Participant Feedback in the Evaluation of Novel Stroke Rehabilitation Technologies
DOI:
https://doi.org/10.12970/2308-8354.2013.01.02.2Keywords:
Robot-assisted treadmill training, cerebral palsy, gross motor function measure, impairment, neurodevelopmental concept.Abstract
Purpose: Stroke participant perspectives are used to evaluate a novel rehabilitation system employing electrical stimulation (ES) technology combined with robotic assistance and virtual reality. The broader implications of such feedback for future technological development are discussed. Method: While supported by a robot, ES was applied to the triceps and anterior deltoid muscles of 5 chronic stroke participants with upper limb impairment to assist them in completing functional, virtual reality tracking tasks. Advanced ES controllers adjusted the amount of ES applied on each attempt to improve accuracy and maximise voluntary effort. The system was evaluated in terms of participants’ perspectives, expressed during a semi-structured interview, and clinical outcome measures. Results: The rehabilitation system was well accepted by participants and viewed positively, despite mixed opinions regarding effectiveness. Feedback demonstrated an alignment in participants’ perceptions of reduced impairment and clinical outcomes, in which a significant (p < 0.001) mean change of 9.3 in Fugl-Meyer scores was observed. Participant feedback also provided insight into individual differences observed in clinical outcomes. From our findings six key issues regarding effectiveness, muscles trained, system flexibility and portability, possible discomfort and the value of participant perspectives emerged that may be relevant for researchers developing new rehabilitation technologies. Conclusion: Participant feedback via a semi-structured interview provided important insight into the usability and effectiveness of using this system as a platform for upper limb stroke rehabilitation. Keywords: Participant perspectives, functional electrical stimulation, upper limb, motor recovery.References
[1] Stroke association. Stroke statistics, 1-7, 2006.
[2] Carroll K, Murad S, Eliahoo J, Majeed A. Stroke incidence and risk factors in a population -based prospective cohort study. Health Statistics Quarterly 2001; 12: 18-26.
[3] Barreca S, Wolf SL, Fasoli S, Bohannon R. Treatment interventions for the paretic upper limb of stroke survivors: A critical review. Neurorehabil Neural Repair 2003; 17: 220-6. http://dx.doi.org/10.1177/0888439003259415
[4] De Kroon JR, IJzerman MJ, Chae J, Lankhorst GJ, Zilvold G. Relation between stimulation characteristics and clinical outcome of the upper extremity in stroke. Rehabil Med 2005; 37: 65-74. http://dx.doi.org/10.1080/16501970410024190
[5] Langhorne P, Coupar F, Pollock A, et al. Motor recovery after stroke: a systematic review. Lancet Neurol 2009; 8: 741-51. http://dx.doi.org/10.1016/S1474-4422(09)70150-4
[6] Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975; 7: 13-31.
[7] Lyle RC. A performance for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res 1981; 4: 483-92. http://dx.doi.org/10.1097/00004356-198112000-00001
[8] Burridge JH, Haugland M, Larsen B, et al. Patients’ perception of the benefits and problems of using the actigait implanted drop-foot stimulator. J Rehabil Med 2008; 40: 873- 5. http://dx.doi.org/10.2340/16501977-0268
[9] Barker RN, Gill TJ, Brauer SG. Factors contributing to upper limb recovery after stroke: A survey of stroke survivors in Queensland Australia. Disabil Rehabil 2007; 29: 981-9. http://dx.doi.org/10.1080/09638280500243570
[10] Chen CC, Granger CV, Peimer CA, Moy OJ, Wald S. Manual Ability Measure (MAM-16): A preliminary report on a new patient-centred and task oriented outcome measure of hand function. J Hand Surg 2005; 30: 207-16. http://dx.doi.org/10.1016/j.jhsb.2004.12.005
[11] Timmermans AAA, Seelen HAM, Geers RPJ, et al. Sensorbased arm skill training in chronic stroke patients: Results on treatment outcome, patient motivation, and system usability. IEEE Trans Neural Syst Rehabil Eng 2010; 18: 284-92. http://dx.doi.org/10.1109/TNSRE.2010.2047608
[12] Donovan-Hall MK, Burridge J, Dibb B, Ellis-Hill C, Rushton D. The views of people with spinal cord injury about the use of functional electrical stimulation. Artificial Organs 2011; 35: 204-11. http://dx.doi.org/10.1111/j.1525-1594.2011.01211.x
[13] Hochstenbach-Waelen A, Seelen HAM. Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke. J Neuroeng Rehabil 2012; 9: 52. http://dx.doi.org/10.1186/1743-0003-9-52
[14] Law M, Baptiste S, Carswell-Opzoomer A, McColl MA, Polatajko H, Pollock N, Canadian Occupational Performance Measure. Toronto, ON: CAOT Publications ACE, 1991.
