Home-based Upper Extremity Stroke Therapy Using a Multiuser Virtual Reality Environment: A Randomized Trial

Thielbar, Kelly O.; Triandafilou, Kristen M.; Barry, Alexander; Yuan, Ning; Nishimoto, Arthur; Johnson, Joelle; Stoykov, Mary Ellen; Tsoupikova, Daria; Kamper, Derek G.

doi:10.1016/j.apmr.2019.10.182

Cited by 48 publications

(61 citation statements)

References 28 publications

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“…At the same time, considering motor skill learning, larger doses (longer therapeutic time or high frequency of repetition) of practice are expected to result in greater effectiveness of practice. A previous study with similar exercise intensity to the present study reported that four-weeks of home-based upper extremity gaming therapy improved upper limb function in patients with chronic stroke [46].…”

Section: Discussionsupporting

confidence: 77%

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

Chen

Lin

et al. 2021

J NeuroEngineering Rehabil

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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.

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Section: Discussionsupporting

confidence: 77%

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

Chen

Lin

et al. 2021

J NeuroEngineering Rehabil

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“…Surrogate measures of perseverance were reported for all quantitative (Adherence [28, 30, 31, 33, 35-38, 40, 43, 45-51, 53, 57, 58, 60, 64, 66-68], Dropouts [28, 31, 34, 36-38, 43, 44, 46, 49-51, 57, 58, 60, 62, 67, 68]) and mixedmethods studies (Adherence [29,32,41,42,55,56,61,63], Dropouts [41,61,63]). Factors perceived to influence perseverance were measured in 27 quantitative studies (Usability [50], Satisfaction [35,36,38,43,68], Motivation [34,40,44,45,50,51,64], UL Outcomes [28, 31, 33-38, 40, 43-51, 53, 57, 58, 60, 62, 64, 66-68]) and six mixed methods studies (Usability [56], UL Outcomes [29,41,42,55,56,63]).…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…Adherence with the prescribed dose was ≤ 50% in five studies [30,36,53,58,61], 51% to 74% in nine studies [38,40,47,48,50,51,56,57,68], 75% to 100% in 13 studies [28, 31-33, 37, 43, 45, 46, 55, 60, 63, 64, 66], ≥ 101% in six studies [29,35,41,42,49,67], and unreported in nine studies [10,34,39,44,52,54,59,62,65]. As duration of trials and frequency of sessions increased, adherence decreased (71% of four week trials [33,35,37,42,64] vs. 50% of 12 week trials had ≥ 75% adherence [41,43]; 71% of training 3-5 days/week trials [29,32,33,35,37,42,46,49,55,63,…”

Section: Characteristics Of Interventionsmentioning

confidence: 99%

Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review

Neibling

Jackson

Hayward

et al. 2021

J NeuroEngineering Rehabil

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Background Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies. Results Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks). Conclusion From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance. Registration: PROSPERO CRD42017072799—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72799

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“…Triandafilou and colleagues developed a 3 D, networked multi-user VR environment for home therapy after stroke where physically remote users are able to interact via avatars whose movements are controlled by the kinematics of the user, retrieved from Kinect cameras located in the home. 36,37 Their recent clinical trial indicated that stroke survivors were able to adhere to the rehabilitation treatment and that arm displacement during a session was a reasonable metric to track progress over the game. Challenges remain in the complexity of interacting within such systems.…”

Section: Sarsmentioning

confidence: 99%

The design of Lil’Flo, a socially assistive robot for upper extremity motor assessment and rehabilitation in the community via telepresence

Sobrepera

Lee

Johnson

2021

Journal of Rehabilitation and Assistive Technologies Engineerin

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Introduction We present Lil’Flo, a socially assistive robotic telerehabilitation system for deployment in the community. As shortages in rehabilitation professionals increase, especially in rural areas, there is a growing need to deliver care in the communities where patients live, work, learn, and play. Traditional telepresence, while useful, fails to deliver the rich interactions and data needed for motor rehabilitation and assessment. Methods We designed Lil’Flo, targeted towards pediatric patients with cerebral palsy and brachial plexus injuries using results from prior usability studies. The system combines traditional telepresence and computer vision with a humanoid, who can play games with patients and guide them in a present and engaging way under the supervision of a remote clinician. We surveyed 13 rehabilitation clinicians in a virtual usability test to evaluate the system. Results The system is more portable, extensible, and cheaper than our prior iteration, with an expressive humanoid. The virtual usability testing shows that clinicians believe Lil’Flo could be deployed in rural and elder care facilities and is more capable of remote stretching, strength building, and motor assessments than traditional video only telepresence. Conclusions Lil’Flo represents a novel approach to delivering rehabilitation care in the community while maintaining the clinician-patient connection.

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Home-based Upper Extremity Stroke Therapy Using a Multiuser Virtual Reality Environment: A Randomized Trial

Cited by 48 publications

References 28 publications

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

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

Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review

The design of Lil’Flo, a socially assistive robot for upper extremity motor assessment and rehabilitation in the community via telepresence

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