Abstract T MP40: A Home-Based Telerehabilitation System for Patients With Stroke

Abstract

Evidence suggests that greater duration and intensity of rehabilitation therapy improves outcomes for patients with stroke. Delivery of care is often limited, however, e.g., due to systems of care delivery, cost, rural location, or difficulty travelling. The current study addressed this unmet need by examining the feasibility of a home-based telerehabilitation system. Entry criteria included age >18 yrs, 12-26 wk post stroke, and arm motor deficits (Fugl-Meyer (FM) score 22-55) that were stable. Each subject received 28 d of daily home-based telerehabilitation using a fixed system that we delivered/assembled. Each day consisted of 1 structured hour (testing, BP check, individualized exercises and games, and stroke prevention education) plus up to 1 hour of free play on dozens of games. Each week, subjects had a 1 videoconference with a licensed therapist and 1 with a research assistant; subjects could also phone the lab for technical support if needed. Enrollees were 54±17 yr (mean±SD), 6M/6F, with baseline FM=39±12 (range 23-55). Compliance was excellent, with subjects engaging in therapy 329 of 336 (97.9%) assigned days. Arm motor status improved (FM change 4.8±3.8 points from baseline to 1 mo post-therapy, p=0.0015). Although scores on tests of computer literacy declined with age (r = -0.90 to -0.92, p<0.0001), as expected, the arm motor gains derived from use of this system did not vary with age. The stroke education module was associated with significant gains in stroke prevention knowledge. BP was recorded by the patient, and results automatically transmitted to lab, on 97.9% of assigned days. Therapist videoconferences detected PHQ-2 scores consistent with depression in 3/12 patients. Therapists were able to review patient performances and upload revised therapy settings to the patient’s home system without difficulty at any time of day. Results of this pilot study support the utility of a home-based system to effectively deliver telerehabilitation, improve patient education, screen for complications of stroke, and as well as to provide a means for patient interaction with medical personnel. The use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.