Remote Assessment of Post-Stroke Elbow Function Using Internet-Based Telerobotics: A Proof-of-Concept Study

Abstract

Purpose: Upper limb hemiparesis is the most common impairment in stroke survivors, and adequate assessment is crucial for setting the rehabilitation strategy and monitoring the effect of treatment. However, adequate timely assessments are difficult due to the limited accessibility to clinics for stroke survivors. We designed this study to investigate whether teleassessments for motor impairments of the spastic elbow (i.e., passive range of motion (PROM), muscle strength, and spasticity) are feasible in stroke survivors.Methods: To implement a telerobotic system for remote assessment with physical interaction, we constructed a system with a master robot interacting with a doctor (assessor) and a slave robot interacting with the elbow of a subject with stroke. The master robot is operated by the doctor, where the torque and the speed are transferred to the slave robot via the Internet, and the reaction of the patient's elbow to the slave robot's movement is measured with a torque sensor, then finally transferred back to the master robot. An intercontinental remote assessment, which is considered one of the worst possible scenarios, was used as a clinical test to strictly check the feasibility. For the clinical tests, the examiner for the teleassessment was located at a lab in the National Institutes of Health (NIH, Bethesda, MD, USA) while the stroke patients were located at Seoul National University Bundang Hospital (Bundang, Kyeonggido, South Korea).Results: In total, 12 stroke patients' elbows (age range, 28–74; M:F = 6:6) were tested. For the PROM, the absolute difference between two assessments (in-person vs. remote) was 5.98 ± 3.51° on average (range, 0–11.2). The agreements for the strength and the spasticity of elbow flexor between in-person and remote assessments were substantial (k = 0.643) and fair (k = 0.308), respectively. No adverse events were observed during or immediately after the telerobotic assessment.Conclusions: Internet-based telerobotic remote assessment for motor impairment of spastic elbow in stroke using our system is feasible even in the worst setting, with too long of a distance and a delayed communication network.

Recent trends in telerehabilitation of stroke patients: A narrative review

“…Other challenges mean insufficient internet capacity and speed requiring for TR, especially among Chen et al, 2020;Cramer et al, 2019;Escalante-Gonzalbo et al, 2021;Guillén-Climent et al, 2021;Jonghyun Kim et al, 2020;Park et al, 2019;Qiu et al, 2020;Rogers et al, 2019;Sarfo, Adusei, et al, 2018;Smith & Tomita, 2020;Szturm et al, 2021;Thielbar et al, 2020; (Faria et al, 2020;Gil-Pagés et al, 2018;Isernia et al, 2019;Lawson et al, 2020;Torrisi et al, 2019;Withiel et al, 2019) Aphasia/linguistic communication disorders Chronic 236 30-120 1-6 4-24 20-100 (Braley et al, 2021;Cherney et al, 2021;Dial et al, 2019;E. S. Kim et al, 2021;Kurland et al, 2018;Maresca et al, 2019;Meltzer et al, 2018;Øra et al, 2020;Peñaloza et al, 2021;Uslu et al, 2020) Total: 995 15-120 1-7 1-24 1.25-100 patients living in homes with different infrastructure.…”

“…Currently, therapists are unable to provide hands on guidance, and thus, patients must rely on verbal instructions and visual demonstrations to understand the TR exercises. However, using remote haptic therapist-patient interactions with exoskeletons and robots might help to achieve promising outcomes in the future (Baur et al, 2019;Jonghyun Kim et al, 2020).…”

Quantitative assessment of spasticity: a narrative review of novel approaches and technologies

“…Kim et al discovered that the agreements for the strength and the spasticity of elbow flexor between in-person and remote assessments were substantial (kappa = 0.643) and fair (kappa = 0.308), respectively ( 110 ). De Donno et al showed that tele-evaluation of spasticity is inadequate and only 7.3% of patients can be accessed, as it involves a lot of ethical, medico-legal and technical issues ( 111 ).…”

Application of digitization and visualization-based muscle strength measurement in ischemic stroke patients with motor dysfunction

“…The implementation of suitable secondary prevention measures assumes paramount importance in enhancing the health outcomes of individuals recovering from a stroke. Moreover, upper limb hemiparesis emerges as the prevailing disability among stroke survivors 17 . Thus, timely assessment of muscle strength holds critical significance for early evaluation, treatment efficacy monitoring, and post-stroke rehabilitation 18 .…”