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RecoverNow: A mobile tablet-based therapy platform for early stroke rehabilitation.

ABSTRACT: INTRODUCTION:Stroke survivors frequently experience a range of post-stroke deficits. Specialized stroke rehabilitation improves recovery, especially if it is started early post-stroke. However, resource limitations often preclude early rehabilitation. Mobile technologies may provide a platform for stroke survivors to begin recovery when they might not be able to otherwise. The study objective was to demonstrate the feasibility of RecoverNow, a tablet-based stroke recovery platform aimed at delivering speech and cognitive therapy. METHODS:We recruited a convenience sample of 30 acute stroke patients to use RecoverNow for up to 3 months. Allied health professionals assigned specific applications based on standard of care assessments. Participants were encouraged to take home the RecoverNow tablets upon discharge from acute care. The study team contacted participants to return for a follow-up interview 3 months after enrollment. The primary outcome of interest was feasibility, defined using 5 facets: recruitment rate, adherence rate, retention rate, the proportion of successful follow-up interventions, and protocol deviations. We tracked barriers to tablet-based care as a secondary outcome. RESULTS:We successfully recruited 30 of 62 eligible patients in 15 weeks (48% recruitment rate). Participants were non-adherent to tablet-based therapy inside and outside of acute care, using RecoverNow for a median of 12 minutes a day. Retention was high with 23 of 30 patients participating in follow-up interviews (77% retention rate) and all but 3 of the 23 interviews (87%) were successfully completed. Only 2 major protocol deviations occurred: one enrollment failure and one therapy protocol violation. Barriers to tablet-based care were frequently encountered by study participants with many expressing the assigned applications were either too easy or too difficult. CONCLUSIONS:Acute stroke patients are interested in attempting tablet-based stroke rehabilitation and are easily recruited early post-stroke. However, tablet-based therapy may be challenging due to patient, device and system-related barriers. Reducing the frequency of common barriers will be essential to keeping patients engaged in tablet-based therapy.

SUBMITTER: Pugliese M

PROVIDER: S-EPMC6347149 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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RecoverNow: A mobile tablet-based therapy platform for early stroke rehabilitation.

Pugliese Michael M Ramsay Tim T Shamloul Rany R Mallet Karen K Zakutney Lise L Corbett Dale D Dukelow Sean S Stotts Grant G Shamy Michel M Wilson Kumanan K Guerinet Julien J Dowlatshahi Dar D

PloS one 20190125 1

<h4>Introduction</h4>Stroke survivors frequently experience a range of post-stroke deficits. Specialized stroke rehabilitation improves recovery, especially if it is started early post-stroke. However, resource limitations often preclude early rehabilitation. Mobile technologies may provide a platform for stroke survivors to begin recovery when they might not be able to otherwise. The study objective was to demonstrate the feasibility of RecoverNow, a tablet-based stroke recovery platform aimed ...[more]

PMID: 30682076

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Project description:BackgroundStroke is a growing global epidemic limiting the ability of millions to function independently due to post-stroke deficits and complications. Although specialized stroke rehabilitation improves the recovery of functional abilities, accessing rehabilitation services has become increasingly challenging as the number of stroke survivors continues to increase and rehabilitation resources remain scarce. Mobile tablet-based therapies (MTBTs) may be a resource-efficient platform for providing stroke rehabilitation services. The feasibility and challenges of offering MTBTs to stroke survivors should be well understood before expensive, large-scale clinical trials are undertaken to study treatment efficacy.MethodA systematic scoping review will be conducted to describe attempted MTBTs following stroke and the challenges encountered by survivors and study staff. Studies of interest will evaluate MTBTs offered to adult stroke patients in response to post-stroke complications or deficits. Journal databases, gray literature sources, clinical trial registries, relevant organizational websites, and reference lists of eligible studies will be searched to identify suitable studies. Study characteristics, barriers to care, methodological challenges, patient-reported outcomes, and health outcomes will be extracted to describe MTBTs and understand the challenges encountered in context. Results will be presented using descriptive statistics, tables, figures, and narrative description to summarize the scope of the field.DiscussionTrends in MTBT feasibility and common challenges will be discussed to summarize major findings and highlight research gaps. Solutions to common challenges experienced by intervention participants and study staff will be proposed. Implications for the conduct of randomized clinical trials of MTBT efficacy and the appropriateness of a systematic review and meta-analysis of completed trials will be discussed. SYSTEMATIC REVIEW REGISTRATION: uO Research ( http://hdl.handle.net/10393/35696 ).

