Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system

Abstract

BackgroundThe effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients’ homes.MethodsAn open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time.ResultsAll subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. The weekly training duration did not change over the course of six weeks (p = 0.146). The arm function of these patients improved significantly by 4.1 points (p = 0.003) in the FMA-UE. Changes in the WMFT were not significant (p = 0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training.ConclusionsSelf-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching.Trial registrationUnique identifier: NCT02098135.

No Overt Effects of a 6-Week Exergame Training on Sensorimotor and Cognitive Function in Older Adults. A Preliminary Investigation

“…To date, the beneficial effects of exergames on fine motor skills have primarily been shown in clinical studies (Sin and Lee, 2013; Pietrzak et al, 2014; da Silva Ribeiro et al, 2015; Wittmann et al, 2016). For example, Paquin et al (2015) could show that a 15 min Wii-based training over 8 weeks enhanced upper limb fine motor performance in stroke patients, as assessed by the JTT which was also used in the present study.…”

Motor Task Performance under Visual and Auditory Feedback Post Stroke: A Randomised Crossover Trial

“…As referred above, there is only anecdotal evidence of the use of IMUs in rehabilitation tools, with only two studies focused on upper limb rehabilitation [23,24], the first being a case report and the second an open-label study involving eleven patients. Both studies addressed the viability and safety of IMU-based systems, as well as possible clinical benefits over the course of several sessions (7 in the case report and an average of 26.5 sessions in the open-label study).…”

“…Despite the high precision [18][19][20], IMUs have only been used so far to quantify and characterize movement patterns and effects of interventions in post-stroke patients [19][20][21], with only anecdotal evidence of their use in rehabilitation tools [22][23][24].…”

Persian Translation, Internal Consistency and Reliability of Wolf Motor Function Test

“…Median of time and sum of the scores are recorded as total score [8,9]. Implementation of WMFT required some equipment, including a medium size box, a 450-gram weight cuff, a drink can, a pencil, a plastic paper clip, a backgammon piece, index cards, lock and key, a standard face towel, a plastic handled basket, a template, a table and a chair, and a chronometer.…”

“…WMFT has so far been translated into French, German, and Korean. Hence, being a performance-based scale is not criteria to not translating it into another language [8][9][10].…”