HoMEcare aRm rehabiLItatioN (MERLIN):preliminary evidence of long term effects of telerehabilitation using an unactuated training device on upper limb function after stroke

BACKGROUND: While short term effects on upper limb function of stroke patients after training with robotic devices have been studied extensively, long term effects are often not addressed. HoMEcare aRm rehabiLItatioN (MERLIN) is a combination of an unactuated training device using serious games and a telerehabilitation platform in the patient’s home situation. Short term effects showed that upper limb function improved after training with MERLIN. The aim was to determine long term effects on upper limb function and quality of life. METHODS: Six months after cessation of the 6 week MERLIN training program, the upper limb function and quality of life of 11 chronic stroke patients were assessed. Upper limb function was measured using the Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE). EuroQoL-5D (EQ-5D) was used to measure quality of life. RESULTS: The WMFT, ARAT and EQ-5D did not show significant differences 6 months after the training period compared to directly after training. At 6 months follow-up, FMA-UE results were significantly better than at baseline. Time plots showed a decreasing trend in all tests. CONCLUSION: Training effects were still present at 6 months follow-up, since arm function seemed similar to directly after training and FMA-UE results were better than at baseline. However, because of the decreasing trend shown in all tests, it is questionable if improvements will be maintained longer than 6 months. Due to the sample size and study design, results should be interpreted with caution. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/753

HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke

HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.This research is part of MERLIN project (19094 and 20649) that has received funding from EIT Health. EIT Health is supported by the European Institute of Innovation and Technology (EIT), a body of the European Union receives support from the European Union´s Horizon 2020 Research and innovation program

Task-specific training methods to improve the upper limb function in stroke survivors

After a stroke, the upper extremity is often affected which may result in a decrease in functioning. Task-specific training is necessary to improve the upper limb function after a stroke. Due to the increase in number of patients and less available healthcare personnel, we need to find different ways to provide task-specific training. This thesis describes two methods of training, namely group training and home training, to train the upper limb function with minimal therapist resources. Within a rehabilitation centre, a standardized group training is able to provide a lower workload for therapists, while providing evidence-based training to a group of patients. We developed a circuit class based training program which entails activities of daily life. When a patient is able to return home, training must continue to prevent non-use of the arm in daily life. Therefore, a home-based training program using an assistive device and telerehabilitation system was investigated. Patients were able to significantly improve their upper limb function, effects were even retained six months after the cessation of the training. These results showed the added benefit of assistive device training. Patients found this way of training enjoyable, however several device flaws were encountered. This thesis showed that task-specific training can be provided in different forms, such as group training or using assistive training devices, and they are effective in improving the upper limb function. We advise to involve patients more during the development of assistive training devices and training programs, to match the training to the patients’ wishes and needs

Circuit Class Training program: A group training program for stroke survivors

This training program is developed within University Medical Center Groningen, Center for Rehabilitation, location Beatrixoord. The training is intended to be performed under supervision of a therapist (occupational or physiotherapy). The participants are working in pairs and perform the exercises alternating while the observer is counting the repetitions

Circuit Class Training program

This training program is developed within University Medical Center Groningen, Center for Rehabilitation, location Beatrixoord. The training is intended to be performed under supervision of a therapist (occupational or physiotherapy). The participants are working in pairs and perform the exercises alternating while the observer is counting the repetitions

Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke:a systematic review and meta-analysis

PURPOSE: Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced.MATERIALS AND METHODS: Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up.RESULTS AND CONCLUSION: Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.Implications for rehabilitationArm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.</p