Integrative rehabilitation of elderly stroke survivors: The design and evaluation of the BrightArm™

Abstract

Purpose: To describe the development of the BrightArm upper extremity rehabilitation system, and to determine its clinical feasibility with older hemiplegic patients. Method: The BrightArm adjusted arm gravity loading through table tilting. Patients wore an arm support that sensed grasp strength and communicated wirelessly with a personal computer. Games were written to improve cognitive, psychosocial and the upper extremity motor function and adapted automatically to each patient. The system underwent feasibility trials spanning 6 weeks. Participants were evaluated pre-therapy, post-therapy, and at 6 weeks follow-up using standardized clinical measures. Computerized measures of supported arm reach and game performance were stored on a remote server. Results: Five participants had clinically significant improvements in their active range of shoulder movement, shoulder strength, grasp strength, and their ability to focus. Several participants demonstrated substantially higher arm function (measured with the Fugl-Meyer test) and two were less-depressed (measured with the Becks Depression Inventory, Second Edition). The BrightArm technology was well-accepted by the participants, who gave it an overall subjective rating of 4.1 on a 5 point Likert scale. Conclusions: Given these preliminary findings, it will be beneficial to evaluate the BrightArm through controlled clinical trials and to investigate its application to other clinical populations.

Implications for Rehabilitation

• It is possible to improve arm function in older hemiplegic patients many years after stroke.

• Integrative rehabilitation through games combining cognitive (memory, focusing, executive function) and physical (arm movement, hand-eye coordination, grasping, dual-tasking) elements is enjoyable for this population.

• The severity of depression in the elderly can be reduced through virtual reality games, as long as games adapt to the patient, are winnable and provide rewards for success.

Keywords::

• Stroke
• elderly
• virtual reality
• BrightArm
• cognition
• shoulder strength
• skilled nursing facility

Acknowledgments

A. Nair OT performed the motor evaluations. M. Jagtap OT, P. Joshi OT, and Y. Lockhart COTA trained the participants.

Declaration of Interest: Research reported here was made possible by grant 1R43NS070613-01 from the National Institutes of Health. Grigore Burdea, Bryan Rabin and Doru Roll are co-inventors on patents related to the technology described in this article. They are shareholders, as well as part-time or contractor employees of Bright Cloud International Corp. Jasdeep Hundal has been a contractor for the same company. Frank Damiani is Administrator and Director of Medical Care for the SNF where the project study took place. Research reported here was supported by grant 1R43NS070613-01 from the National Institutes of Health/NINDS. BrightArm is a trademark of Bright Cloud International Corp.