[15] Clark MS, Smith DS. Factors contributing to patient satisfaction with rehabilitation following stroke. Int J Rehabil Res 1998; 21: 143-53. http://dx.doi.org/10.1097/00004356-199806000-00003
[16] Lewis GN, Woods C, Rosie JA, McPherson KM. Virtual reality games for rehabilitation: Perspectives from the users and new directions, In International Conference on Virtual Rehabilitation (ICVR), Zurich, Switzerland; 2011 June.
[17] Hughes AM, Freeman CT, Burridge JH, Chappell PH, Lewin PL, Rogers E. Feasibility of iterative learning control mediated by functional electrical stimulation for reaching after stroke. Neurorehabil Neural Repair 2009; 23: 559-68. http://dx.doi.org/10.1177/1545968308328718
[18] Hughes AM, Burridge JH, Freeman CT, et al. Stroke participants’ perceptions of robotic and electrical stimulation therapy: a new approach. Disabil Rehabil: Assist Technol 2011; 6: 1308. http://dx.doi.org/10.3109/17483107.2010.509882
[19] Freeman C, Tong D, Meadmore K, et al. Phase-lead Iterative Learning Control Algorithms for Functional Electrical Stimulation based Stroke Rehabilitation. Proceedings of the Institution of Mechanical Engineers - Part I: Journal of Systems & Control Engineering 2011; 225: 850-9. http://dx.doi.org/10.1177/0959651811408976
[20] Freeman C, Rogers E, Hughes AM, Burridge JH, Meadmore KL. Iterative Learning Control in Healthcare: Electrical Stimulation and Robotic-assisted Upper Limb Stroke Rehabilitation. IEEE Control Syst Mag 2012; 32: 18-43.
[21] Freeman CT, Hughes AM, Burridge JH, Chappell PH, Lewin PL. Rogers E. A model of the upper extremity using FES for stroke rehabilitation. J Biomech Eng 2009; 131: 031011-12. http://dx.doi.org/10.1115/1.3005332
[22] Meadmore KL, Hughes AM, Freeman CT, et al. Functional Electrical Stimulation mediated by Iterative Learning Control and 3D robotics reduces motor impairment in chronic stroke. J Neuroeng Rehabil 2012; 9: 32. http://dx.doi.org/10.1186/1743-0003-9-32
[23] Timmermans AAA, Seelen HAM, Willmann RD, Kingma H. Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design. J Neuroeng Rehabil 2009; 6: 1.
[24] Hu XL, Tong KY, Song R, et al. Quantitative evaluation of motor functional recovery process in chronic stroke patients during robot-assisted wrist training. J Electromyogr Kinesiol 19: 639-50.
[25] Knutson JS, Harley MY, Hisel TZ, Chae J. Improving hand function in stroke survivors: A pilot study of contralaterally controlled functional electrical stimulation in chronic hemiplegia. Arch Phys Med Rehabil 2007; 88: 513-20. http://dx.doi.org/10.1016/j.apmr.2007.01.003
[26] Buschfort R, Brocke J, He A, Werner C, Waldner A, Hesse S. Arm studio to intensify upper limb rehabilitation after stroke: concept, acceptance, utilization and preliminary clinical results. J Rehabil Med 2010; 42: 310-4. http://dx.doi.org/10.2340/16501977-0517
[27] Zhang D, Guan TH, Widjaja F, Ang WT. Functional electrical stimulation in rehabilitation engineering: a survey. In Proc. Int Conv Rehab Eng Assistive Tech 2007; 221-6.
[28] Johanson T, Wild C, Telerehabilitation in stroke care – A systematic review. Telemed Telecare 2011; 17: 1-6. http://dx.doi.org/10.1258/jtt.2010.100105
[29] Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009; 31: 427-47. http://dx.doi.org/10.1080/09638280802062553
