Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2014

Open Access 01-12-2014 | Research

Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting

Authors: Manoj Sivan, Justin Gallagher, Sophie Makower, David Keeling, Bipin Bhakta, Rory J O’Connor, Martin Levesley

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2014

Login to get access

Abstract

Background

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness.

Methods

hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND.

Results

Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 – 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes.

Conclusions

The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study.
Literature
1.
Murray CJ, Lopez AD: Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997,349(9061):1269-1276. 10.1016/S0140-6736(96)07493-4CrossRefPubMed
2.
Milano: Stroke Prevention and Educational Awareness Diffusion (SPREAD). The Italian Guidelines for Stroke Prevention and Treatment. Milan, Italy: Hyperphar Group; 2003.
3.
4.
5.
6.
Ada L, Canning CG, Carr JH, Kilbreath SL, Shepherd RB: Task Specific Training of Reaching and Manipulation. Edited by: Bennett KMB, Castiello U. Amsterdam: Elsevier Science; 1994.
7.
Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ: Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003,34(9):2181-2186. 10.1161/01.STR.0000087172.16305.CDCrossRefPubMed
8.
Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1994,75(4):394-398. 10.1016/0003-9993(94)90161-9CrossRefPubMed
9.
Coupar F, Pollock A, Legg LA, Sackley C, van Vliet P: Home-based therapy programmes for upper limb functional recovery following stroke. Cochrane Database Syst Rev 2012., 5: CD006755
10.
Gresham GE DP, Stason WB, Gresham GE, Duncan PW, Stason WB: Post-stroke rehabilitation. Clinical Practice Guideline No.16. Rockville: US Dept Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR; 1995. Report No.: 95–0662
11.
Kwakkel GKB, Wagenaar RC: Therapy impact on functional recovery in stroke rehabilitation. Physiotherapy 1999, 85: 377-391. 10.1016/S0031-9406(05)67198-2CrossRef
12.
Wyller TB, Holmen J, Laake P, Laake K: Correlates of subjective well-being in stroke patients. Stroke 1998,29(2):363-367. 10.1161/01.STR.29.2.363CrossRefPubMed
13.
Riener R, Nef T, Colombo G: Robot-aided neurorehabilitation of the upper extremities. Med Biol Eng Comput 2005,43(1):2-10. 10.1007/BF02345116CrossRefPubMed
14.
Brewer BR, McDowell SK, Worthen-Chaudhari LC: Poststroke upper extremity rehabilitation: a review of robotic systems and clinical results. Top Stroke Rehabil 2007,14(6):22-44. 10.1310/tsr1406-22CrossRefPubMed
15.
Kwakkel G, Kollen BJ, Krebs HI: Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair 2008,22(2):111-121.CrossRefPubMedPubMedCentral
16.
Norouzi-Gheidari N, Archambault PS, Fung J: Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature. J Rehabil Res Dev 2012,49(4):479-496. 10.1682/JRRD.2010.10.0210CrossRefPubMed
17.
Micera S, Carrozza M, Guglielmelli E, Cappiello G, Zaccone F, Freschi C, Colombo R, Mazzone A, Delconte C, Pisano F, Minuco G, Dario P: A simple robotic system for neurorehabilitation. Auton Robot 2005,19(3):271-284. 10.1007/s10514-005-4749-0CrossRef
18.
Zhang H, Austin H, Buchanan S, Herman R, Koeneman J, He J: Feasibility studies of robot-assisted stroke rehabilitation at clinic and home settings using RUPERT. IEEE Int Conf Rehabil Robot 2011, 2011: 5975440.PubMed
19.
Johnson MJ, Feng X, Johnson LM, Winters JM: Potential of a suite of robot/computer-assisted motivating systems for personalized, home-based, stroke rehabilitation. J Neuroeng Rehabil 2007, 4: 6. 10.1186/1743-0003-4-6CrossRefPubMedPubMedCentral
20.
Reinkensmeyer DJ, Pang CT, Nessler JA, Painter CC: Web-based telerehabilitation for the upper extremity after stroke. IEEE Trans Neural Syst Rehabil Eng 2002,10(2):102-108. 10.1109/TNSRE.2002.1031978CrossRefPubMed
21.
Wood SR, Murillo N, Bach-y-Rita P, Leder RS, Marks JT, Page SJ: Motivating, game-based stroke rehabilitation: a brief report. Top Stroke Rehabil 2003,10(2):134-140. 10.1310/WB09-PFYJ-7XRN-RU6WCrossRefPubMed
