Yes / Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after
stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in
domestic settings may enable an increased training dose of functional arm and hand training. The objective of this
study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand
training system at home for patients with chronic stroke.
Methods: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with
motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with
impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility
involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation
were assessed before and after six weeks of training and at two-month follow-up.
Results: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was
5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score
improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up
(40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training,
with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm
Test and Motor Activity Log.
Conclusions: Remotely monitored post-stroke training at home applying gaming exercises while physically
supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training
system independently at home. Usability shows potential, although several usability issues need further attention.
Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate
that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable
self-administered practice at home. Such an approach enables practice without dependence on therapist availability,
allowing an increase in training dose with respect to treatment in supervised settings. / The SCRIPT (Supervised Care & Rehabilitation Involving Personal Telerobotics) project was partly funded by the European Commission Seventh Framework Program under grant agreement no. FP7-ICT-288698.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/11020 |
| Date | 28 September 2015 |
| Creators | Nijenhuis, S.M., Prange, G.B., Amirabdollahian, F., Sale, P., Infarinato, F., Nasr, N., Mountain, Gail, Hermens, H.J., Stienen, A.H.A., Buurke, J.H., Rietman, J.S. |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Article, Published version |
| Rights | © 2015 Nijenhuis et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
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