Telerehabilitation using a 2-D planar arm rehabilitation robot for hemiparetic stroke: A feasibility study of clinic-to-home exergaming therapy

Author:

Ollinger Gabriel Aguirre1,Chua Karen Sui Geok2,Ong Poo Lee2,Kuah Christopher Wee Keong2,Plunkett Tegan Kate2,Ng Chwee Yin2,Khin Lay Wai3,Goh Kim Huat4,Chong Wei Binh2,Low Jaclyn Ai Mei2,Mushtaq Malaika1,Samkharadze Tengiz5,Kager Simone5,Cheng Hsiao-Ju5,Hussain Asif1

Affiliation:

1. Articares Pte Ltd

2. Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre

3. Tan Tock Seng Hospital, Clinical Research and Innovation Office

4. Nanyang Business School, Nanyang Technological University

5. ETH Singapore Centre

Abstract

Abstract

Aims: We evaluated the feasibility, safety and efficacy of a 2D-planar robot for minimally-supervised home-based upper-limb therapy for post-stroke hemiparesis. Materials and Methods: The H-Man, end effector robot, combined with web-based software application for remote tele-monitoring were evaluated at homes of participants. Inclusion criteria were: strokes > 28 days, Fugl-Meyer Motor Assessment (FMA) >10-60/66, presence of a carer and absence of medical contraindications. Participants performed self-directed, minimally-supervised H-Man training for 30 consecutive days at their homes, after 2 therapist-supervised clinic on-boarding sessions. Web-based compliance measures were accessed sessions (>20mins/day), training minutes/day and active training hours/30days. Clinical outcomes obtained at weeks 0, 5 (post-training), 12 and 24 (follow-up) consisted of FMA, Action Research Arm Test (ARAT) and WHO-Stroke Specific Quality Of Life (SSQOL). To estimate immediate economic benefits of the home-based robotic therapy, we performed cost-effectiveness analysis (CEA), followed by budget impact analysis (BIA). Results: Altogether, all 12 participants completed H-Man at home without adverse events; 9 (75.0%) were males, mean (SD) age, 59.4 years (9.5), median (IQR) stroke duration 38.6 weeks (25.4, 79.6) baseline FMA (0-66) 42.1 ±13.2, ARAT (0-57) 25.4 ±19.5, SSQOL (0-245) 185.3 ±32.8. At week 5 follow-up, mean (SD) accessed days were 26.3 days ±6.4, active training hours of 35.3 hours ±14.7/30days, or ~6 days/week and 77 training minutes ± 20.9/day were observed. Significant gains were observed from baseline across time; ΔFMA 2.4 at week 5 (FMA 44.5, CI 95% 39.7 – 49.3, p < 0.05) and ΔFMA 3.7 at week 24 (FMA 45.8, CI 95% 40.5 – 51, p < 0.05); ΔARAT 2.6 at week 5 (ARAT 28.0, CI 95% 19.3 – 36.7, p < 0.05), and ΔARAT 4.8 at week 24 (ARAT 30.2, CI 95% 21.2 – 39.1, p < 0.05). At week 5 follow-up, 91% of participants rated their overall experience as satisfied or very satisfied. Incremental CEA observed savings of -S$144/per cure over 24 weeks, BIA – potentially 12% impact reduction over five years. Conclusions: This study demonstrates the feasibility, acceptability, safety, clinical efficacy and cost-effectiveness of a home-based, web-enabled telemonitored carer-supervised robotics-aided therapy.

Publisher

Springer Science and Business Media LLC

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