22.
Cordo P, Lutsep H, Cordo L, Wright WG, Cacciatore T, Skoss R: Assisted movement with enhanced sensation (AMES): coupling motor and sensory to remediate motor deficits in chronic stroke patients. Neurorehabil Neural Repair 2009,23(1):67-77.CrossRefPubMed
23.
24.
Hingtgen BA, McGuire JR, Wang M, Harris GF: Quantification of reaching during stroke rehabilitation using unique upper extremity kinematic model. Conf Proc IEEE Eng Med Biol Soc 2004, 7: 4916-4919.PubMed
25.
Chang JJ, Yang YS, Wu WL, Guo LY, Su FC: The constructs of kinematic measures for reaching performance in stroke patients. J Med Biol Eng 2008,28(2):65-70.
26.
Caimmi M, Carda S, Giovanzana C, Maini ES, Sabatini AM, Smania N, Molteni F: Using kinematic analysis to evaluate constraint-induced movement therapy in chronic stroke patients. Neurorehabil Neural Repair 2008,22(1):31-39.CrossRefPubMed
27.
Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S: The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1975,7(1):13-31.PubMed
28.
Duncan PW, Jorgensen HS, Wade DT: Outcome measures in acute stroke trials: a systematic review and some recommendations to improve practice. Stroke 2000,31(6):1429-1438. 10.1161/01.STR.31.6.1429CrossRefPubMed
29.
Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C: Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther 1993,73(7):447-454.PubMed
30.
Gladstone DJ, Danells CJ, Black SE: The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002,16(3):232-240. 10.1177/154596802401105171CrossRefPubMed
31.
Lin KC, Hsieh YW, Wu CY, Chen CL, Jang Y, Liu JS: Minimal detectable change and clinically important difference of the Wolf Motor Function Test in stroke patients. Neurorehabil Neural Repair 2009,23(5):429-434. 10.1177/1545968308331144CrossRefPubMed
32.
Hsueh IP, Hsieh CL: Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation. Clin Rehabil 2002,16(6):617-624. 10.1191/0269215502cr530oaCrossRefPubMed
33.
van der Lee JH, Beckerman H, Lankhorst GJ, Bouter LM: The responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients. J Rehabil Med 2001,33(3):110-113. 10.1080/165019701750165916CrossRefPubMed
34.
Salter K, Jutai JW, Teasell R, Foley NC, Bitensky J: Issues for selection of outcome measures in stroke rehabilitation: ICF Body Functions. Disabil Rehabil 2005,27(4):191-207. 10.1080/09638280400008537CrossRefPubMed
35.
Hsieh CL, Hsueh IP, Chiang FM, Lin PH: Inter-rater reliability and validity of the action research arm test in stroke patients. Age Ageing 1998,27(2):107-113. 10.1093/ageing/27.2.107CrossRefPubMed
36.
Lin JH, Hsu MJ, Sheu CF, Wu TS, Lin RT, Chen CH, Hsieh CL: Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke. Phys Ther 2009,89(8):840-850. 10.2522/ptj.20080285CrossRefPubMed
37.
Lang CE, Wagner JM, Dromerick AW, Edwards DF: Measurement of upper-extremity function early after stroke: properties of the action research arm test. Arch Phys Med Rehabil 2006,87(12):1605-1610. 10.1016/j.apmr.2006.09.003CrossRefPubMed
38.
Ashworth B: Preliminary Trial of Carisoprodol in Multiple Sclerosis. Practitioner 1964, 192: 540-542.PubMed
39.
Bohannon RW, Smith MB: Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987,67(2):206-207.PubMed
40.
O'Brien MD: Aids to the Examination of the Peripheral Nervous System. Edited by: Council MR. Philadelphia: Elsevier Saunders; 2000.
41.
Rabadi M, Galgano M, Lynch D, Akerman M, Lesser M, Volpe B: A pilot study of activity-based therapy in the arm motor recovery post stroke: a randomized controlled trial. Clin Rehabil 2008,22(12):1071-1082. 10.1177/0269215508095358CrossRefPubMed
42.
Barreca SR, Stratford PW, Lambert CL, Masters LM, Streiner DL: Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil 2005,86(8):1616-1622. 10.1016/j.apmr.2005.03.017CrossRefPubMed
43.
Barreca SR, Stratford PW, Masters LM, Lambert CL, Griffiths J: Comparing 2 versions of the Chedoke Arm and Hand Activity Inventory with the Action Research Arm Test. Phys Ther 2006,86(2):245-253.PubMed
44.
