Incorporating Robotic-Assisted Telerehabilitation in a Home Program to Improve Arm Function Following Stroke

Abstract

Background and Purpose After stroke, many individuals lack resources to receive the intensive rehabilitation thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function. Case Description The participant was a 54 year-old male, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22/66 on the Fugl-Meyer Motor Assessment (FMA). Intervention The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period. Outcomes The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test (WMFT), and 20 points on the FMA, all of which surpassed the minimal clinically important difference (MCID). Of the 17 tasks of the WMFT, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his stroke recovery on the Stroke Impact Scale quality of life questionnaire from 40/100 to 65/100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points. Discussion This case demonstrates that robotic-assisted therapy paired with a HEP can be successfully delivered within a home environment to a person with stroke. Robotic assisted therapy may be a feasible and efficacious adjunct to a HEP program to elicit substantial improvements in upper extremity motor function especially in those persons with stroke who lack access to stroke rehabilitation centers. Video Abstract available (See Video, Supplemental Digital Content 1.) for more insights from the authors.

The HAAPI (Home Arm Assistance Progression Initiative) Trial

“…42 The primary outcome was the total change in score, from T 1 to T 2, of the affected UE on the Action Research Arm Test (ARAT). The ARAT consists of 19 tasks, which are categorized into 4 domains (grasp, grip, pinch, and gross movements).…”

Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

“…Prior to the study, clinical evaluations were performed by certified clinicians and physiatrist on all subjects to determine their impairment in their extremities, their functional disability, and their cognitive, and depression levels. All of the subjects were included in this study if they were 1) between 21 and 75 years; 2) had hemiparesis due to a cerebral vascular accident (CVA) stroke (confirmed by a physician); 3) were at least 6-months post-stroke and medically stable; 4) had the ability to sit for 60 min and to stand, assisted or unassisted, for 30–40 min; 5) had a score less than eight in the Geriatric Depression Scale [ 49 ] indicating mild depression and a likelihood of completing the 24 sessions required; 6) were no be more than moderately cognitively impaired as defined by a Mini-mental Test [ 41 ] score greater than 20--they were able to give consent and understand instructions; 7) had residual movement in shoulder flexion/adduction and active elbow flexion/extension and/or residual movement in leg flexion/extension and hip adduction as defined by a Brunnstrom Test Score [ 39 ] ranging from 2 to 5; and 8) had a muscle strength scores on the Manual Muscle Test [ 50 ] between >1 and <3 in both extremities. All of the subjects included in this study passed the inclusion criteria above.…”

“…Most robot-assisted therapy devices are expensive with cost greater than 50,000 to 100,000 USD for a single unit [ 32 ]. However, more recent affordable systems are being proposed for the home and rehabilitation facilities use such as Reha-Stim line of devices [ 38 , 39 ], TyroMotion’s Pablo® [ 40 ], Hand Mentor Pro™ from Kinetic Muscle, Inc. [ 41 ], and Haptic Knob [ 42 ] among others. In Germany, a suite of simple robots arranged in the ARM Studio was able to improve functional outcomes after stroke for patients in an inpatient rehabilitation center [ 43 ].…”

A Flexible and Integrated System for the Remote Acquisition of Neuropsychological Data in Stroke Research

“…In a handful of other studies, face-to-face training allowed individuals with neurogenic disorders to subsequently complete home treatment or rehabilitation. [37][38][39][40][41] One unmet challenge is the use of computerized test administration to acquire verbal responses, an essential capability for many language tests. 21,42 It is also unclear whether approaches of this type would be suitable for individuals with stroke, who may have language, cognitive, motor, and sensory impairments that limit the effectiveness and usability of computer-based testing.…”