Integrative rehabilitation of elderly stroke survivors: The design and evaluation of theBrightArm™

Abstract

Purpose To describe the development of the BrightArm upper extremity rehabilitation system, and to determine its clinical feasibility with older hemiplegic patients. Method The BrightArm adjusted arm gravity loading through table tilting. Patients wore an arm support that sensed grasp strength and communicated wirelessly with a personal computer. Games were written to improve cognitive, psychosocial and the upper extremity motor function and adapted automatically to each patient. The system underwent feasibility trials spanning 6 weeks. Participants were evaluated pre-therapy, post-therapy, and at 6 weeks follow-up using standardized clinical measures. Computerized measures of supported arm reach and game performance were stored on a remote server. Results Five participants had clinically significant improvements in their active range of shoulder movement, shoulder strength, grasp strength, and their ability to focus. Several participants demonstrated substantially higher arm function (measured with the Fugl-Meyer test) and two were less-depressed (measured with the Becks Depression Inventory, Second Edition). The BrightArm technology was well-accepted by the participants, who gave it an overall subjective rating of 4.1 on a 5 point Likert scale. Conclusions Given these preliminary findings, it will be beneficial to evaluate the BrightArm through controlled clinical trials and to investigate its application to other clinical populations.

Feasibility study of theBrightBrainer™ integrative cognitive rehabilitation system for elderly with dementia

“…Breakout 3D game was an adaptation of the game developed earlier by this group for unimanual training of stroke survivors on the BrightArm system [13]. The scene (Figure 3a) depicted an island with an array of crates placed in a forest clearing.…”

“…By contrast, Burdea and his group performed a feasibility study of integrative VR (cognitive and motor rehabilitation) on patients with advance-stage AD who were residents of an SNF dementia ward [12]. Unlike other studies which utilized a keyboard or joystick as the patient's interface with the simulation, this feasibility study employed the novel BrightArm rehabilitation table [13]. While the system was rather complex (low-friction motorized tilting table, computerized forearm support with grasp sensing, vision tracking and TV display), the three participants were able to utilize the BrightArm system while assisted by an occupational therapist.…”

A Rehabilitation First—Tournament Between Teams of Nursing Home Residents with Chronic Stroke

“…This high level of technology acceptance is in line with that found in an earlier study of elderly stroke survivors who were residents of the same SNF. 39 Although in the earlier study participants played individually, rather than in teams, and on an older version of the BrightArm, their overall system rating was still 4.1 out of 5.…”

Analysis of the concept of powerlessness in individuals with stroke

“…(30) It affects both body members with perceptible regions with spasticity and contractures making it difficult to reach and manage objects that causes an inoperable sense of less value. (34) The lack of social support and social participation are predictive factors for worse functional outcomes in the domains of cognition, mood and affectivity. (11,28,30,32,(34)(35)(36)(37)(38)(39) With this, family and community reintegration favors the process of linking and communicating, returning to work and participating in community recreational activities.…”

“…Thus, it is urged that rehabilitative practices should not be discontinued at discharge before the completion of three months (50) , and especially in the six weeks after the cerebrovascular event. (34) When the patient requires more than six months bigger are the rates of depression up to the third year associated with severe disability status. (46) The level of participation in rehabilitation worsens functional outcomes increasing the chance of developing depressive episodes.…”