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

• Type of Material: Article
• Authors: Susan M. Linder, Cleveland Clinic Foundation; Aimee Reiss, Emory University; Sharon Buchanan, Kinetic Muscles Inc.; Komal Sahu, Emory University; Anson Rosenfeldt, Cleveland Clinic Foundation; Cindy Clark, Cleveland Clinic Foundation; Steven Wolf, Emory University; Jay L. Alberts, Cleveland Clinic Foundation
• Language: English
• Date: 2013-09-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 Neurology Section, APTA.
• Final Published Version (URL): http://dx.doi.org/10.1097/NPT.0b013e31829fa808
• Title of Journal or Parent Work: Journal of Neurologic Physical Therapy
• ISSN: 1557-0576
• Volume: 37
• Issue: 3
• Start Page: 125
• End Page: 132
• Grant/Funding Information: This study was supported by RC3NS070646 from the National Institute of Neurological Disorders And Stroke.
• Keywords: Clinical Neurology; DEPRESSION SCALE; RANDOMIZED CONTROLLED-TRIAL; INDUCED MOVEMENT THERAPY; robotics; HEMIPLEGIC PATIENT; Life Sciences & Biomedicine; assistive technology; telerehabilitation; MOTOR FUNCTION-TEST; AMERICAN-HEART-ASSOCIATION; RELIABILITY; home exercise program; Neurosciences & Neurology; upper extremity; VALIDITY; CARE; Rehabilitation; Science & Technology; UPPER-EXTREMITY FUNCTION
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical

Abstract

BACKGROUND AND PURPOSE: After stroke, many individuals lack resources to receive the intensive rehabilitation that is 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 man, 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 of 66 on the Fugl-Meyer Assessment. 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, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 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 an 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 an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.