Expanding Tele-rehabilitation of Stroke Through In-home Robot-assisted Therapy
March 2014
International Journal of Physical Medicine & Rehabilitation
Butler et al.
Objective: The purpose of this case series was to examine the feasibility of using an in-home robotic therapy telerehabilitation device to produce quality outcomes in functional ability and mood, while satisfying patient need for access to post-stroke rehabilitation at low cost to the client.
Methods: Thirteen chronic stroke survivors with motor impairments of at least one upper or lower extremity were instructed in a home rehabilitation regimen using a robotic device designed for either the hand or the foot. Assessments of function and depression were made prior to initiation and at the end of 3 months of in-home use to determine any change in outcomes. Satisfaction with the device and access to therapy were determined using written and verbal surveys. Cost analysis was performed to compare the economics of the in-home delivery method to the cost of clinic-based physical or occupational therapy. A licensed physical therapist remotely monitored participant progress throughout the treatment period via weekly telephone calls and a secure database.
Results: Compared to baseline, participants showed improvements in depressive symptoms, functional independence, use of the upper extremity in functional tasks, distance walked, and gait speed at final assessment. Participants indicated satisfaction with the device and with their outcomes at the end of the 3-month treatment period. Using the device in the home expanded access to post-stroke rehabilitation for all participants with a reduced cost compared to clinic-based therapy.
Conclusion: Individuals were able to make functional improvements in the use of their impaired extremities post-stroke using a robotic telerehabilitation device in the home. The in-home service delivery regimen reduced the cost of therapy while expanding access to a rehabilitation modality for individuals who would not otherwise have received services. A small sample of mostly males and no comparison group limits the statistical analysis and generalizability of results.
Principal Findings:
- The Hand Mentor improves upper limb function.
- The Hand Mentor improves subjective reports of depression.
- The Hand Mentor expands access to post-stroke rehabilitation for all participants.
- The Hand Mentor provides a cost effective rehabilitation solution compared to clinic-based therapy.
- Hand Mentor rehabilitation does not require a therapist to be present.