Posts Tagged arm motor

[Abstract+References] A Home-Based Telerehabilitation Program for Patients With Stroke 

Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play. Results. Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores of 39 ± 12 (mean ± SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607 ± 9934 per participant. Arm motor status showed significant gains (FM change 4.8 ± 3.8 points, P = .0015), with half of the participants exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age (r = −0.92; P < .0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge (P = .0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later (r = 0.88; P = .0001). In-person blood pressure values closely matched those obtained via this system (r = 0.99; P < .0001). Conclusions. This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.

1. Winstein CJStein JArena R, . Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:e98e169Google Scholar CrossrefMedline
2. Lang CEMacdonald JRReisman DS, . Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009;90:16921698Google Scholar CrossrefMedline
3. Bernhardt JChan JNicola ICollier JM. Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care. J Rehabil Med. 2007;39:4348Google Scholar CrossrefMedline
4. Kimberley TJSamargia SMoore LGShakya JKLang CE. Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. J Rehabil Res Dev. 2010;47:851862Google Scholar CrossrefMedline
5. Laver KESchoene DCrotty MGeorge SLannin NASherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2013;(12):CD010255Google Scholar Medline
6. Agostini MMoja LBanzi R, . Telerehabilitation and recovery of motor function: a systematic review and meta-analysis. J Telemed Telecare. 2015;21:202213Google Scholar Link
7. Brennan DTindall LTheodoros D, . A blueprint for telerehabilitation guidelines. Int J Telerehabil. 2010;2:3134Google Scholar CrossrefMedline
8. Demiris GShigaki CLSchopp LH. An evaluation framework for a rural home-based telerehabilitation network. J Med Syst. 2005;29:595603Google Scholar CrossrefMedline
9. Bayley MTHurdowar ATeasell R, . Priorities for stroke rehabilitation and research: results of a 2003 Canadian Stroke Network consensus conference. Arch Phys Med Rehabil. 2007;88:526528Google Scholar CrossrefMedline
10. Wolf SLWinstein CJMiller JP, . Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296:20952104Google Scholar CrossrefMedline
11. Wu JQuinlan EBDodakian L, . Connectivity measures are robust biomarkers of cortical function and plasticity after stroke. Brain. 2015;138(pt 8):23592369Google Scholar CrossrefMedline
12. Jimison HGorman PWoods S, . Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved. Rockville, MDAgency for Healthcare Research and Quality2008. Evidence Report/Technology Assessment No. 175. AHRQ Publication No. 09-E004. Google Scholar
13. Woldag HHummelsheim H. Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients: a review. J Neurol. 2002;249:518528Google Scholar CrossrefMedline
14. Takahashi CDDer-Yeghiaian LLe VMotiwala RRCramer SC. Robot-based hand motor therapy after stroke. Brain. 2008;131(pt 2):425437Google Scholar CrossrefMedline
15. Kleim JAJones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51:S225S239Google Scholar CrossrefMedline
16. Cramer SCSur MDobkin BH, . Harnessing neuroplasticity for clinical applications. Brain. 2011;134(pt 6):15911609Google Scholar CrossrefMedline
17. Cramer SCRepairing the human brain after stroke: I. Mechanisms of spontaneous recovery. Ann Neurol. 2008;63:272287Google Scholar CrossrefMedline
18. Dobkin BHDorsch A. The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors. Neurorehabil Neural Repair. 2011;25:788798Google Scholar Link
19. See JDodakian LChou C, . A standardized approach to the Fugl-Meyer assessment and its implications for clinical trials. Neurorehabil Neural Repair. 2013;27:732741Google Scholar Link
20. Mackay JCharles STKemp BHeckhausen J. Goal striving and maladaptive coping in adults living with spinal cord injury: associations with affective well-being. J Aging Health. 2011;23:158176Google Scholar Link
21. Sherbourne CDStewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705714Google Scholar CrossrefMedline
22. Lewis SCDennis MSO’Rourke SJSharpe M. Negative attitudes among short-term stroke survivors predict worse long-term survival. Stroke. 2001;32:16401645Google Scholar CrossrefMedline
23. Williams LSWeinberger MHarris LEClark DOBiller J. Development of a stroke-specific quality of life scale. Stroke. 1999;30:13621369Google Scholar CrossrefMedline
