Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

Sharon M Nijenhuis, Gerdienke B Prange, Farshid Amirabdollahian, Patrizio Sale, Francesco Infarinato, Nasrin Nasr, Gail Mountain, Hermie J Hermens, Arno H A Stienen, Jaap H Buurke, Johan S Rietman, Sharon M Nijenhuis, Gerdienke B Prange, Farshid Amirabdollahian, Patrizio Sale, Francesco Infarinato, Nasrin Nasr, Gail Mountain, Hermie J Hermens, Arno H A Stienen, Jaap H Buurke, Johan S Rietman

Abstract

Background: 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.

Trial registration: This study has been registered at the Netherlands Trial Registry (NTR): NTR3669 .

Figures

Fig. 1
Fig. 1
Technology-supported training system. Left = training system in use at participant’s home, right = more detailed overview of specific components, a Computer containing user interface and games, b Touchscreen showing one of the games, c SaeboMAS, d SCRIPT wrist and hand orthosis
Fig. 2
Fig. 2
Individual results (colored lines) with group averages (dotted line) on user acceptance for a Training duration per week, c System Usability Scale and c Intrinsic Motivation Inventory
Fig. 3
Fig. 3
Individual (colored lines) and group (grey bars) results of the clinical scales for a Fugl-Meyer assessment, b Action Research Arm Test, c Motor Activity Log Amount of Use, d Motor Activity Log Quality of Movement and E Stroke Impact Scale. Abbreviations: FM = Fugl-Meyer, ARAT = Action Research Arm Test, SIS = Stroke Impact Scale, MAL = Motor Activity Log, T01 = baseline measurement pre-training, T08 = evaluation measurement post-training, T15 = two-month follow-up evaluation measurement. *Missing data Stroke Impact Scale: T01 N = 20, T08 N = 21, and T15 N = 19
Fig. 4
Fig. 4
Scatter plot of average training duration and changes in Action Research Arm Test score over training

