An 8-Week Virtual Exercise Environment Intervention for People Post-Stroke: A Longitudinal Mixed Methods Single Case Study

Individuals with hemiplegia using a coupled-crank arm cycle may experience nonparetic arm overcompensation and paretic arm resistance due to neuromechanical deficits. Technologies that foster independent limb contributions may increase paretic arm recovery for people post-stroke. To document in a single case study the effects of 8 weeks of training with a smart trainer arm ergometer on power output, pedal speed, pedal synchronicity, quality of life, enjoyment, and engagement. A longitudinal, mixed methods, case study design was used to examine physical and psychosocial changes in an individual post-stroke after an 8-week arm cycling program using the Advanced Virtual Exercise Environment Device (AVEED) in a non-immersive virtual exergaming environment. After a pretest visit, the cycling speed of each arm was collected with open-ended responses over 24 training visits. A posttest visit and semi-structured interview were conducted. The data were mixed for the training visits and posttest to draw meta-inferences. The participant cycled faster bilaterally and used his paretic arm more than at pretest during cycling after 8 weeks of training with the AVEED. The speed difference between his paretic and non-paretic arms steadily decreased and the participant reported increasing enjoyment and engagement over time. The device, environment, and intervention were rated as usable, and the participant attributed several functional improvements with his paretic arm to the program. The AVEED, combined with an exergaming platform, was successful in improving the cycling speed and paretic arm contribution of an individual post-stroke through an 8-week non-immersive virtual exercise environment program.