Stroke survivors' interaction with hand rehabilitation devices : observational study

Background: The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55% to 75% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function. Objective: In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices. Methods: Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session. Results: A total of 29 participants were included in this study, of whom 10 (34%) had poor hand function, 17 (59%) had moderate hand function, and 2 (7%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness. Conclusions: Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function

An intensive exercise program using a technology-enriched rehabilitation gym for the recovery of function in people with chronic stroke : usability study

Background: Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment. Objective: This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research. Methods: This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures. Results: In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. Conclusions: This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population

Annual report 2023 : Sir Jules Thorn Co-Creation Centre in Rehabilitation Technology

The Sir Jules Thorn Centre for Co-Creation of Rehabilitation Technology (CCRT) was set up in early 2021 following a philanthropic award from the Sir Jules Thorn Charitable Trust of £449,000. This allowed two rooms in the Wolfson centre (Biomedical Engineering, University of Strathclyde, Glasgow) to be equipped with state-of-the-art rehabilitation technology (de-weighting systems, neurostimulation, virtual reality, treadmills, bespoke rehab games, communication apps, powered exercise equipment and gamified resistance equipment) and measurement equipment, to add to existing facilities. Following installation of key equipment and ethical approval from the University, the centre commenced recruitment of participants in September 2021. The centre was established as a response to the overwhelming, global, need for rehabilitation (across many conditions) and our universal inability to meet this need. The stated aim of the centre is to lead a multi-faceted rehabilitation revolution by developing a range of cutting-edge technology based on a co-creation approach with users, clinicians and the wider rehabilitation community. The resulting technology and programmes can then be made available in community settings in a cost effective, user friendly way for society-wide benefit. To achieve the aim the team designed an 8-week supervised rehabilitation program located in a gym-like space equipped using a range of integrated technology designed to holistically address the full range of motor and communication impairments caused by stroke. Through this close engagement between technology and users our team of engineers and therapists could create, design and evaluate truly useful rehabilitation technology and develop the necessary protocols around delivering a technology enriched rehabilitation intervention

A participatory model for co-creating accessible rehabilitation technology for stroke survivors

Background: Globally, one in three people live with health conditions that could be improved with rehabilitation. Ideally this is provided by trained professionals delivering evidence based levels of dose, intensity and content, for optimal recovery. The inability of healthcare providers to deliver this, creates an opportunity for technological innovation. Design processes that lack close consideration of users’ needs and healthcare budgets, however, mean that many rehabilitation technologies are neither useful, nor used. Objective: To develop a model for designing accessible rehabilitation technology using a co-creation approach that is informed by users who have completed, or are completing, an eight-week technology based rehabilitation programme. Methods: To address this problem our multi-disciplinary research group established a co-creation centre for rehabilitation technology that places the user at the centre of the innovation process. The core of this model is an eight-week holistic rehabilitation programme delivered exclusively through commercial and prototype technology so that users are able to provide truly informed feedback on technologies under development, as well as creating an observatory to better understand how patients interact with rehabilitation technologies. The process is supported by focus groups for product development and a translation group advising on broader issues of adoption. As the leading cause of global adult disability, the target population for the centre has been stroke, however the principles can be applied to any clinical population. Results: Our model has been active for more than two years with 80/86 individuals completing the programme. Five new devices have emerged from the process with further ideas logged for future development. In addition, it has led to accessibility modifications to existing technology, including modifications to hand grips and the structure of rehabilitation games. Critically it has also produced a set of co-created protocols for technology enriched rehabilitation that has allowed us to replicate the model on an acute stroke ward. Conclusions: Sub-optimal rehabilitation limits recovery from health conditions. Technology offers support to increase access to intensive and enriched rehabilitation, but needs to be designed to suit users and not just their impairment. Our co-creation model, built around participation in an intensive, technology-based programme, has produced new accessible technology and demonstrated the feasibility of our overall approach to providing the rehabilitation that people need, for as long as needed