Project description:BackgroundPatients with stroke often experience weakened upper limbs, making daily tasks difficult to perform. Although rehabilitation devices are available, patients often relapse post-discharge due to insufficient practice. We present a home-based hand telerehabilitation intervention using the iManus™ platform comprising a sensorized glove, a mobile app for the patients, and a therapist portal for monitoring patient progress.ObjectivesThis research aimed to examine the feasibility, safety, and effectiveness of a home-based telerehabilitation intervention in improving hand function for individuals with mild stroke. A qualitative approach was also used to explore users' experiences, perceived benefits, and challenges associated with using the platform in a home setting.MethodsIn this single-case study, we delivered a hand telerehabilitation intervention to a chronic stroke patient with impaired hand function using the iManus™ platform. The intervention consisted of 40 home sessions over eight weeks. We assessed feasibility through user adherence and feedback obtained using a System Usability Scale (SUS) and a semi-structured interview with the participant and their informal caregiver. Safety was evaluated by monitoring pain levels using the Visual Analog Scale (VAS), and efficacy was determined by observing the changes in the fingers' range of motion using the iManus™ platform and clinical outcomes measures, namely the Fugl-Meyer Assessment (FMA) and Jebsen Taylor Hand Function Test (JTHFT).ResultsOur participant completed all the assigned sessions, with each averaging 20 min. Usability scored 77.5 out of 100 on the SUS. User feedback from the interviews revealed improved mobility and control over therapy as benefits, indicating room for improvement in the intervention's adaptability and functionality. During the intervention, the participant noted no pain increase, and the telerehabilitation platform recorded range of motion improvements for all finger and wrist joints, excluding wrist extension. The FMA scores were 43 at T0, 53 at T1, and 56 at T2, while the JTHFT scores were 223 at T0, 188 at T1, and 240 at T2.ConclusionsThis single case study demonstrated the preliminary feasibility, safety, and efficacy of a novel home-based hand intervention for stroke survivors. The participant showed improved hand functions, good adherence to the program, and reported satisfaction with the intervention. However, these results are based on a single-case study, and further large-scale studies are needed before any generalization is recommended.

Project description:BackgroundIt is still unclear, which physiotherapeutic approaches are most effective in stroke recovery. Vojta therapy is a type of physiotherapy that was originally developed for children and adolescents with cerebral palsy. Vojta therapy has been reported to improve automatic control of body posture. Because acute stroke patients are characterised by a disturbance in the ability to adapt to changes in body position, requiring automatic postural adjustment, we decided to investigate Vojta therapy in the early rehabilitation of stroke patients. Aim of the trial was to test the hypothesis that Vojta therapy - as a new physiotherapeutic approach in early stroke recovery - improves postural control and motor function in patients with acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH).MethodsThis prospective, randomised controlled trial included patients with imaging-confirmed AIS or ICH, severe hemiparesis and randomly assigned them to Vojta therapy or standard physiotherapy within 72 h after stroke onset. Main exclusion criterion was restricted ability to communicate. Primary endpoint was the improvement of postural control measured by the Trunk Control Test (TCT) on day 9 after admission. Secondary endpoint among others was improvement of arm function (measured with Motor Evaluation Scale for Upper Extremity in Stroke Patients [MESUPES]).ResultsForty patients (20 per group) were randomised into the trial. Median age was 75 (66-80) years, 50% were women. The median improvement in TCT within 9 days was 25.5 points (=25.5%) (interquartile range [IQR] 12.5-42.5) in the Vojta group and 0 (IQR 0-13) in the control group (p = 0.001). Patients treated with Vojta therapy achieved a greater improvement in the MESUPES than patients in the control group (20% vs 10%, p = 0.006).ConclusionThis first randomised controlled trial of Vojta therapy in acute stroke patients demonstrates improvement of postural control through Vojta therapy compared to standard physiotherapy. Although this trial has some methodical weaknesses, Vojta therapy might be a promising approach in early stroke rehabilitation and should be studied in larger trials.Trial registrationClinicalTrials.gov; Unique identifier: NCT03035968. Registered 30 January 2017 - Retrospectively registered; http://www.clinicaltrials.gov.

Project description:(1) Background: Current vestibular rehabilitation therapy is an exercise-based approach aimed at promoting gaze stability, habituating symptoms, and improving balance and walking in patients with mild traumatic brain injury (mTBI). A major component of these exercises is the adaptation of the vestibulo-ocular reflex (VOR) and habituation training. Due to acute injury, the gain of the VOR is usually reduced, resulting in eye movement velocity that is less than head movement velocity. There is a higher chance for the success of the therapy program if the patient (a) understands the exercise procedure, (b) performs the exercises according to the prescribed regimen, (c) reports pre- and post-exercise symptoms and perceived difficulty, and (d) gets feedback on performance. (2) Methods: The development and laboratory evaluation of VestAid, an innovative, low-cost, tablet-based system that helps patients perform vestibulo-ocular reflex (VORx1) exercises correctly at home without therapist guidance, is presented. VestAid uses the tablet camera to automatically assess patient performance and compliance with exercise parameters. The system provides physical therapists (PTs) with near real-time, objective (head speed and gaze fixation compliance), and subjective (perceived difficulty and pre- and post- exercise symptoms) metrics through a web-based provider portal. The accuracy of the head-angle and eye-gaze compliance metrics was evaluated. The accuracy of estimated head angles calculated via VestAid's low-complexity algorithms was compared to the state-of-the-art deep-learning method on a public dataset. The accuracy of VestAid's metric evaluation during the VORx1 exercises was assessed in comparison to the output of an inertial measurement unit (IMU)-based system. (3) Results: There are low mean interpeak time errors (consistently below 0.1 s) across all speeds of the VORx1 exercise, as well as consistently matching numbers of identified peaks. The spatial comparison (after adjusting for the lag measured with the cross-correlation) between the VestAid and IMU-based systems also shows good matching, as shown by the low mean absolute head angle error, in which for all speeds, the mean is less than 10 degrees. (4) Conclusions: The accuracy of the system is sufficient to provide therapists with a good assessment of patient performance. While the VestAid system's head pose evaluation model may not be perfectly accurate as a result of the occluded facial features when the head moves further towards an extreme in pitch and yaw, the head speed measurements and associated compliance measures are sufficiently accurate for monitoring patients' VORx1 exercise compliance and general performance.

