Abstract
BackgroundHome-based rehabilitation of arm function is a significant gap in service provision for adult stroke. The EDNA-22 tablet is a portable virtual rehabilitation-based system that provides a viable option for home-based rehabilitation using a suite of tailored movement tasks, and performance monitoring via cloud computing data storage. The study reported here aimed to compare use of the EDNA system with an active control (Graded Repetitive Arm Supplementary Program—GRASP training) group using a parallel RCT design.MethodsOf 19 originally randomized, 17 acute-care patients with upper-extremity dysfunction following unilateral stroke completed training in either the treatment (n = 10) or active control groups (n = 7), each receiving 8-weeks of in-home training involving 30-min sessions scheduled 3–4 times weekly. Performance was assessed across motor, cognitive and functional behaviour in the home. Primary motor measures, collected by a blinded assessor, were the Box and Blocks Task (BBT) and 9-Hole Pegboard Test (9HPT), and for cognition the Montreal Cognitive Assessment (MoCA). Functional behaviour was assessed using the Stroke Impact Scale (SIS) and Neurobehavioural Functioning Inventory (NFI).ResultsOne participant from each group withdrew for personal reasons. No adverse events were reported. Results showed a significant and large improvement in performance on the BBT for the more-affected hand in the EDNA training group, only (g = 0.90). There was a mild-to-moderate effect of training on the 9HPT for EDNA (g = 0.55) and control (g = 0.42) groups, again for the more affected hand. In relation to cognition, performance on the MoCA improved for the EDNA group (g = 0.70). Finally, the EDNA group showed moderate (but non-significant) improvement in functional behaviour on the SIS (g = 0.57) and NFI (g = 0.49).ConclusionA short course of home-based training using the EDNA-22 system can yield significant gains in motor and cognitive performance, over and above an active control training that also targets upper-limb function. Intriguingly, these changes in performance were corroborated only tentatively in the reports of caregivers. We suggest that future research consider how the implementation of home-based rehabilitation technology can be optimized. We contend that self-administered digitally-enhanced training needs to become part of the health literacy of all stakeholders who are impacted by stroke and other acquired brain injuries.Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001557123. Registered 12 November 2019, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378298&isReview=true
Highlights
Home-based rehabilitation of arm function is a significant gap in service provision for adult stroke
The motor and cognitive performance of patients at pre-test was comparable between groups; the one exception was a non-significant trend shown on the Abilhand (p = 0.051)
The level of neurobehavioural impairment reported by caregivers on the Neurobehavioural Functioning Inventory (NFI) was high for the Elements DNA (EDNA) treatment group; only four respondents completed the NFI for the Control group and, as such, the mean score is not presented
Summary
Home-based rehabilitation of arm function is a significant gap in service provision for adult stroke. Training tasks should be scaled in complexity (both motor and cognitive) in a manner that accords with the individual needs and capabilities of the patient, fostering motivation and continued progression To this end, tailored virtual reality (VR), augmented reality (AR) and associated interactive technology can provide a number of key assets for rehabilitation, most notably a medium to increase training doses during critical phases of recovery, scale task difficulty in a systematic way, engage patients’ interest in novel forms of interaction, enhance learning via use of augmented feedback, and record the progress of patients using system-generated metrics. The notion here is to present a task environment that affords physical movement and engages the patient’s cognitive attention—both are critical ingredients in skilled performance This is supported by a recent systematic review and meta-analysis that showed enhanced motor outcomes when these critical ingredients are met with purpose-designed systems [8]
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