Research Report
Population: Adult
Anson B Rosenfeldt, PT, DPT, MBA, NCS, Senior Physical Therapist, Cleveland Clinic rosenfa2@ccf.org
Susan Linder, PT, DPT, NCS, Physical Therapist and Research Scientist, Cleveland Clinic linders@ccf.org
Komal Sahu, MPH, OTR/L, Occupational Therapist, Emory University komal.sahu@emoryhealthcare.org
Steven Wolf, PhD, PT, FATPA, FAHA, Physical Therapist, Professor, Senior Research Scientist, Emory University, Atlanta Veterans Affairs Medical Center swolf@emory.edu
Jay Alberts, PhD, Vice Chair of Health Enablement Technology, Cleveland Clinic albertj@ccf.org
Keywords: Plasticity, Robotic Device, Telerehabilitation, Stroke
Purpose: Robotic therapy delivered through a telerehabilitation model may provide a way to increase access to rehabilitation and objectively monitor exercise compliance and rehabilitation progress in underserved populations. The Hand Mentor Pro (HMP) is a robotic device with remote monitoring capabilities designed to improve distal upper extremity (UE) impairments poststroke. The purpose of the study was to compare UE recovery after stroke when a HMP was incorporated into a home exercise program (HEP) after stroke. We hypothesized use of the HMP would improve motor outcomes after stroke.
Subjects: 99
Materials/Methods: Ninety-nine individuals ≤ 6 months after stroke were randomized into one of the following groups: (1) HMP + HEP who received a combination HEP with the robotic device for 3 hours/day, 5 days/week for 8 weeks or (2) HEP only who received an identical dosage of the HEP only. A neurological physical or occupational therapist developed each individual HEP and remotely monitored individual progress through data transmitted via the HMP and through a self-reported exercise diary for the HEP. Outcome measures included the Wolf Motor Function Test, Action Reach Arm Test, and Fugl Meyer Assessment.
Results: Both groups demonstrated significant improvements across all UE outcome measures compared to baseline. Between group differences on the Wolf Motor Function Test total performance time, fine motor tasks, and number of total and fine motor tasks not completed favored the HEP group.
Conclusions: Both telerehabilitation models were found to be feasible, safe, and resulted in improvements in UE functional and impairment outcomes. The HMP + HEP was not found to be superior to the HEP only group.
Clinical Relevance: Telerehabilitation, both with and without the use of a robotic device, may be a feasible and efficacious way of improving UE function poststroke, especially to those with limited access to care. Further research needs to be completed to determine the ideal user for a robotic device, as it was not found to be superior to a HEP alone.
This project was supported by NIH grant RC3NS070646 from the National Institute of Neurological Disorders and Stroke.
Citation:
Rosenfeldt, Anson B, PT, DPT, MBA, NCS; Linder, Susan M, PT, DPT, NCS; Sahu, Komal , MPH, OTR/L; Wolf, Steven L, PhD, PT, FATPA, FAHA; Alberts, Jay L, PhD. The HAAPI (Home Arm Assistance Progression Initiative) Trial: A Robotic Upper Extremity Intervention after Stroke.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/049_rosenfeldt-et-al/