A Qualitative and Usability Evaluation of Advanced Technologies for Home Upper Limb Neurorehabilitation Post-stroke

Previous research has proven that technology-aided upper limb rehabilitation is non-inferior in terms of feasibility and efficacy when compared to conventional therapy in stroke patients. These rehabilitation devices can be set up as a 'rehabilitation gym' (RehabGym), where patients can interact with several devices that target different body and rehabilitation domains and, thus allows for a holistic and complementary therapy.

Despite recent studies having shown that training with a RehabGym under reduced supervision in a hospital is not only feasible but also equally beneficial in terms of clinical outcomes, however, a RehabGym has never been set up at a patient's home to the best of our knowledge.

This study aims to investigate the feasibility and safety of a RehabGym at home concept using three different upper-limb technologies (H-Man, ReHandyBot, MyoPanda) that are established, clinically tested and allow for on-demand therapy. Objective measures of clinical efficacy will also be examined, and cost-analysis to determine the economic feasibility of a commercial implementation of RehabGym at home in the future will be performed.

Inclusion criteria

• Clinical stroke (ischaemic or haemorrhagic) confirmed by admitting doctors and CT, CT angiography or MRI brain imaging
• Age 21 to 80 years, both males and females
• At least 28 days post-stroke
• Upper limb motor impairment of Fugl-Meyer Assessment (FMA) scale 20 to 50
• Montreal Cognitive Assessment (MoCA) > 21/30
• Ability to sit supported and continuously for 60 minutes
• Stable home abode with enough space to place technologies
• Has a carer/next of kin to supervise home-based exercises

Exclusion criteria

• Functional impairment of the upper limb due to other pathologies
• Medical conditions incompatible with research participation: uncontrolled medical illnesses (hypertension or diabetes, ischaemic heart disease, congestive heart failure, bronchial asthma, severe /untreated depression, agitation, end stage renal/liver/heart/lung failure, unresolved cancers)
• Anticipated life expectancy of less than 6 months
• Pacemakers and other active implants
• Active seizures within 3 months
• Local factors potentially worsened by intensive technology-aided upper-limb therapy and computer-based training:

• Spasticity - modified Ashworth Scale MAS > 2 of any upper limb muscle groups
• Severe pain in affected arm - Visual Analogue Scale for pain VAS > 5/10
• Skin wounds
• Cognitive impairment precluding study participation
• Severe visual impairment or visual neglect affecting ability to use technologies
• History of dementia, depression or behavioural problems
• Pregnant or lactating females will not be allowed to participate