Sensor-Based Arm Skill Training in Chronic Stroke Patients: Results on Treatment Outcome, Patient Motivation, and System Usability

Abstract

As stroke incidence increases, therapists' time is under pressure. Technology-supported rehabilitation may offer new opportunities. The objective of this study was to evaluate patient motivation for and the feasibility and effects of a new technology-supported task-oriented arm training regime (T-TOAT). Nine chronic stroke patients performed T-TOAT (2 x 30 min/day, four days/week) during eight weeks. A system including movement tracking sensors, exercise board, and software-based toolkit was used for skill training. Measures were recorded at baseline, after four and eight weeks of training, and six months posttraining. T-TOAT improved arm-hand performance significantly on Fugl-Meyer, Action Research Arm Test, and Motor Activity Log. Training effects lasted at least six months posttraining. Health-related-quality-of-life had improved significantly after eight weeks of T-TOAT with regard to perceived physical health, but not to perceived mental health (SF-36). None of the EuroQol-5D components showed significant differences before and after training. Participants were intrinsically motivated and felt competent to use the system. Furthermore, system usability was rated very good. However, exercise challenge as perceived by participants decreased significantly over eight weeks of training. The results of this study indicate that T-TOAT is feasible. Despite the small number of stroke patients tested, significant and clinically relevant improvements in skilled arm-hand performance were found.

Body-Worn Sensor Design: What Do Patients and Clinicians Want?

“…24 Finally, a study investigating the perceived usability of a sensor-based training system for stroke patients showed that the system's usability was rated to be good at the end of the training session, but did not mention any user preferences. 31 In general we found that the methods used in the studies often lacked validation and standardization. Many studies had relative small number of participants and provided a limited amount of data.…”

Effect of Mental Practice on the Improvement of Function and Daily Activity Performance of the Upper Extremity in Patients With Subacute Stroke: A Randomized Clinical Trial

“…It is not known to which extent patients were motivated to comply with the prescribed exercise regimen and to which extent the training content on offer managed to keep them motivated. In a previous clinical trial where patients with stroke performed technology-supported, task-oriented arm training, 42 patients found that the exercises that were provided (n ¼ 22) were insufficient in number and in the challenge level to keep them motivated for prolonged training. Future research should focus on the identification of the number and variability of exercises that is needed to serve average patients' needs and to keep patients motivated for extensive exercise repetition and sufficient duration.…”

European Portuguese Validation of Usefulness, Satisfaction and Ease of Use Questionnaire (USE)

“…For example, it has been utilized to evaluate technologies in the health care domain (e.g. evaluation of rehabilitation equipment for patients with stroke [9], robotics applied to rehabilitation [10], personal health records [11,12], prevention applications [13][14][15], tools to support diagnostic [16] or informal caregivers empowerment [17]), applications to browse the contents of maps [18] or videos [19], social networking sites [20], elearning environments [21,22], tools to support engineering work [23], virtual reality [15], remote labs management [24] or visualization of ontologies [25].…”