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Incorporating Robotic-Assisted Telerehabilitation in a Home Program to Improve Arm Function Following Stroke

Linder, Susan M. PT, DPT, NCS; Reiss, Aimee PT, DPT; Buchanan, Sharon OTR/L; Sahu, Komal MPH, OTR/L; Rosenfeldt, Anson B. PT, DPT; Clark, Cindy OTR/L; Wolf, Steven L. PhD, PT, FAPTA, FAHA; Alberts, Jay L. PhD

Journal of Neurologic Physical Therapy: September 2013 - Volume 37 - Issue 3 - p 125–132
doi: 10.1097/NPT.0b013e31829fa808
Case Studies
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Background and Purpose: After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function.

Case Description: The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment.

Intervention: The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period.

Outcomes: The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points.

Discussion: This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.

Video Abstract available (See Video, Supplemental Digital Content 1, for more insights from the authors.

Supplemental Digital Content is Available in the Text.

Department of Biomedical Engineering (S.M.L, A.B.R., C.C., J.L.A.) and Center for Neurological Restoration (S.M.L., A.B.R., C.C., J.L.A.), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia (A.R., K.S., S.L.W.); Kinetic Muscles Inc, Tempe, Arizona (S.B.);Atlanta VA Rehabilitation R&D Center, Decatur, Georgia (S.L.W.); and Cleveland FES Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio (J.L.A.).

Correspondence: Jay L. Alberts, PhD, Department of Biomedical Engineering, Center for Neurological Restoration, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195 (

This study was supported by RC3NS070646 from the National Institute of Neurological Disorders And Stroke.

Dr Wolf is chairman of the Scientific Advisory Board for Kinetic Muscles Inc and is a paid consultant for Kinetic Muscles Inc. Sharon Buchanan is also a paid consultant for Kinetic Muscles Inc. No other authors have any financial relationship with Kinetic Muscles Inc.

Remaining authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 Neurology Section, APTA