References

    1. Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34(9):2181–6. doi: 10.1161/.
    1. Schaechter JD. Motor rehabilitation and brain plasticity after hemiparetic stroke. Prog Neurobiol. 2004;73(1):61–72. doi: 10.1016/j.pneurobio.2004.04.001.
    1. Krakauer JW. Arm function after stroke: from physiology to recovery. Semin Neurol. 2005;25(4):384–95. doi:10.1055/s-2005-923533.
    1. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225–39. doi: 10.1044/1092-4388(2008/018).
    1. Fisher BE, Sullivan KJ. Activity-dependent factors affecting poststroke functional outcomes. Top Stroke Rehabil. 2001;8(3):31–44. doi: 10.1310/B3JD-NML4-V1FB-5YHG.
    1. Hermens HJ, Vollenbroek-Hutten MMR. Towards remote monitoring and remotely supervised training. J Electromyogr Kinesiol. 2008;18(6):908–19. doi: 10.1016/j.jelekin.2008.10.004.
    1. Lupton D, Seymour W. Technology, selfhood and physical disability. Soc Sci Med. 2000;50(12):1851–62. doi: 10.1016/S0277-9536(99)00422-0.
    1. Burdea GC. Virtual rehabilitation—benefits and challenges. Methods Inf Med. 2003;42(5):519–23.
    1. Vugts CJ, van der Velden LFJ, Hingstman L, (NIVEL), van der Velde F, van der Windt W, (Prismant).Behoefteraming fysiotherapeuten 2002-2015. Utrecht: Nivel () 2003.
    1. Johansson T, Wild C. Telerehabilitation in stroke care—a systematic review. J Telemed Telecare. 2011;17(1):1–6. doi: 10.1258/jtt.2010.100105.
    1. Laver KE, Schoene D, Crotty M, George S, Lannin NA, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2013;12:CD010255.
    1. Fasoli SE, Krebs HI, Hogan N. Robotic technology and stroke rehabilitation: translating research into practice. Top Stroke Rehabil. 2004;11(4):11–9. doi: 10.1310/G8XB-VM23-1TK7-PWQU.
    1. Maciejasz P, Eschweiler J, Gerlach-Hahn K, Jansen-Troy A, Leonhardt S. A survey on robotic devices for upper limb rehabilitation. J Neuroeng Rehabil. 2014;11:3. doi: 10.1186/1743-0003-11-3.
    1. Prange GB, Jannink MJ, Groothuis-Oudshoorn CG, Hermens HJ, Ijzerman MJ. Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J Rehabil Res Dev. 2006;43(2):171–84. doi: 10.1682/JRRD.2005.04.0076.
    1. Kwakkel G, Kollen BJ, Krebs HI. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair. 2008;22(2):111–21. doi: 10.1177/1545968307305457.
    1. Mehrholz J, Hadrich A, Platz T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2012;6:CD006876.
    1. Basteris A, Nijenhuis SM, Stienen AH, Buurke JH, Prange GB, Amirabdollahian F. Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review. J Neuroeng Rehabil. 2014;11(1):111. doi: 10.1186/1743-0003-11-111.
    1. Lo AC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2010;362(19):1772–83. doi: 10.1056/NEJMoa0911341.
    1. Wagner TH, Lo AC, Peduzzi P, Bravata DM, Huang GD, Krebs HI, et al. An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke. 2011;42(9):2630–2. doi: 10.1161/STROKEAHA.110.606442.
    1. Klamroth-Marganska V, Blanco J, Campen K, Curt A, Dietz V, Ettlin T, et al. Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial. Lancet Neurol. 2014;13(2):159–66. doi: 10.1016/S1474-4422(13)70305-3.
    1. Balasubramanian S, Klein J, Burdet E. Robot-assisted rehabilitation of hand function. Curr Opin Neurol. 2010;23(6):661–70. doi: 10.1097/WCO.0b013e32833e99a4.
    1. Timmermans AA, Seelen HA, Willmann RD, Kingma H. Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design. J Neuroeng Rehabil. 2009;6:1. doi: 10.1186/1743-0003-6-1.
    1. Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med. 2009;52(3):269–93. doi: 10.1016/j.rehab.2008.10.003.
    1. Wisneski KJ, Johnson MJ. Quantifying kinematics of purposeful movements to real, imagined, or absent functional objects: implications for modelling trajectories for robot-assisted ADL tasks. J Neuroeng Rehabil. 2007;4:7. doi: 10.1186/1743-0003-4-7.
    1. Loureiro RC, Harwin WS, Lamperd R, Collin C. Evaluation of reach and grasp robot-assisted therapy suggests similar functional recovery patterns on proximal and distal arm segments in sub-acute hemiplegia. IEEE Trans Neural Syst Rehabil Eng. 2014;22(3):593–602. doi: 10.1109/TNSRE.2013.2265263.
    1. Jansen-Kosterink SM. The added value of telemedicine services for physical rehabilitation. Enschede: University of Twente; 2014.
    1. Amirabdollahian F, Ates S, Basteris A, Cesario A, Buurke J, Hermens H, et al. Design, development and deployment of a hand/wrist exoskeleton for home-based rehabilitation after stroke - SCRIPT project. Robotica. 2014;32(Special Issue 08):1331–46. doi: 10.1017/S0263574714002288.
    1. Ates S, Lobo-Prat J, Lammertse P, van der Kooij H, Stienen AH. SCRIPT Passive Orthosis: design and technical evaluation of the wrist and hand orthosis for rehabilitation training at home. IEEE Int Conf Rehabil Robot. 2013;2013:1–6.
    1. Ryan RM. Control and information in the intrapersonal sphere: an extension of cognitive evaluation theory. J Pers Soc Psychol. 1982;43(3):450–61. doi: 10.1037/0022-3514.43.3.450.
    1. McAuley E, Duncan T, Tammen VV. Psychometric properties of the Intrinsic Motivation Inventory in a competitive sport setting: a confirmatory factor analysis. Res Q Exerc Sport. 1989;60(1):48–58. doi: 10.1080/02701367.1989.10607413.
    1. Brooke J. SUS: A Quick and Dirty Usability Scale. In: Jordan PW, Thomas B, Weerdmeester BA, McClelland IL, editors. Usability Evaluation in Industry. London: Taylor & Francis. 1996.
