Authors (including presenting author) :
Mr SHUM MHH(1), Dr HU XL(2), Dr Nam CY(3), Mr CHAN KLM(4), Mr YU KP(6)
Affiliation :
(1)Occupational Therapist, Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital
(2)Assistant Professor, Dept of Biomedical Engineering, The Hong Kong Polytechnic University
(3)Postdoctoral Fellow, Dept of Biomedical Engineering, The Hong Kong Polytechnic University
(4)Senior Occupational Therapist, Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital
(5)AM/Technology, Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital
Introduction :
Home-based tele-rehabilitation after stroke can reduce the dependency of stroke patients on the public healthcare resources (e.g., hospital / centre-based rehab programs) by providing a relatively self-supported and non-location-dependent service mode, to achieve intensive long-term rehabilitation. A novel mobile exo-neuro-musculo-skeleton (ENMS) was designed for self-help post-stroke upper limb training under minimized professional supervision with proved rehabilitative efficacy in the laboratory.In this study, the tele-rehabilitation program is further translated to the Community Rehabilitation Service Support Centre (CRSSC) in routine service by rehabilitation professionals for evaluation of the feasibility and efficacy.
Objectives :
To evaluate the effectiveness of home based upper Limb Exo-neuromusculo-Skeleton for post-stroke pateint
Methodology :
The study is on-going. Patients with chronic stroke are recruited from CRSSC to attend a 20-session home-based tele-rehabilitation with the mobile ENMS on their upper limb, with an intensity of 3-5 sessions/week and 1.5hr/session. The system can assist a stroke survivor in performing wrist-finger extension and flexion during multi-joint coordinated movements. Seven participants completed the training program at the time of writing. Tutorial sessions were provided by the professionals in the CRSSC before the start of the home-based self-help rehabilitation. Tele-supervisions, technical support, and emergency hotlines were provided to the participants. The training progress, including the training frequency and duration, was telemonitored. These data recorded by the mobile ENMS and the therapist (experiment operator) reviewed it through an encrypted network. Rehabilitation effectiveness in the upper limb function was evaluated by clinical assessments, electromyography and kinematic measurement with quantitative motion capturing, before and after the training, as well as at 6-month follow-up.
Result & Outcome :
All of the participants completed the tele-rehabilitation with the mobile ENMS during the COVID-19 pandemic in Hong Kong, with the prescribed training intensity and duration. All of them were determined as having sufficient competence to perform the training at home after the third supervised sessions in the CRSSC. Three of them completed the training at home independently, whereas the others completed the training with partial assistance from their caregivers at home. It was found that the preferred training time slots selected by the participants were 14:00 to 16:00 and 20:00 to 22:00. After 20-session training, motor function improvements associated with improved clinical scores were observed in all of the participants. An increase of 8.6±3.1 (Mean±SD) points in the Fugl–Meyer Assessment score was found after the training, and it indicated an improvement in voluntary motor control of the entire upper limb. The spasticity of the elbow, wrist and finger joints were reduced after the training , which indicated by the decrease of 0.8±0.2 points in the Modified Ashworth Scale (MAS) elbow, 0.8±0.4 points in the MAS wrist, and 0.9±0.5 points in the MAS finger. The improved independence of activities of daily living (ADL) was also observed after the training that revealed by an increase of 1.3±1.0 points in the Motor Functional Independence Measure score.
The results suggested that the home-based tele-rehabilitation program assisted with the mobile ENMS was feasible and effective for improving upper limb function after stroke.
