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Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2016

Open Access 01-12-2016 | Research

Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system

Authors: Frieder Wittmann, Jeremia P. Held, Olivier Lambercy, Michelle L. Starkey, Armin Curt, Raphael Höver, Roger Gassert, Andreas R. Luft, Roman R. Gonzenbach

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2016

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Abstract

Background

The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients’ homes.

Methods

An open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time.

Results

All subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. The weekly training duration did not change over the course of six weeks (p = 0.146). The arm function of these patients improved significantly by 4.1 points (p = 0.003) in the FMA-UE. Changes in the WMFT were not significant (p = 0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training.

Conclusions

Self-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching.

Trial registration

Unique identifier: NCT02098135.
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Metadata
Title
Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system
Authors
Frieder Wittmann
Jeremia P. Held
Olivier Lambercy
Michelle L. Starkey
Armin Curt
Raphael Höver
Roger Gassert
Andreas R. Luft
Roman R. Gonzenbach
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2016
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/s12984-016-0182-1

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