Penta M, Tesio L, Arnould C, Zancan A, Thonnard JL: The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke 2001,32(7):1627-1634. 10.1161/01.STR.32.7.1627CrossRefPubMed
45.
van der Lee JH, Beckerman H, Knol DL, de Vet HC, Bouter LM: Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients. Stroke 2004,35(6):1410-1414. 10.1161/01.STR.0000126900.24964.7eCrossRefPubMed
46.
van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM: Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke 1999,30(11):2369-2375. 10.1161/01.STR.30.11.2369CrossRefPubMed
47.
Klamroth-Marganska V, Blanco J, Campen K, Curt A, Dietz V, Ettlin T, Felder M, Fellinghauer B, Guidali M, Kollmar A, Luft A, Nef T, Schuster-Amft C, Stahel W, Riener R: Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial. Lancet Neurol 2014,13(2):159-166. 10.1016/S1474-4422(13)70305-3CrossRefPubMed
48.
Coote S, Murphy B, Harwin W, Stokes E: The effect of the GENTLE/s robot-mediated therapy system on arm function after stroke. Clin Rehabil 2008,22(5):395-405. 10.1177/0269215507085060CrossRefPubMed
49.
Whitall J, McCombe Waller S, Silver KH, Macko RF: Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke 2000,31(10):2390-2395. 10.1161/01.STR.31.10.2390CrossRefPubMed
50.
Stein J, Krebs HI, Frontera WR, Fasoli SE, Hughes R, Hogan N: Comparison of two techniques of robot-aided upper limb exercise training after stroke. Am J Phys Med Rehabil 2004,83(9):720-728. 10.1097/01.PHM.0000137313.14480.CECrossRefPubMed
51.
Lum PS, Burgar CG, Shor PC, Majmundar M, Van der Loos M: Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil 2002,83(7):952-959. 10.1053/apmr.2001.33101CrossRefPubMed
52.
Volpe BT, Krebs HI, Hogan N, Edelstein OL, Diels C, Aisen M: A novel approach to stroke rehabilitation: robot-aided sensorimotor stimulation. Neurology 2000,54(10):1938-1944. 10.1212/WNL.54.10.1938CrossRefPubMed
53.
Chang JJ, Tung WL, Wu WL, Huang MH, Su FC: Effects of robot-aided bilateral force-induced isokinetic arm training combined with conventional rehabilitation on arm motor function in patients with chronic stroke. Arch Phys Med Rehabil 2007,88(10):1332-1338. 10.1016/j.apmr.2007.07.016CrossRefPubMed
54.
Hsieh YW, Wu CY, Liao WW, Lin KC, Wu KY, Lee CY: Effects of treatment intensity in upper limb robot-assisted therapy for chronic stroke: a pilot randomized controlled trial. Neurorehabil Neural Repair 2011,25(6):503-511. 10.1177/1545968310394871CrossRefPubMed
55.
Timmermans AA, Lemmens RJ, Monfrance M, Geers RP, Bakx W, Smeets RJ, Seelen HA: Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: a randomized controlled trial. J Neuroeng Rehabil 2014, 11: 45. 10.1186/1743-0003-11-45CrossRefPubMedPubMedCentral
56.
Hesse S, Werner C, Pohl M, Rueckriem S, Mehrholz J, Lingnau ML: Computerized arm training improves the motor control of the severely affected arm after stroke: a single-blinded randomized trial in two centers. Stroke 2005,36(9):1960-1966. 10.1161/01.STR.0000177865.37334.ceCrossRefPubMed
57.
Lum PS, Burgar CG, Van der Loos M, Shor PC, Majmundar M, Yap R: MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study. J Rehabil Res Dev 2006,43(5):631-642. 10.1682/JRRD.2005.02.0044CrossRefPubMed
58.
Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY: Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med 2009,52(3):269-293. 10.1016/j.rehab.2008.10.003CrossRefPubMed
59.
Fasoli SE, Krebs HI, Stein J, Frontera WR, Hogan N: Effects of robotic therapy on motor impairment and recovery in chronic stroke. Arch Phys Med Rehabil 2003,84(4):477-482. 10.1053/apmr.2003.50110CrossRefPubMed
60.
Prange GB, Jannink MJ, Groothuis-Oudshoorn CG, Hermens HJ, Ijzerman MJ: Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J Rehabil Res Dev 2006,43(2):171-184. 10.1682/JRRD.2005.04.0076CrossRefPubMed
61.
Ferraro M, Palazzolo JJ, Krol J, Krebs HI, Hogan N, Volpe BT: Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke. Neurology 2003,61(11):1604-1607. 10.1212/01.WNL.0000095963.00970.68CrossRefPubMed
62.
