Robotic telerehabilitation: a feasibility study in patients with stroke

Abstract

Stroke is the world’s second leading cause of death and the leading cause of disability. Robotic therapy is a well-established approach for the rehabilitation of the upper limb, as a way to increase the amount and intensity of the therapy and standardize the treatment [1]. The coronavirus pandemic has required a reorganization of rehabilitation services but also an enhancement of technology as a tool in the rehabilitation field that can allow treatment in compliance with social distancing [2]. Many scientific works have confirmed the usefulness of these approaches to overcome the limits imposed by the pandemic, in particular for the treatment of stroke patients [3]. The proposed study aimed to test the feasibility of rehabilitation treatment in a home setting using a system of teleconsultation, telemonitoring and robotic telerehabilitation with the use of the robot Icone and integrated sensors, to overcome the limits imposed by the COVID-19 pandemic in a cohort of patients with stroke. For the study, 18 stroke patients were recruited. Patients underwent robotic telerehabilitation treatment, carried out at home, directly supervised by a caregiver and, remotely (using three webcams), by a multidisciplinary team. A total of 20 treatment sessions were provided. Patients underwent an initial (T0) and final (T1) evaluation through clinical scales (Fugl-Meyer Assessment Upper Extremity, FMA-UE, and Numerical Rating Scale for pain, NRS) and instrumental evaluations (based on the sensors present in the robot and additional sensors for the evaluation of joint kinematics, the galvanic response of the skin and the ECG signal) during kinematic and kinetic tasks. The clinical and instrumental evaluation was also performed remotely, to assess its reliability. Finally, the subjective perception of the treatment by the patient and the therapist were evaluated in terms of usability, acceptability and satisfaction. The main results related to the instrumental evaluation through the sensors embedded in the robot are reported in Table 1. Six over ten robotic indices were responsive to the treatment, while eight indices showed excellent reliability in the remote assessment. Clinical scales confirmed the effectiveness and the safety of the treatment, and the FMA showed excellent reliability when performed online. (ICC>0.75). Finally, the subjective perception of the treatment in both patients and therapists was high. Our preliminary results suggest that the proposed treatment is feasible, effective and well tolerated by patients, and that remote clinical and instrumental evaluation is a reliable way to assess patients. Then, the proposed approach can represent an effective way to ensure the continuum of care for patients with disabilities, even in situations such as the current pandemic.