JMIR Publications

ABSTRACT

Background:

Optimizing rehabilitation intensity using a Robotic-Assisted Hand Rehabilitation Exercise (RAHRE) coupled with a virtual environment is a promising intervention as it aligns with key neuroplasticity principles.

Objective:

To assess the feasibility, safety, preliminary effects and satisfaction of the two-week RAHRE Program offered as an adjunct to conventional rehabilitation.

Methods:

Eleven adults with hand hemiparesis following a recent stroke and undergoing intensive functional rehabilitation were randomized into experimental and control groups. Both groups received conventional rehabilitation therapy over a two-week period. The experimental group received ten additional 30-minute sessions of the RAHRE Program (5x/week) incorporating four hand opening/closing exercises with personalized glove assistance/resistance levels with augmented virtual reality over the same period. Measures of feasibility (i.e., attendance rate, compliance rate, repetitions/session, active training time, therapist verbal cueing and support required), safety (i.e., discomfort, adverse effects) and satisfaction (i.e., satisfaction questionnaire) were collected. Functional outcomes (i.e., ARAT, FMA-UE, BBT, ABILHAND) were also assessed pre- and post-intervention in both groups.

Results:

Attendance and compliance rates in the experimental group reached 96% and 95%, respectively. Participants performed a median of 2543 additional movement repetitions during the RAHRE Program (median repetitions/session=260; median active training time of 1478.5 seconds). Minimal therapist verbal cueing and support were necessary for technology use (median glove donning time=46 seconds; median independence achieved in 6 sessions). No abnormal discomfort nor adverse effects were reported. Functional improvements in ARAT, FMA-UE, BBT and ABILHAND were measured in both groups with median score changes for the control and experimental groups of 4.50 and 4.00, and 4.00 and 5.00 for the primary outcomes (i.e., ARAT and FMA-UE), respectively. Excellent overall program satisfaction (median = 5/5) was reported for the RAHRE Program.

Conclusions:

The RAHRE Program, as an adjunct to conventional rehabilitation therapy, emerges as being feasible, beneficial, safe and satisfying for adults with hand hemiparesis following a recent stroke. However, careful interpretation of the results remains recommended given the strength of the evidence and future studies providing higher quality evidence are needed.