Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study

Shih-Ching Chen, Chueh-Ho Lin, Sheng-Wen Su, Yu-Tai Chang, Chien-Hung Lai, Shih-Ching Chen, Chueh-Ho Lin, Sheng-Wen Su, Yu-Tai Chang, Chien-Hung Lai

Abstract

Background: Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation.

Methods: In this prospective case-control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category.

Results: Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70).

Conclusion: The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

Keywords: Balance; Berg Balance Scale; Randomized controlled trial; Stroke; Telerehabilitation.

Conflict of interest statement

All authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Architecture of the bidirectional telerehabilitation system. This system links a main controller side for therapists and an end-user side for stroke survivors with chronic stroke by wireless sensor network technologies. Both sides have a peripheral component interconnect (PCI) network card. A cloud database center allows therapist to monitor the gaming exercises by stroke survivors instantly or review performance data later
Fig. 2
Fig. 2
Design of the target-oriented stepping task. Participants underwent the interactive target-oriented stepping task according to the falling objects on the television screen (a). Participants raised their legs according to the falling objects on the monitor (b)
Fig. 3
Fig. 3
Diagram of the multidirectional reaching task. Participants performed the multidirectional reaching task in front of the monitor (a). They were instructed to reach toward a given target in eight directions according to a random cue (b)
Fig. 4
Fig. 4
Design of the Tai Chi exercises. Participants underwent the interactive Tai Chi exercises by imitating motions of avatar on the screen (a). Avatar representations of participants’ movements were displayed on the monitor (b)
Fig. 5
Fig. 5
Experimental flow diagram. Thirty participants with chronic stroke were randomly assigned to experimental and control groups. Participant performance was assessed before and after the 4-week intervention

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