Expanding stroke telerehabilitation services to rural veterans: a qualitative study on patient experiences using the robotic stroke therapy delivery and monitoring system program

Abstract

Telerehabilitation robotic devices can be used as a tool to extend effective, evidence-based and specialized rehabilitation services for upper and lower limb rehabilitation to rural Veterans with poor access to care. Implications for Rehabilitation Participants whose formal therapy services had ended either because they had exhausted their benefits or because traveling to outpatient therapy was too cumbersome due to distance were able to perform therapeutic activities in the home daily (or at least multiple times per week). Participants who were still receiving formal therapy services either in-home or in the clinic were able to perform therapeutic activities in the home on the days they were not attending/receiving formal therapy. Based on the feedback from these veterans and their caregivers, the manufacturing company is working on modifying the devices to be less cumbersome and more user-friendly (lighter-weight, more mobile, changing software, etc.), as well as more adaptable to participants' homes. Removing these specific barriers will potentially allow participants to utilize the device more easily and more frequently. Since participants expressed that they wished they could have the device in their homes longer than the 3-month usage period required for this pilot project, the project team is working on a proposal to extend this project to a wider area and the new paradigm would extend the usage period until the patient reaches a plateau in progress or no longer wants to use the device.

Perceptions of Existing Wearable Robotic Devices for Upper Extremity and Suggestions for Their Development: Findings From Therapists and People With Stroke (Preprint)

“…This reflects that even though people with stroke would agree to rely on assistive devices; still they want to feel independent while using such devices. Research conducted by Colleen O'Brien Cherry et al [38] resonated with our finding that users (people with stroke) reported that having a device that is easy to wear and to use is a crucial feature to accept a new assistive device. On contrast, both occupational and physical therapists did not mind to have complex devices to cover a larger spectrum of patients.…”

A qualitative study exploring views and experiences of people with stroke undergoing transcranial direct current stimulation and upper limb robot therapy

“…21 In contrast to tDCS, views and experiences of RT from people with stroke have been explored in three studies. 22,23,24 A small sample size of five participants with chronic stroke agreed that UL threedimensional RT was usable and that their arm felt stronger but not functionally improved. 23,24 Using observation and semi-structured interviews, ten participants with sub-acute and chronic stroke reported a home-based RT system was beneficial for their UL mobility, a positive outlet for releasing anxiety and increased their independence in activities of daily living and motivation.…”

“…23,24 Using observation and semi-structured interviews, ten participants with sub-acute and chronic stroke reported a home-based RT system was beneficial for their UL mobility, a positive outlet for releasing anxiety and increased their independence in activities of daily living and motivation. 22 Barriers of use included technical difficulties and challenges when wearing and adjusting the device. The robot involved in this study promoted two-dimensional wrist movements but not functional shoulder, elbow and hand movements.…”

A 3D printing approach toward targeted intervention in telerehabilitation

“…Low-cost gaming systems are increasingly being repurposed for applications in telerehabilitation, to deliver physical therapy to patients' homes and drive down the costs of treatment. Their affordability and portability can particularly benefit disadvantaged patient populations who cannot access quality medical care due to cost or geography [7][8][9] . By performing rehabilitative exercise at their convenience, patients can regain motor skills faster and accelerate their recovery toward reintegration into society.…”