Abstract
BackgroundHoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke).MethodsPatients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.ResultsTwelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements.ConclusionPatients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home.Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18–02-2019, https://www.trialregister.nl/trial/7535.
Highlights
HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform
The aim of the study was to investigate if MERLIN training can improve the arm function of chronic stroke patients during a 6-week task specific home rehabilitation program
The improvement on the Action Research Arm Test (ARAT) (3.7 points; 13.2%) was less than the Minimal Clinically Important Difference (MCID) which could be due to the specific fine motor functions that are assessed in this test which require independent finger control
Summary
HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. Rozevink et al J NeuroEngineering Rehabil (2021) 18:48 is emerging that patients in the chronic phase of stroke are able to improve the upper limb function significantly [7, 8]. Training has to involve a few key parameters that are important for motor learning such as high intensity training, many repetitions and a task specific approach [9] This is not yet generally available in practice for patients in the chronic phase of stroke, possibly due to the high costs of individual sessions with a therapist. By providing various serious games with different levels of difficulty, the patient may be more motivated to continue the training program, which may lead to more improvement in arm function [12]. A positive dose–response relation between the amount of training and upper limb improvement emphasizes the need for intensive training [13]
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