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Study: Can video game help stroke patients recover?
Julia Duda | MUSC News Center | April 16, 2015

duck duck punch
Photos by Sarah Pack

Lisa Chewning plays "Duck, Duck, Punch," a video game that's helping her recover from a major stroke. 

Today Lisa Chewning can hold a toothbrush, get dressed and raise her left arm – three things she couldn’t do two years ago when she suffered a major stroke. 

Her husband, Chuck, watches her play a video game “Duck, Duck, Punch” and cheers as she extends her arm to virtually hit ducks, crabs and seagulls. “Perfect, that’s it! Up and across!” 

Michelle Woodbury 
Dr. Michelle Woodbury helped create "Duck, Duck, Punch." 

Michelle Woodbury, OTR/L., Ph.D., impressed, pauses the game to increase the difficulty. “Last time we couldn’t even do seagulls” she said. The seagulls fly across the very top of the TV screen, making those punches the hardest to throw. 

Of the 75 percent of people who live through a stroke and experience some level of paralysis of their arm and hand, less than 10 percent will ever regain full function, says Woodbury. 

Woodbury, an occupational therapist and research director of the upper extremity motor function lab in MUSC’s Center for Rehabilitation Research in Neurological Conditions (CRRNC) sees firsthand how difficult the world is for patients who have moderate to severe levels of impairment. 

Knowing how widespread a problem stroke is and how lack of opportunities to practice impedes stroke recovery, Woodbury wanted to find a way to make the world easier for patients. 

With the help of Larry Hodges, Ph.D., the endowed chair and director of the Clemson School of Computing and his team of then-Ph.D. students, Austen Hayes and Patrick Dukes, “Duck, Duck, Punch” was born. The video game is actually a virtual environment, or VE system, for rehabilitation. 

The goals of Woodbury’s feasibility study using the VE system is to provide therapy that is adjunct to regular therapy in a low-cost way and allow stroke survivors to own their therapy process. The study, which is a pilot project funded by an NIH Institutional Development Award, was obtained through a collaboration between MUSC and the University of Delaware. The study is currently integrating “Duck, Duck, Punch” into patient homes and at Roper Rehabilitation Hospital, or Roper Rehab with 20 patients enrolled in each. 

Lisa Chewning 
Chewning has regained significant arm mobility and flexibility. 

Chewning is one of several participants in Woodbury’s “Virtual Environment for Stroke Rehabilitation” study who has regained significant arm mobility and flexibility.  

Steven Kautz, Ph.D., chairman of the Department of Health Sciences Research and co-director of the CRRNC, said he is excited by the potential for “Duck, Duck, Punch” to impact stroke rehabilitation. The Clemson computer science team has worked with Woodbury to allow the Kinect to essentially act as a therapist looking over the shoulder of the person while they play the game alone. 

“This clever design of the game means that the person has to play using only properly performed movements, making it a quantum leap forward from most rehabilitation games. Perhaps, the biggest shortcoming in our current rehabilitation system is that people do not get enough supervised practice to allow their nervous system to make the neuroplastic changes that are possible,” Kautz said.  

“Neuroplastic changes” refers to the brain’s ability to change its structure and neural pathways, a critical need in stroke rehabilitation.

In order to use the VE system, stroke patients’ arms are first calibrated with an avatar arm using the Microsoft Kinect system and are then given various targets to “punch.” 

Woodbury said the game makes therapy fun. “Now they have full range of motion in the virtual world. Their avatar can go wherever they want. It’s very motivating because whereas in the real world they can’t, in the virtual world, they can. Success is motivating and motivates more play, and therefore more practice.”

Wilbur Wise plays "Duck, Duck, Punch" as Roper St. Francis occupational therapist Angie Langford helps. 

In addition to a group of at-home players, the VE system was installed at Roper Rehab in January 2014 for a second group of study participants to use. In Woodbury’s mind, Roper Rehab was an obvious place to start due to its proximity to MUSC.  

“We’ve had extreme, overwhelming support. I couldn’t speak higher of how much support we’ve had. They made it possible at every point when we were providing education from the therapist to the nurses to the evening nursing staff. People are so excited about this,” Woodbury said about the Roper Rehab collaboration. 

Since many Roper Rehab patients originate from MUSC, a collaborative bed reserve agreement was established in which MUSC would send patients treated for stroke to Roper Rehab for physical and occupational therapy. The collaboration eliminated the possibility of having two competing rehab centers, located blocks away from each other. 

“We’re doing it for the patients, and we’re doing it for the community and that’s the right thing to do,” said Cathy Therrell, director of Roper Rehab. “We do the good clinical rehab care, and they do the interventional stroke and the research part of it.”

So far “Duck, Duck, Punch” has been well received by patients and staff at Roper Rehab. 

Jessica Trego, a physical therapist and Roper Rehab supervisor said, “It’s really nice adjunct to the extra therapy, because you know, our therapy day has an end point at some point. To have this option for after hours and on weekends, to allow patients some more increased mobility is tremendous, and I think it’s only going to benefit them.” 

Although the study is still ongoing, early reports indicate that patients who are enrolled in the at-home group are completing 400 - 500 movement repetitions per day, which enhances the amount of upper extremity movement practice in a short period of time. In addition, there have been no reports of adverse events, fatigue or pain from either study group. 

Woodbury said, “This isn’t going to cure everything. This isn’t going to make somebody go back to work. But it’s one small piece of the puzzle for getting better after stroke.” 

“Duck, Duck, Punch” is licensed through Recovr, Inc., a company co-founded by Woodbury, Dukes, Hodges and current CEO, Austen Hayes. The company aims to create more VE systems for patients with various physical impairments. 

“At Recovr, Inc., we want to make sure therapists and patients have the tools they need for an engaging and effective therapy experience, not just for stroke, but every type of exercise-based therapy,” Hayes said. 

Nancy Bunch 
Nancy Bunch, her husband Kenny and grandson Wyatt 

Nancy Bunch, another at-home study participant, said she has been blessed to have been part of Woodbury’s study and hopes that one day Recovr, Inc.’s VE systems are commercialized. 

Bunch lost the ability to sit up, walk and raise her arms after suffering a stroke in March 2014.  Despite only being given three hours to live, Bunch persevered and slowly recovered. She spent a total of 12 days in the intensive care unit and 60 days at Roper Rehab. Bunch was amongst the first participants to play while a patient at Roper Rehab, and later signed up as an in-home participant. 

The first time Bunch played “Duck, Duck, Punch” as an inpatient at Roper, she surpassed her goal of 150 repetitions by completing 200. The second time she completed more than 300. Bunch credits “Duck, Duck, Punch” for helping her to regain arm mobility and said she’s about 65 percent better than where she was a year ago. 

Bunch believes “Duck, Duck, Punch” is hope for people like her who felt utterly hopeless post-stroke. 

“I could not even move my arm, but with that game, my mind, and the competitive spirit within me, I moved that arm.”

For more information please contact Michelle Woodbury, OTR/L., Ph.D. at 843-792-1671.




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Resources >>

MUSC Neurosciences Stroke Neurology Division

MUSC News Center archives



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