Project description:Background: Telehealth affords rehabilitation professionals opportunities to expand access to intervention for people in rural areas. Complex interventions have not been adapted for remote delivery using mobile health technologies. Strategy training is a complex intervention that teaches clients skills for identifying barriers and solutions to engagement in meaningful activities. Our goal was to adapt the delivery of strategy training for remote delivery using mobile health technology.Methods: We conducted a sequential descriptive case series study (n = 5) in which community-dwelling participants with chronic stroke and prior exposure to strategy training used the iADAPTS mobile health application for 5 weeks. Expert practitioners advised revisions to the intervention process. Safety was assessed via monitoring occurrence of adverse events and risk for adverse events. Acceptability was assessed via the Client Satisfaction Questionnaire-8 (CSQ-8) and the Patient-Provider Connection Short Form of the Healing Encounters and Attitudes Lists (HEAL PPC).Results: Revisions to the intervention process supported the delivery of strategy training using mobile health technology after stroke. No adverse events occurred and risk for adverse events was managed through the intervention process. Acceptability was high (CSQ-8, 25 to 32; HEAL PPC, 59.9 to 72.5).Conclusions: Strategy training can be adapted for delivery using mobile health technology, with careful consideration to methods for training participants on new technology and the intervention delivery. Future research should establish the efficacy and effectiveness of integrating mobile health in delivery of interventions that promote engagement in client-selected activities and community participation.Implications for rehabilitationTranslating the strategy training intervention from face-to-face to remote delivery required thoughtful adaptation of the intervention protocol.Strategies for training clients to use mobile health technology during intervention may be important when designing remotely delivered mHealth intervention protocols.Client safety should be considered within the design of the intervention protocol for a complex intervention designed to be delivered remotely.Future studies should examine the efficacy of complex rehabilitation interventions such as strategy training on clinical outcomes (e.g., community participation).

Project description:Introduction: Stroke rehabilitation should start early in order to optimize patients' outcomes, but most trials include subacute or chronic patients. Although suggested that early stroke rehabilitation trials face difficulties regarding patient recruitment with corresponding low recruitment rates, no systematically collected information regarding screening and associated costs has been published. Such knowledge is essential for optimizing enrollment. Therefore, this study evaluated screening procedures for an early upper limb rehabilitation study including first-ever ischemic stroke patients <48 h after onset. Methods: Screening data for a monocentric longitudinal observational cohort study was prospectively collected. Researchers screened health-care records, during the morning round and face-to-face at the stroke-unit on working days. Outcomes were the recruitment rate, reasons for non-enrollment, and screening costs. Results: Over 15 months, 27 out of 845 screened ischemic stroke patients were enrolled, equaling a recruitment rate of 1.8/month. Main reasons for non-enrollment were no upper limb paresis (N = 456), >48 h post-stroke (N = 257), general comorbidity (N = 150), unable to follow commands (N = 148), and recurrent stroke (N = 146). Four patients were missed due to time constraints of the personnel or patient. The recruitment rate would have been 1.2 higher if also patients with recurrent strokes but without residual motor deficits or pre-stroke mRS ≥2 were considered eligible. Screening costed € 7.48 per patient. Discussion: Screening at working days is sufficient to enroll patients in early stroke rehabilitation trials. Inclusion criteria regarding recurrent strokes should be less stringent to boost recruitment rates without increasing bias. Multicenter collaborations are needed to finish well-powered early stroke rehabilitation studies within a reasonable time. Ethics and Study Registration: Authorization from the local ethical committee was not required, as this study does not fall within the scope of the Human Research Act (BASEC Identifier: Req-2017-00844). The project was registered at http://www.clinicaltrials.gov (Identifier: NCT03633422).

Dataset Information

RecoverNow: A mobile tablet-based therapy platform for early stroke rehabilitation.

Publications

RecoverNow: A mobile tablet-based therapy platform for early stroke rehabilitation.

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