Fazekas G, Horvath M, Troznai T, Toth A: Robot-mediated upper limb physiotherapy for patients with spastic hemiparesis: a preliminary study. J Rehabil Med 2007,39(7):580-582. 10.2340/16501977-0087CrossRefPubMed
63.
Bovolenta F, Goldoni M, Clerici P, Agosti M, Franceschini M: Robot therapy for functional recovery of the upper limbs: a pilot study on patients after stroke. J Rehabil Med 2009,41(12):971-975. 10.2340/16501977-0402CrossRefPubMed
64.
Lo AC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, Ringer RJ, Wagner TH, Krebs HI, Volpe BT, Bever CT Jr, Bravata DM, Duncan PW, Corn BH, Maffucci AD, Nadeau SE, Conroy SS, Powell JM, Huang GD, Peduzzi P: Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke. N Engl J Med 2010,362(19):1772-1783. 10.1056/NEJMoa0911341CrossRefPubMed
65.
Kahn LE, Zygman ML, Rymer WZ, Reinkensmeyer DJ: Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study. J Neuroeng Rehabil 2006, 3: 12. 10.1186/1743-0003-3-12CrossRefPubMedPubMedCentral
66.
Higgins J, Salbach NM, Wood-Dauphinee S, Richards CL, Cote R, Mayo NE: The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial. Clin Rehabil 2006,20(4):296-310. 10.1191/0269215505cr943oaCrossRefPubMed
67.
Volpe BT, Lynch D, Rykman-Berland A, Ferraro M, Galgano M, Hogan N, Krebs HI: Intensive sensorimotor arm training mediated by therapist or robot improves hemiparesis in patients with chronic stroke. Neurorehabil Neural Repair 2008,22(3):305-310. 10.1177/1545968307311102CrossRefPubMed
68.
Wagner TH, Lo AC, Peduzzi P, Bravata DM, Huang GD, Krebs HI, Ringer RJ, Federman DG, Richards LG, Haselkorn JK, Wittenberg GF, Volpe BT, Bever CT, Duncan PW, Siroka A, Guarino PD: An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke 2011,42(9):2630-2632. 10.1161/STROKEAHA.110.606442CrossRefPubMedPubMedCentral
69.
Takahashi CD, Der-Yeghiaian L, Le V, Motiwala RR, Cramer SC: Robot-based hand motor therapy after stroke. Brain 2008,131(Pt 2):425-437.CrossRefPubMed
70.
Masia L, Krebs HI, Cappa P, Hogan N: Design and Characterization of Hand Module for Whole-Arm Rehabilitation Following Stroke. IEEE ASME Trans Mechatron 2007,12(4):399-407.CrossRefPubMedPubMedCentral
71.
Loureiro R, Harwin W, Lamperd R, Collin C: Evaluation of Reach and Grasp Robot-Assisted Therapy Suggests Similar Functional Recovery Patterns on Proximal and Distal Arm Segments in Sub-Acute Hemiplegia. IEEE Trans Neural Syst Rehabil Eng 2013,22(3):593-602.CrossRefPubMed
72.
Lambercy O, Dovat L, Gassert R, Burdet E, Teo CL, Milner T: A haptic knob for rehabilitation of hand function. IEEE Trans Neural Syst Rehabil Eng 2007,15(3):356-366.CrossRefPubMed
73.
Johnson MJ, Wisneski KJ, Anderson J, Nathan D, Smith R: Development of ADLER: The activities of Daily Living Exercise Robot. Conf Proc IEEE-EMBS Biomedical Robotics (BioRob 2006) 2006, 881-886.
74.
Duncan PW, Lai SM, Keighley J: Defining post-stroke recovery: implications for design and interpretation of drug trials. Neuropharmacology 2000,39(5):835-841. 10.1016/S0028-3908(00)00003-4CrossRefPubMed
Metadata
Title
Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting
Authors
Manoj Sivan
Justin Gallagher
Sophie Makower
David Keeling
Bipin Bhakta
Rory J O’Connor
Martin Levesley
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2014
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-11-163

Other articles of this Issue 1/2014

Journal of NeuroEngineering and Rehabilitation 1/2014 Go to the issue

Research

A robotic object hitting task to quantify sensorimotor impairments in participants with stroke

Research

Nicotine exposure increases the complexity of dopamine neurons in the parainterfascicular nucleus (PIF) sub-region of VTA

Review

Perspectives on human-human sensorimotor interactions for the design of rehabilitation robots

Research

Modifications in ankle dorsiflexor activation by applying a torque perturbation during walking in persons post-stroke: a case series

Research

Association between toe flexor strength and spatiotemporal gait parameters in community-dwelling older people

Research

Increased frontal brain activation during walking while dual tasking: an fNIRS study in healthy young adults