Rehab CARES In USA: Clinical Trial

Rehabilitation Using Community-Based Affordable Robotic Exercise Systems (Rehab CARES)

In Phase 2, Patients in a community-based setting who have had a stroke will be evaluated by rehabilitation professionals and asked to perform a battery of clinical assessments before and after standard of care and robot assisted therapy with Rehab CARES system of simple force-feedback robots that are adapted to deliver single and group therapy.

Study Overview

• Status: Completed
• Conditions: Stroke; Hemiplegia
• Intervention / Treatment: Other: Standard of Care; Device: Robot-Assisted Therapy with Rehab CARES system

Detailed Description

In Phase 2, we will develop the hardware to allow three haptic robots to dock (a gym) and be configured to allow patients to play therapy games alone or collaboratively. We will test the safety and feasibility of the gym in a community-based rehabilitation setting. We will treat 36 patients randomized to either a control group getting standard of care therapy and a robot group receiving standard of care with upper limb therapy being given using the robot gym instead of an occupational therapist. Therapy will occur over 4 weeks with two follow-up assessments. Key milestones will be to show that the robot group has the same or better functional outcomes, motivation, and adverse events as the control group. Also to show that the robot gym is a cost-effective solution to increasing access to quality rehabilitation care in low-resource, community-based settings. Success here will validate this potential solution, justify design changes revealed via user-feedback and a larger clinical trial.

• Study Type: Interventional
• Enrollment (Actual): 27
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19146
      • Penn Medicine Rittenhouse
    • Philadelphia, Pennsylvania, United States, 19145
      • Mercy Living Independently for Elders (L.I.F.E) - West Philadelphia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 55 and older (based on who is admitted to the CBR site)
• >3 months post-stroke
• Stroke diagnosis
• Diagnosis of hemiparesis as a result of stroke (verified by radiology data)
• Motor control score on Upper Extremity Fugl-Meyer scale > 15 and < 60;
• Able to understand and speak
• Upper arm manual muscle strength scores >1
• Pain Scores < 8 based on NIH Pain Intensity Scale

Exclusion Criteria:

• no cerebellum lesions due to stroke
• severe cognitive function

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Standard of Care; 60 min OT sessions; 3 sessions per week; for 4 weeks;-- augmented Standard therapy - consisting of PT, OT and SLP. Clinical Assessment (B1-pre, B2-post, B3-follow-up#1, B4-follow-up#2).	Other: Standard of Care; 60 min sessions; 3 sessions per week; for 4 weeks of OT, PT, and SLP
Experimental: Robot-Assisted Therapy with Rehab CARES system; 60 min sessions; 3 sessions per week; for 4 weeks;----of Upper Limb therapy using 1 or more affordable robots. Robot sessions can be group play and/or single play. Robot Assessment (B1-pre, B2-post, B3-follow-up#1, B4-follow-up#2)	Device: Robot-Assisted Therapy with Rehab CARES system; 60 min sessions; 3 sessions per week; for 4 weeks; Patients uses 1 or more affordable robots to exercise the UL with adaptive games assessments as OT; standard of care PT and SLP; Subjects' motor and cognitive impairment will be used to set the game and modes. The game parameters will be adjusted according to motor and cognitive impairment of that station's user while the controller will automatically adjust assisting or resisting torques experienced. The 60 minutes will be broken up into 15-minute training intervals.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Motivation	Measured by the Self-Assessment Manikin (SAM) scale which consist of 3 subscales: enjoyment, engagement, and control. Each subscale is from 0 to 9. For enjoyment and engagement the higher score is the better and for control the lower score is better.	at pre, at post-intervention (after 12 sessions), at follow-up
Motor Control	Measured by Upper Extremity Fugl-Meyer Assessment (UE-FM); scale is out of 66. A lower score means more impaired.	After 12 sessions (post-pre), after follow-up at 4 weeks (post-follow-up)
Gross Hand Function	Measured by Box and Block (BnB) Test; metric # of blocks transferred. A higher score means less impaired.	After 12 sessions (post-pre), after follow-up at 4 weeks (post-follow-up)
Hand Dexterity	Measured by NIH Toolbox 9-Hole Pegboard Dexterity Test; metric time and # of peg transferred over time. A higher number of pegs means less impaired.	After 12 sessions (post-pre), after follow-up at 4 weeks (post-follow-up)
Upper Extremity Function	Measured by Neuro-QoL: Upper Extremity Function - Fine Motor, ADL Short Form. Short form is a self-report on 8 items to assesses fine motor function and activity of daily living in upper arm.	at pre, at post-intervention (after 12 sessions), at follow-up
Quality of life (Participation)	Measured by Neuro-QoL: Ability to Participate in Social Role and Activities Short Form.	at pre, at post-intervention (after 12 sessions), at follow-up
Quality of life (Satisfaction)	Measured by Neuro-QoL Satisfaction with Social Roles and Activities Short Form.	at pre, at post-intervention (after 12 sessions), at follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Spatial Attention	Measured by changes in Color Trails 1.A timed trail making assessment. A faster time result is better. Timed results are normalized by age and education and reported as a normalized z-score.	at pre, at post-intervention (after 12 sessions), at follow-up
Executive Function	Measured by performance on Color Trails 2. A timed trail making assessment. A lower time is better. Timed results are normalized by age and education and reported as a normalized z-score.	at pre, at post-intervention (after 12 sessions), at follow-up
Active Joint Range of Motion (ROM)	Range of Motion joint testing of the upper limb. Subjects shoulder, elbow, and wrist joint active joint movements are evaluated in the impaired arm. Reported in degrees.	at pre, at post-intervention (after 12 sessions), at follow-up
Passive Joint Range of Motion (ROM)	Range of Motion joint testing of the upper limb. Subjects shoulder, elbow, and wrist joint passive joint movements are evaluated in the impaired arm. Reported in degrees.	at pre, at post-intervention (after 12 sessions), at follow-up
Grip Strength	Measured by NIH toolbox Grip Strength Test. The amount of pound-force is measured. The higher pound-force is better.	at pre, at post-intervention (after 12 sessions), at follow-up
Exertion Level	Measured by score on Borg Exertion Scale. Score is from 0 to 10. 0 is low and 10 is max. Subjects are asked to report pain experienced during a 60 minute session. Exertion between 0 and 6 is expected.	at each of 12 therapy sessions
Pain Level	Measured by score on Visual Analog Pain Scale. Patients indicate a pain score is from 0 to 10. 0 is low and 10 is max. Subjects are asked to report pain experienced during a 60 minute session. Pain < 4 is expected.	at each of 12 therapy sessions
Usability	Measured by score on System Usability Scale. Score is from 0 to 100. 0 is low and 100 is max. A score greater than or equal to 68 is ideal.	at pre, at post-intervention (after 12 sessions), at follow-up
Work Load	Measured by NASA TLX Task Demand Scale. The scale consist of 6 questions scored on a likert scale of 0 to 21. The responses are processed to define a workload score. A workload score at or above 37 which is MOD-HIGH is expected.	at pre, at post-intervention (after 12 sessions), at follow-up
Cognition	Measured by Montreal Cognitive Assessment (MocA)	After 12 sessions (post-pre), after follow-up at 4 weeks (post-follow-up)

