Abstract
Stroke is currently the world’s second cause of disability. It can cause deficits such as postural control, and telerehabilitation could improve the therapeutic dose as well as functional results. The aim of this work is to determine the effectiveness and usability of a low-cost telerehabilitation system in patients with stroke. We developed a telerehabilitation system based on exergames on smartphones, inertial sensors, and a cloud database. We trained the balance of six participants (three men and three women) in early subacute stroke (seven weeks of progress). In addition to their conventional treatment, these participants trained for a total of nine sessions of 30 min per week, for four weeks. The telerehabilitation group was compared with a control group of four clinically similar participants (three men and one woman). Clinical and usability measurements were made before and after the training. The results show a significant improvement of 11.3 ± 3.5 points in the Berg Balance Scale, 8.3 ± 3.01 points in the Mini-BESTest, and 17.5 ± 9.87 points in the Barthel scale for the telerehabilitation group. However, only the improvements of Berg and Barthel scales were statistically higher for the telerehabilitation group compared to the control group. The proposed system achieved excellent usability on the System Usability Scale (87.5 ± 11.61). Our results demonstrate that a complementary low-cost telemedicine approach is feasible, and that it can significantly improve the balance of stroke patients; therefore, the proposed clinical strategy could potentially improve dosage and overall treatment effectiveness.
Highlights
Worldwide, stroke is the second largest contributor of disability-adjusted life years (DALYs) in developing countries, and the third largest in developed countries [1]
This study reports changes of balance, functional independence, and usability in participants with stroke in the subacute stage who use telerehabilitation complementary to conventional rehabilitation
That study’s methodology was a prospective observational design with 26 stroke participants in the subacute stage measured before and after 10 one-hour sessions over two weeks of conventional therapy focused on balance training without an adherence report
Summary
Stroke is the second largest contributor of disability-adjusted life years (DALYs) in developing countries, and the third largest in developed countries [1]. Postural control is among the most common alterations producing fall risk during mobility tasks, which severely affects a person’s independence and life quality [2]. Balance training studies are mostly performed in the late subacute stage or in the chronic stage [3], but recent consensus [4] in the stroke rehabilitation literature suggests the need for studies on the acute and/or early subacute phase to demonstrate that training in these stages where there is a major level of plasticity can lead to better results than those of spontaneous recovery [4]. Simple video conference or telephone systems, or recorded videos for self-education strategies have increased patients’ exercise rehabilitation dose (frequency and intensity) and balance results, which may be similar or even better than those of conventional therapy [8,9]. Simple systems increase therapist time (synchronous systems), complex systems seem extremely difficult to use outside the research protocols [10,11,12] or in a mobile manner (with an easy transition from hospitals, labs, and homes)
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