{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:21:32Z","timestamp":1789755692103,"version":"4.0.1"},"reference-count":67,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Serious Games"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Accumulating evidence and medical guidelines recommend high-dose neurorehabilitation for recovery after stroke. The reality, however, is that most patients receive a fraction of this dose, with therapist availability and costs of delivery being major implementational barriers.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to explore a potential solution by conducting a retrospective analysis of a real-world enhanced clinical service that used gamified self-training technologies at home under remote therapist supervision.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data from 17 patients who completed a 12\u201018 week full-body, high-dose neurorehabilitation program entirely at home were analyzed. Program delivery relied primarily on patients training independently (asynchronously) with the MindMotion GO (MindMaze) gamified-therapy solution. Accompanying telerehabilitation training sessions with a therapist occurred weekly while therapists used a web application to continuously monitor and manage the program remotely. Effectiveness of the program was assessed through measured active training time, a measure that more closely reflects delivered dosage as opposed to scheduled dose. Patient recovery was evaluated with standardized impairment and functional clinical measures and patient self-reported outcome measures. Finally, a cost model was computed to evaluate the resource efficiency of the program.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Patients maintained high training adherence throughout the program and reached an average total active training time of 39.7 (SD 21.4) hours, with the majority delivered asynchronously (mean 82.2%, SD 10.8%). Patients improved in both upper-limb (Fugl-Meyer Upper Extremity, mean 6.4, SD 5.1;\n P<\/jats:italic>\n <.001) and gait and balance measures (Functional Gait Assessment, mean 3.1, SD 2.6;\n P<\/jats:italic>\n <.001; Berg Balance Scale, mean 6.1, SD 4.4;\n P<\/jats:italic>\n <.001). Overall, the program was viewed very favorably among patients who completed a post-program survey, with 73.7% (14\/19) of respondents being satisfied or very satisfied, while 63.2% (12\/19) of respondents reported subjective improvements in physical abilities. Per-patient therapist costs approximated US $338, representing a resource-efficient alternative to delivering the same dose via one-on-one in-person training sessions (US $1903).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This work demonstrates effective high-dose neurorehabilitation delivery via gamified therapy technologies at home. The approach shows that training time can be successfully decoupled from therapist-presence without compromising adherence, outcomes, or patient satisfaction over an extended program period. Given growing concerns over therapist availability and increasing health care costs, this resource-efficient approach can help achieve medical guidelines and complement existing clinic-based approaches.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/69335","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T11:56:32Z","timestamp":1752580592000},"page":"e69335-e69335","source":"Crossref","is-referenced-by-count":11,"title":["A Resource-Efficient, High-Dose, Gamified Neurorehabilitation Program for Chronic Stroke at Home: Retrospective Real-World Analysis"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5855-6808","authenticated-orcid":false,"given":"Spencer A","family":"Arbuckle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8365-1740","authenticated-orcid":false,"given":"Anna Sophie","family":"Knill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1883-9317","authenticated-orcid":false,"given":"Michelle H","family":"Chan-Cort\u00e9s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9538-2456","authenticated-orcid":false,"given":"Gabriela","family":"Rozanski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9733-7353","authenticated-orcid":false,"given":"Anastasia Elena","family":"Ford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2286-5677","authenticated-orcid":false,"given":"Louis T","family":"Derungs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4316-1846","authenticated-orcid":false,"given":"John W","family":"Krakauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-4588","authenticated-orcid":false,"given":"Naveed","family":"Ejaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2232-3324","authenticated-orcid":false,"given":"David","family":"Putrino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4664-0594","authenticated-orcid":false,"given":"Jenna","family":"Tosto-Mancuso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-6916","authenticated-orcid":false,"given":"Meret","family":"Branscheidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"issue":"4","key":"R1","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/S1474-4422(24)00038-3","article-title":"Global, regional, and national burden of disorders affecting the nervous system, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"Steinmetz","journal-title":"Lancet Neurol"},{"issue":"7","key":"R2","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1161\/STROKEAHA.114.004695","article-title":"Is more better? 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