Telerehabilitation Initiated Early in Post-Stroke Recovery: A Feasibility Study

Abstract

Background Enhanced neural plasticity early after stroke suggests the potential to improve outcomes with intensive rehabilitation therapy. Most patients do not get such therapy, however, due to limited access, changing rehabilitation therapy settings, low therapy doses, and poor compliance. Objective To examine the feasibility, safety, and potential efficacy of an established telerehabilitation (TR) program after stroke initiated during admission to an inpatient rehabilitation facility (IRF) and completed in the patient’s home. Methods Participants with hemiparetic stroke admitted to an IRF received daily TR targeting arm motor function in addition to usual care. Treatment consisted of 36, 70-minute sessions (half supervised by a licensed therapist via videoconference), over a 6-week period, that included functional games, exercise videos, education, and daily assessments. Results Sixteen participants of 19 allocated completed the intervention (age 61.3 ± 9.4 years; 6 female; baseline Upper Extremity Fugl–Meyer [UEFM] score 35.9 ± 6.4 points, mean ± SD; NIHSS score 4 (3.75, 5.25), median, IQR; intervention commenced 28.3 ± 13.0 days post-stroke). Compliance was 100%, retention 84%, and patient satisfaction 93%; 2 patients developed COVID-19 and continued TR. Post-intervention UEFM improvement was 18.1 ± 10.9 points ( P < .0001); Box and Blocks, 22.4 ± 9.8 blocks ( P = .0001). Digital motor assessments, acquired daily in the home, were concordant with these gains. The dose of rehabilitation therapy received as usual care during this 6-week interval was 33.9 ± 20.3 hours; adding TR more than doubled this to 73.6 ± 21.8 hours ( P < .0001). Patients enrolled in Philadelphia could be treated remotely by therapists in Los Angeles. Conclusions These results support feasibility, safety, and potential efficacy of providing intense TR therapy early after stroke. Clinical Trial Registration: clinicaltrials.gov; NCT04657770

Neurotechnology-based intensive upper-extremity supplementary training for inpatients with sub-acute stroke: A feasibility study

“…Substantial improvement was reported in all motor outcome measures. This improvement was larger in comparison to other reported recovery measures 13,14,41 . A new study showed that adding 30 hours of upper extremity training resulted in better motor improvement than standard of care alone 16 .…”

“…Another suggested avenue is to expand this protocol in time and to include a telerehabilitation component. Although this type of rehabilitation is relatively new, it has been shown to be feasible 41 . Therefore, we suggest further studies regarding the implementation of high dosage and intensity with a such a component.…”

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

“…The majority (86/103, 83%) [ 47 - 51 , 53 - 56 , 58 , 59 , 61 , 63 - 68 , 71 - 86 , 89 - 95 , 97 - 105 , 107 , 109 , 111 , 112 , 114 , 115 , 117 - 126 , 128 - 136 , 138 - 148 ] were published in the past 10 years. Most studies took place in North America (41/103, 40%) [ 46 - 49 , 52 , 55 , 56 , 60 , 64 - 67 , 69 , 70 , 72 , 74 , 76 - 78 , 80 , 85 - 88 , 92 , 93 , 97 , 99 , 101 , 108 - 110 , 126 - 129 , 137 , 138 , 141 , 142 , 145 ] and Europe (35/103, 34%) [ 51 , 53 , 54 , 57 , 58 , 62 , 63 , 68 , ...…”

“…Most studies took place in North America (41/103, 40%) [ 46 - 49 , 52 , 55 , 56 , 60 , 64 - 67 , 69 , 70 , 72 , 74 , 76 - 78 , 80 , 85 - 88 , 92 , 93 , 97 , 99 , 101 , 108 - 110 , 126 - 129 , 137 , 138 , 141 , 142 , 145 ] and Europe (35/103, 34%) [ 51 , 53 , 54 , 57 , 58 , 62 , 63 , 68 , 71 , 79 , 81 - 84 , 89 , 111 , 113 - 125 , 132 , 136 , 140 , 143 , 146 , 147 ], with the remainder in Asia (16/103, 16%) [ 50 , 59 , 61 , 91 , 94 , 95 , 98 , 100 , 102 - 104 , 107 , 135 , 139 ,…”

“…Over three-quarters (83/103, 81%; 2508 participants) of studies reported the time since the onset of stroke. Of these 83 studies, 1 (1%; 48 participants) study [ 91 ] was conducted in the acute phase, 14 (17%; 504 participants) studies [ 60 , 61 , 68 , 74 , 79 , 92 , 100 , 102 , 109 , 114 , 133 , 144 , 146 , 148 ] were conducted in the early subacute phase, 11 (13%; 316 participants) studies [ 59 , 65 , 66 , 72 , 75 , 76 , 81 , 104 , 107 , 121 , 134 ] were conducted in the late subacute phase, and 57 (69%; 1640 participants) studies [ 46 , 48 , 49 , 51 , 53 , 54 , 57 , 63 , 64 , 67 , 69 , 70 , 73 , 78 , 80 , 82 , 84 , 85 , 88 , 89 , 93 - 99 , 101 , 103 , 105 , 106 , 108 , 111 - 113 , 117 - 120 , 122 - 125 , 127 - 131 , 13...…”