Beling J.1, Kamrava S.1, Kromnick E.1, Morsey T.1, Bartolo E.1, Zondervan D.2, Reinkensmeyer D.2,3
1California State University, Physical Therapy, Northridge, United States, 2University of California at Irvine, Mechanical and Aerospace Engineering, Irvine, United States, 3University of California at Irvine, Anatomy and Neurobiology; Biomedical Engineering, Irvine, United States
Background: Robotic arm therapy devices that incorporate motion assistance can improve arm recovery, motivate patients to practice, and allow physical therapists to deliver semi-autonomous training. However, because such devices actively apply forces and are often complex, they are not widespread in the rehabilitation setting. This deice was designed for use in scarce resourced countries because it is convenient, inexpensive, mimics robotic active assistance and does not rely on powered actuators.
Purpose: The purpose of this study was to determine the effect of a Resonating Arm Exerciser (RAE), which provides patient active assistance for upper extremity training, on arm function in people with moderate to severe chronic stroke.
Methods: We recruited participants from the outpatient population of a rehabilitation hospital in Vietnam. The RAE consists of a lever that reversibly attaches to a wheelchair wheel rim, a padded forearm support, and an elastic band that stores energy. Patients push and pull on the lever in a sagital plane to roll the wheelchair back and forth around a neutral position. We assigned participants to two groups based on their availability. Participants in the RAE-Rest group (n=7) exercised with the device for 3 consecutive weeks, and then continued with regularly scheduled PT for 3 consecutive weeks. Participants in the Rest-RAE (n=6) reversed the order of RAE and Rest. Subjects exercised with RAE for eight 45 minutes sessions for three weeks. All subjects continued regularly scheduled PT treatment x six weeks which included passive range of motion and thereapeutic exercise to the participants involved upper extremity. Pre, mid, and post measurements were taken on the primary outcome of sensorimotor performance (Fugl-Meyer Upper Extremity Assessment tool [FM]) and secondary outcomes of how stroke affected the participants life and pain levels (Stroke Impact Scale and a VAS pain scale, respectively). All data were analyzed using SPSS 23.0. A 2 X 2 mixed ANOVA was used to investigate the effect of the RAE on FM and SIS scores. The Wilcoxan Signed Rank test was used to analyze the difference between groups for pain scores. All statistical tests were conducted at the P 0.05.
Results: Thirteen subjects, five women and eight men, mean age 57 years old (±10.5 SD), 34.2 months s/p stroke (±22.7 SD), with severe upper extremity impairment (mean FM score=15.9/66 ± 10 SD) participated. The main effect of time showed a statistically significant difference in mean FM scores at the different time points, F (1.28, 12.80)=13.108, P=.002, partial eta-squared=.567. The mean FM score increased 11.77±8.34 points. There was no statistically significant findings for the SIS or pain.
Conclusion(s): Combined exercise with the RAE and conventional therapy led to significantly greater improvements in the FM scores than conventional therapy alone. In conclusion, data support use of the RAE for chronic stroke rehabilitation secondary to its ability to improve upper extremity function without increasing pain in patients involved arm.
Implications: The low cost of this device allows patients in developing countries to gain access to affordable autonomous care without direct supervision of a physical therapist where the number of physical therapists may be limited.
Funding acknowledgements: Funding was provided by CSUN IRA grant. Clinical Trials Registry: United States National Institutes of Health Clinical Trials Registry (NCT02327767).
Topic: Neurology: stroke
Ethics approval: This project was approved by the Office of Research and Sponsored Projects at California State University, Northridge, California, USA.
All authors, affiliations and abstracts have been published as submitted.
