Improved Hand Function in Cerebral Palsy
A Rutgers-based study, recently published in the IEEE Transactions on Information Technology in Biomedicine journal, has shown that an at-home treatment regimen involving video games can improve hand function in teenagers with cerebral palsy.
The pilot study, involving only three teenage participants, combined a Sony Playstation 3 console and a commercial gaming glove with their custom-made games. Rutgers engineers created custom game and exercise software aimed at improving hand speed and range of motion.
The system enhanced the participants’ abilities to perform a range of daily personal and household activities.
After three months of therapy, two study participants were able to lift heavy objects, a task they were unable to accomplish before the trial. Participants showed varying improvement in activities of daily living including brushing teeth, shampooing, dressing and opening heavy doors.
The study was the result of a collaboration between engineers at Rutgers University’s Tele-Rehabilitation Institute and clinicians at the Indiana University School of Medicine.
In addition to game and exercise software, the apparatus features an online telerehabilitation platform that allowed researchers to oversee participants’ routines and evaluate their recovery of motor function.
Here’s a link to the full article (requires a subscription to the journal).
Here’s a video from the Rutgers website:
ReJoyce For Stroke and Spinal Cord Rehab: Video
This video was put together by Alberta Innovates and published in mid-March. It features interviews with ReJoyce inventors Dr. Jan Kowalczewski and Dr. Arthur Prochazka, as well as clinical trial investigators Dr. Mary Galea and Su Ling Chong. Ginny Bockman, a study participant, is also featured.
Here’s the transcript:
Dr. Prochazka – “As far as we know, this is the first large-scale study of in-home telerehabilitation in the world. I think this is the first study where we have learned how to interact with people in their homes, take them right through a training program of many weeks, measure the outcome, and then also, of course, develop the technology that allows all of this to happen.”
Dr. Kowalczewski – “I really hope it reaches as many people as it can. The reason why I’m saying this is because we’re seeing such positive results in our studies. I really hope that anyone that’s had a stroke or spinal cord injury can really benefit from this.”
Su-ling Chong – “In conventional therapy, you go to a place and you just do the functional tasks. We sneak the functions into the game, and patients enjoy it. Most of the time I have to tell the person that their hour is up because, usually, they just want to keep going.”
Dr. Galea – “A device like the ReJoyce is useful for people because it can be installed in their own home very simply, and people can use it in the comfort of their own home without needing to travel. The telerehabilitation enables the therapist to keep in touch with them, monitor their progress, and deal with any difficulties they might be having. That is a very important way to of continuing to enable people to continue improving without tying them to the hospital’s apron strings. It allows them to get on with their own lives.”
Mrs. Bockman – “When I woke up in the hospital, I couldn’t move my arms; I couldn’t move my hands and I thought, “how am I going to live my life?” When I started doing this [ReJoyce telerehabilitation], a lot more things started coming back to me. I’m able to hold my brush, with my hand, brush my own hair, brush my own teeth, feed myself. Senses have also gone back to playing with a Sony Playstation. I can kick my husband’s but on a lot of games, and I’m happy with that.”
Report: Stroke Rehabilitation Services In Canada Are Inadequate
Today, a report in the Canadian Medical Association Journal suggested that Canadian stroke rehabilitation services are inadequate. According to the article, Canada’s stroke rehabilitation programs suffer from:
“inadequate facilities, beds and staff to deliver services; inadequate treatment, including outpatient services, and inadequate funding.”
The article cites Christina O’Callaghan, executive director of the Ontario Stroke Network, who says that three out of every four people who have a stroke severe enough to require hospital admission fail to get sent to rehabilitation.
“It has created a situation in which stroke sufferers often have little option but to languish in long-term care facilities or nursing homes, says Dr. Mark Bayley, medical director of the neuro rehabilitation program at the Toronto Rehabilitation Institute in Ontario. “If some people with more severe strokes were provided with the adequate amount of rehabilitation, a certain number of them would be able to go home. This would save our health care system from having to utilize our very limited and expensive long-term care resources as much as we do currently.”
Read the full report here.
Robot Stroke Rehabilitation Results in "Modest Improvements"
A recent randomized trial of 127 stroke survivors has shown no significant difference between rehabilitation with the assistance of a robotic workstation and more conventional rehabilitation with the assistance of a human.
The study, conducted by Dr. Albert Lo of the Providence VA Medical Center in Rhode Island, separated 127 participants into three groups: human-assisted rehabilitation (50 patients), robot-assisted rehabilitation (49 patients), and usual care consisting of treatment with antiplatelets, antihypertensives and recommendations for diet and exercise (28 patients).
Dr. Lo described improvements in both the robot-assisted and human-assisted as “fairly modest.” He went on to say that the improvements were important “because there’s very little available for people with chronic stroke.”
The study focused on rehabilitation of the upper extremity, involving repetitive rehabilitation exercises in stroke patients with moderate-to-severe arm disability. The rehabilitation programs lasted 12 weeks, three one-hour sessions per week, and involved the same number of repetitions of arm exercises.
Outcome evaluations were performed immediately after the 12 week rehabilitation program, and included the Fugl-Meyer Assessment of basic motor function (the primary endpoint), the Wolf Motor Function Test of time to complete everyday tasks, and the Stroke Impact Scale. No significant differences were found between the human-assisted and robot-assisted treatment groups.
At the end of the follow-up period (36 weeks), patients who received robot or human-assisted rehabilitation had slightly better scores on all outcome measures than those in the usual care.
There were no differences between robot-assisted and human-assisted rehab on any of the outcomes at any time point.
The cost difference in treatment was substantial: the initial cost of the robots was $200,000, and the cost of the robot-assisted rehab program was around $1200 more per patient than that of usual care over the course of the year.
From this article, I gather that the robots were made by Interactive Motion Technologies.