In chronic diseases, self-management is encouraged to maintain function. Some recent experimental findings highlights the relevant to blend botulinum toxin and exercises to increase benefits. Usually, self-management is on printed medium. Serious games on rehabilitation offer a new form of games that integrating from their conception the patient's needs. Gaming seems to increase compliance, repeatability and intensity, and can be organized without supervision. The purpose of this observational study is to consider feasibility of an intensive and autonomous exercise program intended for chronic post-stroke patients who regularly receive toxin injections with two different supports including serious game. The ethical committee of Rennes's University Hospital issued a favorable opinion for this study

The included subjects are chronic post-stroke patients with regular biceps brachii or pectoralis major toxin injections. They are encouraged to do a 3 months’ daily home-based program. Traditional booklet or serious game medium containing the same exercises are assigned after randomization. Assessed parameters are mobility (inclinometer), motricity (Held & Pierrot Scale), spasticity (modified Ashworth scale and Spasticity Impact Assessment), function (Fugel Mayer sale) satisfaction and motivation (Likert scale-based questionnaire).

Seventeen patients have been included. Seven patients had to withdraw (3 “booklet” and 4 “serious game”) due to shoulder pain in 6 cases. After 3 months, improvement of function (FM: +9.5%, P=0.01) and spasticity impact on abilities (SIA: +17,4%, P=0.02) were significant. Mobility also progress (Abd: +19,6%, NS). Concerning the medium, serious game may be more efficient than booklet (FM +12,3% vs. +6,2%; SIA+23,4% vs. +14,8%; abd: +22,4% vs. 14,8%). Serious games were still motivating after 3 months of use (83% of users). Satisfaction was also high (100%).

Despite encouraging outcomes, high rate of withdrawal makes us wonder about program's relevance, regarding intensity and patients’ profile. Concerning patients who left the program, initial mobility was 47% lower than for those who finished the study. As 4 patients in booklet group and 6 in serious game group have finished and regarding results, it may do not question the interest of this new medium. Obviously, further studies must be conduct.