HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke

Abstract

Background: 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. 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).

Methods: Patients 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.

Results: Twelve 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.

Conclusion: Patients 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 .

Keywords: Hand; Home training; Rehabilitation; Stroke; Task specific; Telerehabilitation; Training device; Upper limb.

Fig. 1

a ArmAssist device; b MERLIN system for training at home; c Example of the game “Words”

Fig. 2

Flow diagram of time points and outcomes. ARAT Action Research Arm Test, D-QUEST Dutch-Quebec User Evaluation of Satisfaction with Assistive Technology, EQ-5D Euro-Quality of Life -5 Dimensions, FMA-UE Fugl Meyer Assessment -Upper Extremity, IMI Intrinsic Motivation Inventory, SUS System Usability Scale, WMFT Wolf Motor Function Test. One of the two patients that dropped out was willing to complete the subsequent measurements

Fig. 3

Mean score on arm function measurements over time for the primary outcome Wolf Motor Function (a) and secondary outcomes Fugl-Meyer Assessment-Upper Extremity and Action Research Arm Test (b and c). ARAT Action Research Arm Test, FMA-UE  Fugl-Meyer Assessment-Upper Extremity, WMFT Wolf Motor Function Test. T0 = baseline, T1 = 6 weeks after baseline, pre-intervention, T2 = post-intervention, T3 = 6 weeks after intervention. * = p < 0.008, ** = p < 0.001. Thick black line = mean; grey striped/dotted lines: individual data. Vertical bars represent standard deviation, N = 12