Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports

Grigore Burdea, Nam Kim, Kevin Polistico, Ashwin Kadaru, Namrata Grampurohit, Jasdeep Hundal, Simcha Pollack, Grigore Burdea, Nam Kim, Kevin Polistico, Ashwin Kadaru, Namrata Grampurohit, Jasdeep Hundal, Simcha Pollack

Abstract

Background: BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games.

Objective: The aim of this study is to design and test a robotic rehabilitation table-based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase.

Methods: A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations.

Results: The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225% and 100% increase), grasp strength (27% and 16% increase), and pinch strength (31% and 15% increase). The shoulder flexion range increased by 17% and 18% and elbow supination range by 75% and 58%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale).

Conclusions: The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance.

Trial registration: ClinicalTrials.gov NCT04252170; https://ichgcp.net/clinical-trials-registry/NCT04252170.

Keywords: BrightArm Compact; BrightArm Duo; cognition; depression; gamification; integrative rehabilitation; subacute stroke; therapeutic game controller; upper extremity; virtual reality.

Conflict of interest statement

Conflicts of Interest: GB is the majority owner of Bright Cloud International, which developed the medical device described in this paper. GB and NK are coinventors on several US patents covering the BrightArm Compact device and its therapeutic games.

©Grigore Burdea, Nam Kim, Kevin Polistico, Ashwin Kadaru, Namrata Grampurohit, Jasdeep Hundal, Simcha Pollack. Originally published in JMIR Rehabilitation and Assistive Technology (https://rehab.jmir.org), 13.04.2022.

Figures

Figure 1
Figure 1
Robotic rehabilitation tables and controller: (A) the BrightArm Duo system, (B) the BrightArm Compact system training case 1, and (C) the BrightBrainer Grasp therapeutic game controller. Reprinted by permission of Bright Cloud International Corp.
Figure 2
Figure 2
A sample of integrative therapeutic games played during the BrightArm Compact study. Sequence, from left to right, shows game scenes at start, midgame, and end for (A) Treasure Island and (B) Towers of Hanoi 3D. Reprinted by permission of Bright Cloud International Corp.
Figure 3
Figure 3
Flowchart diagram of the case study protocol. Reprinted by permission of Bright Cloud International Corp. BAC: BrightArm Compact.
Figure 4
Figure 4
Game performance for the 2 participants early subacute phase after stroke training on the BrightArm Compact robotic rehabilitation table. Reprinted by permission of Bright Cloud International Corp.
Figure 5
Figure 5
Participants’ blood pressure progression over 12 BrightArm Compact rehabilitation sessions. Reprinted by permission of Bright Cloud International Corp.

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