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Collaborators: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Recupero Robotics LLC; Mercy Living Independently for Elders (LIFE) - West Philadelphia (Trinity Health Pace); enAble Games LLC
• Investigators: Principal Investigator: Michelle J Johnson, PhD, University of Pennsylvania; Principal Investigator: Alwyn Johnson, MS, Recupero Robotics LLC

Publications and helpful links

General Publications

• Azar RM, Sobotka NS, Cacchione P, Mendonca RJ, Johnson MJ. Evaluating the Relationship Between Motor and Cognitive Impairment and Lesion Size and Location Post-Stroke Using CT Scans. IEEE Int Conf Rehabil Robot. 2025 May;2025:1467-1472. doi: 10.1109/ICORR66766.2025.11063052.
• Shang Y, Bahrami S, Gaardsmoe S, Johnson A, Johnson MJ, Diefenbach P. General Purpose Haptic/Biometric-Based Dynamic Difficulty Adjustment for Post-Stroke Upper-Limb Rehabilitation Games. IEEE Int Conf Rehabil Robot. 2025 May;2025:248-253. doi: 10.1109/ICORR66766.2025.11062998.
• Waters EL, Johnson MJ. Motor Learning in Robot-Based Haptic Dyads: A Review. IEEE Trans Haptics. 2024 Oct-Dec;17(4):510-527. doi: 10.1109/TOH.2024.3379035. Epub 2024 Dec 19.
• Waters EL, Mendonca RJ, Cacchione PZ, Johnson MJ. TheraDyad: Feasibility of an Affordable Robot for Multi-User Stroke Rehabilitation. Proc IEEE RAS EMBS Int Conf Biomed Robot Biomechatron. 2024 Sep;2024:1498-1503. doi: 10.1109/biorob60516.2024.10719912. Epub 2024 Oct 23.
• Waters EL, Azar R, Opong-Duah J, Gaardsmoe S, Johnson A, Mendonca RJ, Cacchione PZ, Johnson MJ. Towards an Optimal Model of Post-Stroke Sensorimotor Control. IEEE Int Conf Rehabil Robot. 2025 May;2025:1313-1319. doi: 10.1109/ICORR66766.2025.11063066.
• Meng NY, Waters EL, Lin G, Gaardsmoe S, Johnson A, Hallock LA, Mendonca RJ, Cacchione PZ, Johnson MJ. Analysis of Induced Muscle Activations by an Affordable, Reconfigurable Robot for Comprehensive Post-Stroke Rehabilitation. IEEE Int Conf Rehabil Robot. 2025 May;2025:1361-1367. doi: 10.1109/ICORR66766.2025.11063060.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2022
• Primary Completion (Actual): August 30, 2025
• Study Completion (Actual): August 30, 2025

Study Registration Dates

• First Submitted: September 6, 2022
• First Submitted That Met QC Criteria: September 13, 2022
• First Posted (Actual): September 15, 2022

Study Record Updates

• Last Update Posted (Actual): September 3, 2026
• Last Update Submitted That Met QC Criteria: August 28, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Paralysis; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Stroke; Hemiplegia; Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: 853607; R42HD104325 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

It is a priority of the research team to share primary data collected as a result of this project with other researchers and the National Institute of Health and associated funding agents. Findings will be disseminated within a reasonable time via newsletters sponsored by the institutions involved, peer-reviewed conference papers and journals. All journal papers will be placed on PubMed and made publically accessible. All acknowledgements will clearly define the funding agency and follow guidelines stipulated by the NIH. Copies of all publications will provided promptly. All copyright procedures will comply with the standard of NIH copyright clause.

After study completion, de-identified data sets will be available to NIH and to other investigators contingent on the execution of relevant institutional data use agreements.

• IPD Sharing Time Frame: Within 2 years of project end
• IPD Sharing Access Criteria: Those wishing to see protocol and ICF will need to contact study PI
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No