Based on the RAHFT score achieved by the patient, certain games may be utilized over others to ensure best rehabilitation results:
RAHFT score: 0-20 (Clients with virtually no proximal range of motion and minimal distal function)
We encourage use of the affected limb by starting with forward and backward reaching games as well as left-right movement games with the hand positioned on one of the handles. The goal is to progress to games involving the gripper. Suitable games include Boxing, FreeRacer3D, Catcher, and Tennis.
RAHFT score: 15-40 (Clients with moderate proximal range of motion and minimal distal function due to spasticity)
In this case, overcoming flexor spasticity is the primary goal. Games such as Bullseye and Cupid’s Arrow, involving the gripper, are designed to encourage the user to relax and release grasp after each squeeze. No special emphasis should be put on training proximal range of motion as the games automatically lead the client into performing these naturally as part of game play.
RAHFT score: 30-65 (Clients with dexterous impairment but with reasonable proximal function)
Use games that require the individual to make numerous grasps and releases in a short period of time (Stack Attack, Bullseye). For lower functioning patients it may help initially to allow the less affected hand to help with the tasks presented (unless the methods of constraint-induced movement therapy are preferred). These games can be quite tiring, without the client always realizing it, so appropriate rest breaks should be suggested. Focus can also be on games that combine range of motion with dexterity. Using any range of motion game that requires little dexterity (such as driving with handles) is appropriate when the person starts to fade from the more challenging games.
RAHFT score: 40-65 (Clients with reasonable distal function but limited proximal function)
In this case, clients benefit mostly from tasks designed to increase their range of motion. Games that combine range of motion with a dexterous task are best (Weedo, Biplane). Shooting games (Bullseye, Cupid’s Arrow) work well as a starting point for more the more complex games. It is not uncommon that clients will fatigue quickly when playing games requiring a large range of motion. In these cases, range of motion games can be substituted for games requiring dexterous tasks, like Stack Attack and Freeracer (with doorknob control).
RAHFT score: 65+ (Clients with mild impairments)
Typically, high-functioning clients benefit most from dexterous tasks involving the ReJoyce key, doorknob, peg and coins while performing large movements of the proximal arm segments. High-functioning individuals will benefit most from games that challenge them, especially games that gradually increase speed, like Stack Attack. Games that require more complex movement patterns, like ReJoyce Bartender, are also effective.