zink PhD, Mona Bahouth MD, PhD

Stroke remains a common disease and is a leading cause of adult disability in the US. Although early physical activity given in the acute phase post stroke can maximize recovery when given at the right time and dose, the acute hospitalization after stroke has historically focused on diagnosis and medical management. Instead, hospitalized stroke patients often spend a large amount of time immobile and alone. Incorporating rehabilitation activities in stroke centers is often delayed in part due to by systems factors such as staffing availability, inefficiencies in diagnostic testing, and competing clinical priorities.

Here, we describe the deployment of an immersive gaming room with a neuroanimation platform in an inpatient stroke unit to deliver high-intensity neurorestorative care to hospitalized stroke patients and results of an initial safety pilot.

We built an immersive gaming room with a neuroanimation platform to promote increased high-quality cognitive motor training for patients hospitalized with stroke. The immersive treatment room is a dedicated space to “escape” from the hospital environment into a neuroanimation experience that guides the patient through a series of high-intensity movements within a playful and motivating environment. An interprofessional team including neurologists, nurses, and therapists developed standardized protocols and measures to assess safety of initiating use of the gaming environment within the first 14 days after stroke. In the safety pilot, patients receive standard therapy plus up to 60 minutes of additional time-on-task training in the immersive treatment room. Patients are guided through the protocol by a trained clinician. Primary outcomes include pre-defined safety endpoints, completion of training sessions, and adverse events during a session.

The treatment room is located at the center of the stroke unit in an urban, comprehensive stroke center. In the initial pilot, 21 stroke patients completed the protocol. The cohort was an average of 66 years of age, with baseline NIHSS score of 7. On average, patients completed 27 minutes of time-on-task upper limb movement per session. No safety issues were identified during the 77 treatment sessions. Patients responded positively to the immersive treatment room and neuroanimation platform.

Use of the immersive gaming room and neuroanimation platform appears safe and feasible for hospitalized acute stroke patients. This type of treatment approach could move high value neurorestorative activities to an earlier point after stroke without significantly increasing staffing needs. It may promote more continuous and meaningful therapeutic movements based on its motivational features.

Clinical Implications:
Decreasing the number of trained staff required to engage patients in high-intensity movement may improve system efficiency and improve patient outcome after stroke. If proven effective, the immersive, enriched gamin environment with neuroanimation deployed in a protocolized fashion may be translated into other stroke hospitals, rehabilitation centers, and potentially home spaces to enhance self-managed, high-intensity therapy beyond traditional rehabilitation modalities.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog