Abstract WP193: A Pilot Study of Expanded Home-Based Telerehabilitation After Stroke

Abstract

Introduction: High doses of activity-based rehabilitation therapy help but many patients do not receive this, e.g., due to access, cost, and low compliance. Home-based telerehabilitation (TR) can address these issues. A prior study found 6 weeks of TR targeting arm motor deficits after stroke comparably efficacious vs. therapy delivered in-clinic. Here, we evaluated a program expanded in TR dose and scope. Methods: Adults with stroke and arm motor deficits saw a licensed OT/PT who performed a live exam then supervised home-based TR (6 days/week, 1 hour/day) through games, exercises, and education. New features examined herein included (a) extending therapy to 12 weeks, (b) treating both arm and leg motor deficits, (c) augmented reality games, (d) wireless smart devices, (e) ingesting a daily experimental (placebo) pill, (f) using functional objects, (g) evaluating social networks, and (h) automated actionable reports. Results: Patients (n=13) were median age 61 [IQR=52-65.5], and 129 [52-486] days post-stroke. Patients initiated therapy on 79.9% of the 72 assigned days and completed >30 min on 65.7% of days, for a 12-week total therapy dose of 50.4 [33.3 - 56.7] hours. Non-compliant days during weeks 7-12 were double those of weeks 1-6. Modified Rankin scores improved by 1 level in 6/13 patients, 3 of whom were > 3month post-stroke. Fugl-Meyer motor scores increased by 6 [2.5-12.5] points in the arm and 1 [-0.5 - 5] point in the leg, mainly in weeks 1-6. Geriatric Depression Scale scores fell from 3 [1-5] at baseline (3/13 with depression) to 1 [0-4] (0/13 with depression) at week 12. Augmented reality gaming and functional objects were well received. Communication with smart devices was challenging. The experimental pill was taken, with photo verification, on 90.9% of days. Enrollees had large social networks. Automatic reports reliably notified study personnel when compliance was low or behavioral scores were concerning. Conclusions: High doses of home-based TR targeting arm and leg motor deficits are feasible and improve functional outcomes, motor deficits, and mood. The current system automates experimental pill ingestion and actionable reports to clinicians. Compliance declined over time, suggesting the need for novel approaches to extended periods of TR.