24. Bunz U. The Computer-Email-Web (CEW) Fluency Scale: development and validation. Int J Hum Comput Interact. 2004;17:479506Google Scholar Crossref
25. Duncan PWallace DLai SJohnson DEmbretson SLaster L. The Stroke Impact Scale version 2.0: evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30:21312140Google Scholar CrossrefMedline
26. Jones FPartridge CReid F. The Stroke Self-Efficacy Questionnaire: measuring individual confidence in functional performance after stroke. J Clin Nurs. 2008;17(7B):244252Google Scholar CrossrefMedline
27. Zondervan DKFriedman NChang E, . Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program. J Rehabil Res Dev. 2016;53:457472Google Scholar CrossrefMedline
28. Page SJFulk GDBoyne P. Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther. 2012;92:791798Google Scholar CrossrefMedline
29. van der Lee JBeckerman HLankhorst GBouter LThe responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients. J Rehabil Med. 2001;33:110113Google Scholar CrossrefMedline
30. Baranowski TBuday RThompson DIBaranowski J. Playing for real: video games and stories for health-related behavior change. Am J Prev Med. 2008;34:7482Google Scholar CrossrefMedline
31. Brox EFernandez-Luque LTøllefsen T. Healthy gaming—video game design to promote health. Appl Clin Inform. 2011;2:128142Google Scholar CrossrefMedline
32. Lieberman D. Designing serious games for learning and health in informal and formal settings. In: Ritterfeld MVorderer P eds. Serious Games: Mechanisms and Effects. New York, NYRouteledge; 2009:117130Google Scholar
33. Chou Y. Actionable Gamification—Beyond Points, Badges, and Leaderboards. Fremont, CAOctalysis Media2015Google Scholar
34. Winstein CJMiller JPBlanton S, . Methods for a multisite randomized trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from a cerebrovascular stroke. Neurorehabil Neural Repair. 2003;17:137152Google Scholar Link
35. Sluijs EMKok GJvan der Zee J. Correlates of exercise compliance in physical therapy. Phys Ther. 1993;73:771782; discussion 783-786. Google Scholar CrossrefMedline
36. Miller KKPorter REDeBaun-Sprague EVan Puymbroeck MSchmid AA. Exercise after stroke: patient adherence and beliefs after discharge from rehabilitation. Top Stroke Rehabil. 2017;24:142148Google Scholar CrossrefMedline
37. McCabe JMonkiewicz MHolcomb JPundik SDaly JJ. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96:981990Google Scholar CrossrefMedline
38. Griffith V. A Stroke in the Family. New York, NYDelacorte Press1970Google Scholar
39. Herrmann NSeitz DFischer H, . Detection and treatment of post stroke depression: results from the registry of the Canadian stroke network. Int J Geriatr Psychiatry. 2011;26:11951200Google Scholar Medline
40. Kothari RSauerbeck LJauch E, . Patients’ awareness of stroke signs, symptoms, and risk factors. Stroke. 1997;28:18711875Google Scholar CrossrefMedline
41. Zerwic JHwang SYTucco L. Interpretation of symptoms and delay in seeking treatment by patients who have had a stroke: exploratory study. Heart Lung. 2007;36:2534Google Scholar CrossrefMedline
42. Qureshi AISuri MFGuterman LRHopkins LN. Ineffective secondary prevention in survivors of cardiovascular events in the US population: report from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2001;161:16211628Google Scholar CrossrefMedline
43. Putrino D. Telerehabilitation and emerging virtual reality approaches to stroke rehabilitation. Curr Opin Neurol. 2014;27:631636Google Scholar CrossrefMedline
44. Chen JJin WZhang XXu WLiu X-NRen C-C. Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2015;24:26602668Google Scholar CrossrefMedline
45. Nakayama HJorgensen HRaaschou HOlsen T. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75:394398Google ScholarCrossrefMedline
46. Ottenbacher KJSmith PMIllig SBLinn RTOstir GVGranger CV. Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA. 2004;292:16871695Google Scholar CrossrefMedline
47. Tong XKuklina EVGillespie CGeorge MG. Medical complications among hospitalizations for ischemic stroke in the United States from 1998 to 2007. Stroke. 2010;41:980986Google ScholarCrossrefMedline

Source: A Home-Based Telerehabilitation Program for Patients With StrokeNeurorehabilitation and Neural Repair – Lucy Dodakian, Alison L. McKenzie, Vu Le, Jill See, Kristin Pearson-Fuhrhop, Erin Burke Quinlan, Robert J. Zhou, Renee Augsberger, Xuan A. Tran, Nizan Friedman, David J. Reinkensmeyer, Steven C. Cramer, 2017

, , , , ,

Leave a comment

%d bloggers like this: