Integrative rehabilitation of residents chronic post-stroke in skilled nursing facilities: the design and evaluation of the BrightArm Duo

Abstract

Purpose: To describe the novel BrightArm Duo bimanual upper extremity (UE) rehabilitation system; to determine its technology acceptance and clinical benefit for older hemiplegic participants. Methods: The system table tilted to adjust arm gravity loading. Participants wore arm supports that sensed grasp strength and wrist position on the table. Wrist weights further increased shoulder exertion. Games were designed to improve UE strength, motor function, cognition and emotive state and adapted automatically to each participant. The system underwent feasibility trials spanning 8 weeks in two skilled nursing facilities (SNFs). Participants were evaluated pre-therapy and post-therapy using standardized clinical measures. Computerized measures of supported arm reach, table tilt and number of arm repetitions were stored on a remote server. Outcomes: Seven participants had significant improvements in their active range of shoulder movement, supported arm reach, shoulder strength, grasp strength and their ability to focus. The group demonstrated higher arm function measured with FMA (p = 0.01) and CAHAI (p = 0.05), and had an improvement in depression (Becks Depression Inventory, II). BrightArm Duo technology was well accepted by participants with a rating of 4.4 out of 5 points. Conclusions: Given these findings, it will be beneficial to evaluate the BrightArm Duo application in SNF maintenance programs.

Implications for Rehabilitation

• Integrative rehabilitation that addresses both physical and cognitive domains is promising for post-stroke maintenance in skilled nursing facilities.

• Simultaneous bilateral arm exercise may improve arm function in older hemiplegic patients several years after stroke.

• Virtual reality games that adapt to the patient can increase attention and working memory while decreasing depression in elderly.

Keywords:

• Bimanual interaction
• integrative rehabilitation
• stroke
• skilled nursing facility
• virtual reality

Acknowledgements

Abby Eisner OT performed the motor evaluations. Daniel Saldana performed the cognitive and emotive evaluations. Pooja Joshi OT and Melissa Langewisch OT trained the participants.

Declaration of interest

Gregory House, PhD, is CTO of Bright Cloud International Corp (BCI). Grigore Burdea, PhD, is inventor on a patent related to the technology described in this article. His is majority shareholder of BCI. Kevin Polistico is a full-time employee of BCI, Doru Roll is a part-time employee and shareholder of BCI, Jay Kim has been an intern of BCI and Namrata Grampurohit is a part-time employee of BCI. Frank Damiani, MD, is Administrator and Director of Medical Care of Roosevelt Care Center, a Skilled Nursing Facility in which the study took place. Samantha Keeler is Director of Quality & Service Delivery for JFK Hartwyck Nursing & Rehabilitation Centers, a second Skilled Nursing Facility in which the study took place. Jasdeep Hundal, PsyD, is President of Hundal Neuropsychology Group LLC. Simcha Pollack, PhD, President of Data Drive Innovation, performed bio-statistical analysis. Research reported here was made possible by grant 9R44AG044639-02A1 from the National Institute on Aging/NIH. Permission to publish photos has been given by the subjects as part of the consent process for the study. However subject names cannot be divulged due to privacy rules in the US, as imposed by our IRBs.