Abstract
BackgroundStroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback.ObjectiveTo examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments.MethodsmRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user’s perception of mRehab.ResultsA total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant’s perception of mRehab was positive.ConclusionsDespite heterogeneity in participants’ use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes.Trial RegistrationClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944
Highlights
BackgroundStroke is a major cause of disability, leading to restriction of occupational performance for stroke survivors [1,2]
It is estimated that 30%-60% of stroke survivors continue to have residual limitations in upper extremity movements after traditional rehabilitation services [3]
Participants were excluded if they met any of the following criteria: (1) acute or chronic pain that would interfere with participation, (2) severely limited range of motion of the upper limb, (3) absent or severely impaired proprioception of the upper limb, (4) musculoskeletal or circulatory conditions affecting the upper limb, (5) spasticity graded as 3 or greater for upper extremity movement on the Modified Ashworth Scale (MAS), or (6) botulinum toxin injections for spasticity management within 3 months of starting the study
Summary
Stroke is a major cause of disability, leading to restriction of occupational performance for stroke survivors [1,2]. It is estimated that 30%-60% of stroke survivors continue to have residual limitations in upper extremity movements after traditional rehabilitation services [3]. At the end of rehabilitation services, survivors are commonly given a written home exercise program to guide recovery in chronic stages of stroke [4]. Upper limb recovery after stroke is identified as a research priority by survivors of stroke, caregivers, and health professionals [6]. Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback
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