Beling J1, Gregerson E1, McDonell J1, Soliva C1, Watkins J1, Mwalfulirwa A2, Smith B3
1California State University, Northridge, Department of Physical Therapy, Northridge, California, United States, 2University of Malawi, Physiotherapy Department, Blantyre, Malawi, 3Loyola Marymount University, Mechanical Engineering, Los Angeles, California, United States
Background: Robotic arm therapy devices that incorporate motion assistance can improve arm recovery, motivate patients to practice, and allow physiotherapists 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 device was designed for use in resource scarce countries because it is convenient, inexpensive, mimics robotic active assistance and does not rely on powered actuators.
Purpose: To determine the effect of repeated use of the Resonating Arm Exerciser (RAE) on arm function in people with severe, acute stroke at a rehabilitation centre in Malawi.
Methods: Nineteen volunteers with acute stroke were recruited from the outpatient population of a rehabilitation centre in Malawi. 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 sagittal plane to roll the wheelchair back and forth around a neutral position. Subjects were randomly allocated into an experimental or control group. The experimental group exercised with the RAE X 3 weeks X 45 minute sessions, 3 times per week for 8 sessions. Both groups continued with physiotherapy at the rehabilitation centre. Pre and post measurements were taken on sensorimotor performance (Fugl Meyer Upper Extremity Assessment tool [FMA] and Box and Block test [BBT]) and pain level (Faces Pain Scale Revised [FPS-R]). The Wilcoxon signed rank test was used to make comparisons within each group to determine the effect of the RAE on FMA and FPS-R change scores and the Mann-Whitney U test was used to analyze the difference between groups for both outcome scores. A two (intervention) x two (time) mixed ANOVA with repeated measures on the last factor was used to investigate the effect of the RAE on BBT scores. P≤ 0.05.
Results: Three men and 3 women, X=51 years old (± 17.6), with acute stroke (3.7 ± 3.4 mos s/p stroke) and severe upper extremity impairment (FMA score X=22.7±7.6) participated. A Wilcoxon signed-rank test revealed the RAE elicited a statistically nonsignificant median increase in FMA scores (6.00) in all subjects in the experimental group and in one subject (0.00) in the control group, z=1.604 and .447, respectively, P>.05. There were no statistically significant findings for the BBT or FPS-R.
Conclusion(s): The use of the RAE in addition to standard physiotherapy was not superior to standard physiotherapy in improving upper extremity function in subjects in Malawi with a diagnosis of acute stroke. However, given the limited sample size and the nature of spontaneous recovery that occurs in subjects immediately post-stroke, future studies are needed to explore possible benefits of using the RAE, especially as it did not cause additional pain to any of the subjects in this study.
Implications: The low cost of this device allows patients with stroke in resource-scarce countries to gain access to affordable autonomous care without direct supervision of a physiotherapist when the number of physiotherapists may be limited.
Keywords: Arm rehabilitation, Stroke, Active Assistance
Funding acknowledgements: Funding was provided by grants from California State University, Northridge and the Borchard Foundation.
Purpose: To determine the effect of repeated use of the Resonating Arm Exerciser (RAE) on arm function in people with severe, acute stroke at a rehabilitation centre in Malawi.
Methods: Nineteen volunteers with acute stroke were recruited from the outpatient population of a rehabilitation centre in Malawi. 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 sagittal plane to roll the wheelchair back and forth around a neutral position. Subjects were randomly allocated into an experimental or control group. The experimental group exercised with the RAE X 3 weeks X 45 minute sessions, 3 times per week for 8 sessions. Both groups continued with physiotherapy at the rehabilitation centre. Pre and post measurements were taken on sensorimotor performance (Fugl Meyer Upper Extremity Assessment tool [FMA] and Box and Block test [BBT]) and pain level (Faces Pain Scale Revised [FPS-R]). The Wilcoxon signed rank test was used to make comparisons within each group to determine the effect of the RAE on FMA and FPS-R change scores and the Mann-Whitney U test was used to analyze the difference between groups for both outcome scores. A two (intervention) x two (time) mixed ANOVA with repeated measures on the last factor was used to investigate the effect of the RAE on BBT scores. P≤ 0.05.
Results: Three men and 3 women, X=51 years old (± 17.6), with acute stroke (3.7 ± 3.4 mos s/p stroke) and severe upper extremity impairment (FMA score X=22.7±7.6) participated. A Wilcoxon signed-rank test revealed the RAE elicited a statistically nonsignificant median increase in FMA scores (6.00) in all subjects in the experimental group and in one subject (0.00) in the control group, z=1.604 and .447, respectively, P>.05. There were no statistically significant findings for the BBT or FPS-R.
Conclusion(s): The use of the RAE in addition to standard physiotherapy was not superior to standard physiotherapy in improving upper extremity function in subjects in Malawi with a diagnosis of acute stroke. However, given the limited sample size and the nature of spontaneous recovery that occurs in subjects immediately post-stroke, future studies are needed to explore possible benefits of using the RAE, especially as it did not cause additional pain to any of the subjects in this study.
Implications: The low cost of this device allows patients with stroke in resource-scarce countries to gain access to affordable autonomous care without direct supervision of a physiotherapist when the number of physiotherapists may be limited.
Keywords: Arm rehabilitation, Stroke, Active Assistance
Funding acknowledgements: Funding was provided by grants from California State University, Northridge and the Borchard Foundation.
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: University of Malawi, College of Medicine
Ethics committee: College of Medicine Research and Ethics Committee (COMREC)
Ethics number: P.03/17/2130
All authors, affiliations and abstracts have been published as submitted.