    1. Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usability Stud. 2009;4(3):114–23.
    1. Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. Int J Hum Comput Interact. 2008;24(6):574–94. doi: 10.1080/10447310802205776.
    1. Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981;4(4):483–92. doi: 10.1097/00004356-198112000-00001.
    1. Carroll D. A quantitative test of upper extremity function. J Chronic Dis. 1965;18:479–91. doi: 10.1016/0021-9681(65)90030-5.
    1. Yozbatiran N, Der-Yeghiaian L, Cramer SC. A standardized approach to performing the action research arm test. Neurorehabil Neural Repair. 2008;22(1):78–90. doi: 10.1177/1545968307305353.
    1. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13–31.
    1. Deakin A, Hill H, Pomeroy VM. Rough guide to the Fugl-Meyer Assessment: upper limb section. Physiotherapy. 2003;89(12):751–63. doi: 10.1016/S0031-9406(05)60502-0.
    1. van der Lee JH, Beckerman H, Knol DL, de Vet HC, Bouter LM. Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients. Stroke. 2004;35(6):1410–4. doi: 10.1161/01.STR.0000126900.24964.7e.
    1. van de Port IGL, Leendes K, Sellmeijer D, Zuidgeest A, Kwakkel G. Betrouwbaarheids en concurrente validiteit van de Nederlandse Stroke Impact Scale 2.0 bij patienten met een CVA. Ned Tijdschrift Fysiotherapie. 2008;118(1):12–8.
    1. Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30(10):2131–40. doi: 10.1161/01.STR.30.10.2131.
    1. Luft AR, McCombe-Waller S, Whitall J, Forrester LW, Macko R, Sorkin JD, et al. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. JAMA. 2004;292(15):1853–61. doi: 10.1001/jama.292.15.1853.
    1. van der Lee JH, Beckerman H, Lankhorst GJ, Bouter LM. The responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients. J Rehabil Med. 2001;33(3):110–3. doi: 10.1080/165019701750165916.
    1. van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. 1999;30(11):2369–75. doi: 10.1161/01.STR.30.11.2369.
    1. Sivan M, Gallagher J, Makower S, Keeling D, Bhakta B, O’Connor RJ, et al. Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting. J Neuroeng Rehabil. 2014;11(1):163. doi: 10.1186/1743-0003-11-163.
    1. Coupar F, Pollock A, Legg LA, Sackley C, van Vliet P. Home-based therapy programmes for upper limb functional recovery following stroke. Cochrane Database Syst Rev. 2012;5:CD006755.
    1. Holden MK, Dyar TA, Schwamm L, Bizzi E. Virtual-environment-based telerehabilitation in patients with stroke. Presence: Teleoperators and Virtual Environments. 2005;14(2):214–33. doi: 10.1162/1054746053967058.
    1. Taub E, Lum PS, Hardin P, Mark VW, Uswatte G. AutoCITE: automated delivery of CI therapy with reduced effort by therapists. Stroke. 2005;36(6):1301–4. doi: 10.1161/01.STR.0000166043.27545.e8.
    1. Lum PS, Taub E, Schwandt D, Postman M, Hardin P, Uswatte G. Automated Constraint-Induced Therapy Extension (AutoCITE) for movement deficits after stroke. J Rehabil Res Dev. 2004;41(3A):249–58. doi: 10.1682/JRRD.2003.06.0092.
    1. Donoso Brown EV, McCoy SW, Fechko AS, Price R, Gilbertson T, Moritz CT. Preliminary investigation of an electromyography-controlled video game as a home program for persons in the chronic phase of stroke recovery. Arch Phys Med Rehabil. 2014;95(8):1461–9. doi: 10.1016/j.apmr.2014.02.025.
    1. Standen PJ, Threapleton K, Connell L, Richardson A, Brown DJ, Battersby S, et al. Patients’ use of a home-based virtual reality system to provide rehabilitation of the upper limb following stroke. Phys Ther. 2014;11:11.
    1. Amirabdollahian F, Loureiro R, Gradwell E, Collin C, Harwin W, Johnson G. Multivariate analysis of the Fugl-Meyer outcome measures assessing the effectiveness of GENTLE/S robot-mediated stroke therapy. J Neuroeng Rehabil. 2007;4:4. doi: 10.1186/1743-0003-4-4.
    1. Prange GB, Kottink AI, Buurke JH, Eckhardt MM, van Keulen-Rouweler BJ, Ribbers GM et al. The effect of arm support combined with rehabilitation games on upper-extremity function in subacute stroke: a randomized controlled trial. Neurorehabil Neural Repair. 2014. doi:10.1177/1545968314535985
    1. Stein J, Krebs HI, Frontera WR, Fasoli SE, Hughes R, Hogan N. Comparison of two techniques of robot-aided upper limb exercise training after stroke. Am J Phys Med Rehabil. 2004;83(9):720–8. doi: 10.1097/01.PHM.0000137313.14480.CE.
    1. Lum PS, Godfrey SB, Brokaw EB, Holley RJ, Nichols D. Robotic approaches for rehabilitation of hand function after stroke. Am J Phys Med Rehabil. 2012;91(11 Suppl 3):S242–54. doi: 10.1097/PHM.0b013e31826bcedb.
    1. Van Peppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: what’s the evidence? Clin Rehabil. 2004;18(8):833–62. doi: 10.1191/0269215504cr843oa.
    1. Burgar CG, Lum PS, Scremin AM, Garber SL, Van der Loos HF, Kenney D, et al. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. J Rehabil Res Dev. 2011;48(4):445–58. doi: 10.1682/JRRD.2010.04.0062.
    1. Kwakkel G. Impact of intensity of practice after stroke: issues for consideration. Disabil Rehabil. 2006;28(13–14):823–30. doi: 10.1080/09638280500534861.
    1. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke. 2004;35(11):2529–39. doi: 10.1161/01.STR.0000143153.76460.7d.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する