Development of the Home based Virtual Rehabilitation System (HoVRS) to remotely deliver an intense and customized upper extremity training

Abstract

Background After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. Methods In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least 15 min every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. Results All subjects completed the study without any adverse events. Subjects on average spent 13.5 h using the system. Clinical and kinematic data were collected pre and post study in the subject’s home. Subjects demonstrated a mean increase of 5.2 (SEM = 0.69) on the Upper Extremity Fugl-Meyer Assessment (UEFMA). They also demonstrated improvements in six measurements of hand kinematics. In addition, a combination of these kinematic measures was able to predict a substantial portion of the variability in the subjects’ UEFMA score. Conclusion Persons with chronic stroke were able to use the system safely and productively with minimal supervision resulting in measurable improvements in upper extremity function.

Virtual Rehabilitation of the Paretic Hand and Arm in Persons With Stroke: Translation From Laboratory to Rehabilitation Centers and the Patient's Home

“…Our group's study of home based rehabilitation in persons with chronic stroke has demonstrated some interesting new trends. Adherence rates with these subjects has been comparable to other studies of technology supported, home based rehabilitation and better than traditional home based exercise programs in persons with stroke ( 64 , 65 ). Interestingly, age and previous computer experience did not have an impact on adherence ( 76 ), similar to findings of a recent home based rehabilitation study ( 77 ).…”

“…The camera-based system collects finger and arm position at a fidelity and speed that allows HoVRS to utilize real time algorithms to shape desired movement patterns. This high quality data also allows the system to provide kinematic data to therapists on or offline, allowing them to monitor and modify ‘patients’ rehabilitation programs remotely ( 64 ). Recent pilot study subjects demonstrated statistically and clinically significant improvements in hand motor performance as measured by clinical tests [mean UEMA improvement = 4.53 (SD = 2.3), Repeated Measures ANOVA ( p < 0.001)] ( 65 ).…”

“…Recent pilot study subjects demonstrated statistically and clinically significant improvements in hand motor performance as measured by clinical tests [mean UEMA improvement = 4.53 (SD = 2.3), Repeated Measures ANOVA ( p < 0.001)] ( 65 ). They also made statistically significant error reductions during sine wave tracing tasks controlled by hand opening, wrist extension and forearm pronation measured by the home rehabilitation system ( 64 ). These outcomes are comparable with other studies of technology supported home based rehabilitation ( 66 – 70 ).…”

Effect of Comprehensive Rehabilitation Training Program in Orthopedic Nursing of Patients with Residual Limb Injury Caused by Crush

“…Block et al [ 10 ] designed a single-finger exoskeleton training device based on three-dimensional (3D) printing technology, but it shows some disadvantages such as poor flexibility and high cost. Qiu et al [ 11 ] optimized the finger joint rehabilitation training device and initially realized remote rehabilitation, but it still showed the shortcomings of single system control and unstable performance, which has to be optimized further.…”

Sensing System for Plegic or Paretic Hands Self-Training Motivation

“…A similar system architecture was used by Adamovitch et al in a virtual reality-based exercise system for hand rehabilitation in which a web portal was set up for patient-database remote access, while patients used a VR-based application set up on a PC computer [ 10 ]. A current version of the system, described by Qiu et al, uses a LeapMotion controller with a series of games with real-time feedback by a virtual therapist while a remote web portal is set up for the clinicians and scientists to collect the data, guide patients, and select adequate exercises [ 28 ]. Authors reported high adherence to the training regime and improved patient scores in Fugl–Meyer assessment.…”