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.
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.
The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period.
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.
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.
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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 (firstname.lastname@example.org).
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.
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