A robotic rehabilitation intervention in a home setting during the Covid-19 outbreak: a feasibility pilot study in patients with stroke

Abstract

Background: Telerehabilitation allows patients to engage in therapy away from healthcare facilities, often in the comfort of their homes. Studies have suggested that it can effectively improve motor and cognitive function. However, its applicability may be limited to patients with severe impairments who require physical assistance. The proposed study aims to evaluate the feasibility and effects of a home-based rehabilitation program for post-stroke patients, based on the use of a planar robot, able to overcome the limitations posed by the COVID-19 pandemic.

Methods: We enrolled 20 patients with stroke (11 men, aged 66.1 ± 9.2 years). Patients underwent 20 one-hour robotic upper limb rehabilitation sessions, consisting of the execution of planar point-to-point reaching exercises, using a robotic device in their own home, with the remote supervision of a physical therapist. We assessed the feasibility of this intervention by examining adverse events, patient satisfaction (measured on a Likert scale), usability (using the System Usability Scale, SUS), acceptability (evaluated through the Technology Acceptance Model questionnaire, TAM+), and pain onset (measured with the Numeric Rating Scale). To gauge the clinical effects of the treatment, we analyzed changes in the motor and sensory components of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) before and after the intervention.

Results: The approach was safe, as we did not observe any adverse events, and patients did not experience an increase in pain levels. Patients expressed their appreciation for the treatment, providing an average Likert scale score of 8 out of 10. The usability of the treatment received high marks, with an average SUS score of 78 ± 12. Similarly, the treatment acceptability was favorable, with all examined domains scoring above 4, indicating a positive attitude towards the proposed solution. Moreover, we observed a statistically significant improvement in the motor part of the FMA-UE (p < 0.001).

Conclusion: Our results demonstrate the feasibility, safety, and effectiveness of employing a rehabilitation robot for upper limb rehabilitation in post-stroke patients within a home-based environment. These findings mark a significant step in advancing innovative and easily accessible rehabilitation options for stroke survivors, ensuring uninterrupted care and creating new opportunities to enhance their functional abilities.

Trial registration: clinicaltrial.gov (NCT05250934).

Keywords: Covid-19; Rehabilitation; Robotics; Stroke; Telerehabilitation; Upper extremity.

Fig. 1

The robot Icone

Fig. 2

Some of the serious games of Icone

Fig. 3

Home-based set-up with remote supervision

Fig. 4

Study timing (red, in-presence phases; green, remote phases)

Fig. 5

Flow-chart of the study

Fig. 6

Numeric rating scale (NRS) for pain before (T0) and after (T1) the treatment

Fig. 7

Feasibility measures of usability, satisfaction, and acceptance of the home-based rehabilitation intervention

Fig. 8

Clinical evaluation before (T0) and after (T1) the rehabilitation treatment, using the Fugl-Meyer Assessment for upper extremity (FMA-UE) score. The symbol *** indicates a p < 0.001, according to the Wilcoxon Signed Rank test

Fig. 9

Subscores of upper extremity motor function section of the Fugl-Meyer Assessment. Changes before (T0) and after (T1) the treatment are reported, together with the statistical analysis (** p < 0.01, *** p < 0.001, according to the Wilcoxon Signed Rank test)