Post-stroke Robotic Upper-Limb Telerehabilitation Using Serious Games to Increase Patient Motivation: First Results from ArmAssist System Clinical Trial

J NeuroEngineering Rehabil

et al. 2021

Self Cite

Background HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). Methods Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation. Results Twelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements. Conclusion Patients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18–02-2019, https://www.trialregister.nl/trial/7535.

Section: Introductionmentioning

confidence: 99%

HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke

Rozevink

Sluis

J NeuroEngineering Rehabil

et al. 2021

Self Cite

“…In this study a robotic tele-rehabilitation system based on serious games has been brought to stroke patient's home to be tested. This is the rst time that this system has been tested in a home environment, because previously it was tested in clinical setting (24,18,27).…”

Section: Discussionmentioning

confidence: 99%

“…The system is composed by the ArmAssist (AA) cost-effective robotic system based on serious games developed by TECNALIA, and the Antari Home Care platform (21) to supervise, organize and customize the patients' daily training remotely, which has been developed by GMV (22). The AA system is a modular solution which includes an affordable and portable robotic device for an upper limb complete rehabilitation, and a software platform based on serious games for the patients engagement and training assessment (18). The AA robotic device can measure the patient's self-directed active movements which are performed on a mat put on a regular table thanks that the robotic system includes different sensors (see Fig.…”

Section: The Merlin Robotic-assisted Telerehabilitation Systemmentioning

confidence: 99%

“…On the other hand, game-based telerehabilitation combined with robotic systems have created a motivating and engagement environment for patients (17). Serious games designed speci cally for the tasks to be performed can increase the quality and quantity of the therapy due to an enjoyable environment (18). The purpose of this manuscript is to present the usability validation of MERLIN robotic system based on serious games for the upper limb rehabilitation in patients with a stroke brought to homes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Usability Study in Patients With Stroke Using MERLIN, a Robotic System Based on Serious Games for Upper Limb Rehabilitation in Home Setting

Guillén-Climent

Muñoz-Alcaraz

et al. 2020

Preprint

Background: Neuroscience and neurotechnology are changing stroke rehabilitation. Robotic devices as well as telerehabilitation have become of great interest and are increasingly being used to train the upper extremities after stroke. Its use in home settings allows to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of MERLIN robotic system based on serious games for the upper limb rehabilitation in stroke patients in a home environment.Methods: 12 participants with a stroke in three different stages of evolution (subacute, chronic of short evolution and long-term chronic) with impaired arm/hand function were recruited to use the MERLIN system for 3 weeks: one week of training at the Maimonides Biomedical Research Institute of Cordoba (IMIBIC), and 2 weeks at patients’ home. Evaluation of usability involved System Usability Scale (SUS), Adapted Intrinsic Motivation Inventory (IMI), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), and ArmAssist Usability Assessment Questionnaire which were evaluated post-intervention. Clinical outcomes on upper extremity motor function were assessed pre- and post-intervention.Results: Finally, 9 patients participated in the study, 3 drop-off due to the COVID-19. The usability assessment reported a high level of satisfaction: mean SUS score was 71.94 % (SD=16.38), mean QUEST scale was 3.81 (SD=0.38), and mean IMI score was 6.12 (SD=1.36). The results of the ArmAssist Questionnaire was an average of 6 out of 7, which indicates that MERLIN is easy to learn, easy to use and intuitive. Regarding clinical assessment, Fugl-Meyer scores showed moderated improvements from pre- to post-intervention in the total score of motor function (p = 0.002). There were no significative changes in Modified Ashworth scale outcomes (p = 0.169) Conclusions: This usability study indicates that home-based rehabilitation for upper limb with MERLIN system is safe, useful, feasible and motivating. The telerehabilitation suppose an important step towards an intensive rehabilitation to be bring to home.Trial registration: ClinicalTrials.gov, NCT04405609. Registered 06 January 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04405609

“…What is more, the combination of game-based telerehabilitation and robotic systems creates a motivating, engaging environment for patients (17). The enjoyment patients derive from playing these so called 'serious games', designed speci cally for the rehabilitation tasks, can greatly increase the quality and quantity of the therapy delivered (18).…”

Section: Introductionmentioning

confidence: 99%

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

Guillén-Climent

Muñoz-Alcaraz

et al. 2021

Preprint

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: one 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