Feasibility of integrative games and novel therapeutic game controller for telerehabilitation of individuals chronic post-stroke living in the community.

The sample size was very small (n=7 completers), resulting in low statistical power and an inability to control for multiple comparisons. The study lacked a control group, making it impossible to determine if improvements were due to the specific intervention or other factors like natural recovery or placebo effects. There was a significant conflict of interest, as the system's developer owned the company selling the device. The participant sample had an unusually high rate of spasticity (86%), which is not representative of the general chronic stroke population, limiting generalizability. Technical problems were frequent, particularly with the use of standard VIVE controllers by participants with spastic hands, which may have affected engagement and data accuracy. The four-week duration may have been too short to observe significant motor recovery, as suggested by the authors.

One of the authors, Grigore Burdea, is the owner of Bright Cloud International Corp, the company that developed the BrightBrainer system used in the study. The system is a commercially available medical device.

Do not interpret the significant improvements in self-reported function and depression as evidence that this system produces clinically meaningful motor recovery. The primary objective measure of arm function (Fugl-Meyer) did not change significantly, and the study was too small and short to draw firm conclusions about efficacy.