A Fully Automated, Quantitative Test of Upper Limb Function

Abstract

ABSTRACT. The Rehabilitation Joystick for Computerized Exercise (ReJoyce, Rehabtronics Inc., Edmonton, Alberta, Canada), is a workstation on which participants exercise dexterous movement tasks in the guise of computer games. The system incorporates the ReJoyce Arm and Hand Function Test (RAHFT). Here the authors evaluate the RAHFT against the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA). All 3 tests were performed in 36 separate sessions in 13 tetraplegic individuals. Concurrent and criterion validities of the RAHFT were supported by a high level of correlation with the ARAT (r² = .88). Regarding responsiveness, the effect size of the RAHFT at week 6 of 1 hr/day exercise training was 1.8. Regarding reliability, the mean test–retest difference in RAHFT baseline scores was 0.67% ± 3.6%, which was not statistically significant. The RAHFT showed less ceiling effect than either ARAT or FMA. These data help validate the RAHFT as a quantitative, automated alternative to the ARAT and FMA. The RAHFT is the first comprehensive test of arm and dexterous hand function that does not depend on human judgment. It offers a standardized, quantitative outcome evaluation, which can be performed not only in the clinic, but also in the participant's home, administered by a remote therapist over the Internet.

Keywords:

• rehabilitation
• upper extremity
• hand

ACKNOWLEDGMENTS

The authors thank Su Ling Chong, PT, for help in recruiting subjects for this trial; Kelly Brunton, PT, for the blinded rating of the ARAT and FMA clinical UL tests; Andrew Prochazka for help developing the ReJoyce hardware; and Antoni Kowalczewski, Jeremy Burns, and Al Adsit for their contribution to the ReJoyce software.

FUNDING

The following agencies provided funding for the study: International Spinal Research Trust (ISRT), Canadian Foundation for Innovation (CFI), Alberta Heritage Foundation for Medical Research (AHFMR), and the Canadian Institutes of Health Research (CIHR). Jan Kowalczewski and Dr. Arthur Prochazka are the named inventors on several issued patents concerning the ReJoyce system and the RAHFT. They are stakeholders in Rehabtronics Inc., manufacturer of the commercial version of the ReJoyce system.