A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting

Abstract

Background Neuroscience and neurotechnology are transforming stroke rehabilitation. Robotic devices, in addition to telerehabilitation, are increasingly being used to train the upper limbs after stroke, and their use at home allows us to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of the MERLIN robotic system based on serious games for upper limb rehabilitation in people with stroke in the home environment. Methods 9 participants with a stroke in three different stages of recovery (subacute, short-term chronic and long-term chronic) with impaired arm/hand function, were recruited to use the MERLIN system for 3 weeks: 1 week training at the Maimonides Biomedical Research Institute of Cordoba (IMIBIC), and 2 weeks at the patients’ homes. To evaluate usability, the System Usability Scale (SUS), Adapted Intrinsic Motivation Inventory (IMI), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), and the ArmAssist Usability Assessment Questionnaire were used in the post-intervention. Clinical outcomes for upper limb motor function were assessed pre- and post-intervention. Results 9 patients participated in and completed the study. The usability assessment reported a high level of satisfaction: mean SUS score 71.94 % (SD = 16.38), mean QUEST scale 3.81 (SD = 0.38), and mean Adapted IMI score 6.12 (SD = 1.36). The results of the ArmAssist Questionnaire showed an average of 6 out of 7, which indicates that MERLIN is extremely intuitive, easy to learn and easy to use. Regarding clinical assessment, the Fugl-Meyer scores showed moderate improvements from pre- to post-intervention in the total score of motor function (p = 0.002). There were no significant changes in the Modified Ashworth scale outcomes (p = 0.169). Conclusions This usability study indicates that home-based rehabilitation for upper limbs with the MERLIN system is safe, useful, feasible and motivating. Telerehabilitation constitutes a major step forward in the use of intensive rehabilitation at home. Trial registration ClinicalTrials.gov, NCT04405609. Registered 06 January 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04405609

Recent trends in telerehabilitation of stroke patients: A narrative review

“…Findings demonstrated improvements in FMA and WMFT (p < 0.05), showed effectiveness of VR-based treatment in addition to CR, and a more pronounced effect regarding active range of motion of the proximal UE. Similar solution was obtained in a smaller study (Guillén-Climent et al, 2021), in which a single group of 9 patients (aged 41-89, MA 63.9) underwent 3-week training using TR system based on serious games, including a week of supervised training at the research institute, one more week of a homed-based supervised rehabilitation, and one week at home with remote supervision and support. The system contained a portable cost-effective robotic system ArmAssist (AA) based on exergames and the Antari Home Care platform for supervising, customizing, and managing TR remotely.…”

“…Multiple TR studies revealed improvements in FM and other tests related to motor recovery (Cramer et al, 2019;Hughes et al, 2019;Park et al, 2019;Perrochon et al, 2019;Rogers et al, 2019;Chen et al, 2020;Smith & Tomita, 2020;Qiu et al, 2020;Guillén-Climent et al, 2021;Szturm et al, 2021). Reviewed papers indicate TR is effective and comparable in clinical outcomes to CR for patients with motor function disorders.…”

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

“…The continuous feedback of the therapist during in-clinic training of a spastic limb is missing during classical home training. The visual information provided by EMG or sensor assessment helps the patient to perform the movements correctly and efficiently while also increasing their motivation [6,17,47].…”

A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

“…RT can enable patients to achieve a higher number of movement practice repetitions, a necessary element of neuroplasticity during recovery [ 3 , 4 ]. RT can increase motivation for therapy by providing physical assistance that allows patients to attempt and complete movements [ 5 – 7 ] or by incorporating gaming environments and quantitative feedback [ 8 ]. Finally, it can also reduce the need for providing continuous physical assistance or supervision to a patient, which can increase productivity or can increase patient access to therapeutic training [ 9 ].…”