Key takeaways:

• The technology targeted abnormal muscle co-activation in the upper arm of stroke survivors.
• At 6 weeks, groups saw significant improvement in a motor function test, while the sham group saw minimal improvement.

Wearable video game technology showed promising results with helping chronic stroke survivors recover movement and motor function in the upper arm, according to data published in Neurorehabilitation and Neural Repair.

A study from Northwestern University showed “clinically meaningful” data regarding the use of myoelectric interface for neurorehabilitation (MINT) technology, which allows patients recovering from stroke to reduce abnormal muscle co-activation by playing a customized video game in their own homes, Marc Slutzky, MD, PhD, professor of neurology at the Northwestern University Feinberg School of Medicine, told Healio.

Data derived from Khorasani, A. et al. Neurorehabilitation and Neural Repair. 2026:10.1177/15459683261454937.

“A key part of this patient group that we studied was that most of them were severely impaired, meaning they could lift up their arm a little bit, but not straighten it out,” Slutzky said. “And those patients still improved with MINT therapy. It’s very uncommon that therapy helps severely impaired participants, so that’s encouraging.”

The single-blind, randomized study took data from 59 participants with moderate to severe upper limb impairment who experienced unilateral ischemic or hemorrhagic stroke an average of 6.4 years before enrollment.

After 10 weeks, all groups using MINT showed significant improvements as measured by the Wolf Motor Function Test (WMFT), while a sham group did not, authors wrote.

In addition, Slutzky said the MINT groups improved reach kinematics, specifically range of motion, which he said indicates that patients were recovering arm movement ability as opposed to compensating for their impairment.

“A lot of therapies kind of guide patients to just do better at their activities of daily living, however that happens, and a lot of times that leads to compensation rather than recovery of the movement of that injured limb,” Slutzky said. “[With MINT], the actual movement improved their range of motion, and so we know that it wasn’t just compensation.”

By the numbers

The study focused on muscle co-activation in the upper arm, including shoulder-elbow and shoulder-scapular coupling, the authors wrote.

The MINT technology requires participants to play customized games that involve moving a cursor into targets, with electromyographic envelopes mapped to orthogonal components of the cursor position. As the game advances, targets gradually move farther away from co-activation (a diagonal between the two directions), until participants have to isolate one muscle activity to hit the target, Slutzky said.

Participants played the game 90 minutes per day, 5 days per week at home and 1 day per week in a supervised laboratory setting for 6 weeks. They were split up into four groups:

• 15 participants in a 2D group, which used two muscles mapped to x and y directions;
• 14 participants in a 2D Reach group, which also used two muscles but with additional in-game encouragement to use more effort to move the arm in the direction of the target muscle activation;
• 14 participants in a 3D group, which used three muscles mapped to x, y, and z directions; and
• 16 participants in the sham group, which used only one muscle mapped to one direction.

After 6 weeks, participants in the 3D group improved WMFT scores by 6.9 seconds (95% CI, 2.1-11.6 seconds), which researchers said exceeded the minimum clinically important difference of 1.5 seconds.

Combined WMFT scores across all experimental groups improved by a mean of 4.1 seconds (95% CI, 1.4-6.8 seconds) at the 6-week period, compared with baseline. Scores for the sham group, by comparison, did not improve significantly.

Slutzky and colleagues also measured wrist kinematics relative to the shoulder during various reaching movements. By week 6, the 3D group improved range of motion significantly compared to the sham group in a sweep task (275 cm² difference; P = .03). Improvements were also seen in active range of motion during reaching forward (4.8 cm difference; P = .02), reaching vertically (7.4 cm difference; P = .01).

Researchers also followed up with patients 4 weeks after the end of treatment. At 10 weeks, improvements on WMFT included 9.4 seconds (95% CI, 4.6-14.1) for the 3D group, 5.8 seconds (95% CI, 1.2-10.4) for the 2D group, and 5.4 seconds (95% CI, 0.7-10.1) for the 2D reach group.

The 4 second improvement for the sham group at 10 weeks was not significant.

Moving forward

Slutzky told Healio that one of the benefits of MINT is accessibility.

“Many patients live in areas of the country that are underserved in terms of access to therapy and/or can’t afford therapy, or their insurance won’t pay for it, and so this may a way that they can do the therapy on their own,” he said.

He added that researchers are now working on refining the technology to make it more user-friendly and ready for clinical use, including by making it less cumbersome and simpler to set up.

The study, which began with 94 participants, saw 35 subjects drop out, with the main reasons being insufficient ability or desire to adhere to the protocol, and family or personal issues, according to the researchers.

Slutzky said the dropout rate should be considered in the broader context of stroke recovery, where nonadherence rates are very high for conventional therapy. One promising aspect of the MINT is that many of the subjects who did not drop out reported high enthusiasm and engagement when using the technology, he said, something that will be a major focus as newer versions are studied.

“We saw that patients did upwards of 315 repetitions per day, which is roughly 10 times what they would get from a typical therapy session,” Slutzky told Healio. “We think that's part of the reason that they improved.”

Two other trials are nearing completion, Slutzky said, one of which involves earlier examination of MINT’s effects on patients with stroke, when the brain is more plastic. Another trial involves combining MINT with a sleep-based intervention to try to enhance the learning effect, Slutzky said.

In addition, development is underway on a next-generation device that will be tested on reducing muscle co-activation in the legs.