A randomized controlled trial of gravity-supported, computer-enhanced arm exercise for individuals with severe hemiparesis.
OBJECTIVE
The authors previously developed a passive instrumented arm orthosis (Therapy Wilmington Robotic Exoskeleton [T-WREX]) that enables individuals with hemiparesis to exercise the arm by playing computer games in a gravity-supported environment. The purpose of this study was to compare semiautonomous training with T-WREX and conventional semiautonomous exercises that used a tabletop for gravity support.


METHODS
Twenty-eight chronic stroke survivors with moderate/severe hemiparesis were randomly assigned to experimental (T-WREX) or control (tabletop exercise) treatment. A blinded rater assessed arm movement before and after twenty-four 1-hour treatment sessions and at 6-month follow-up. Subjects also rated subjective treatment preferences after a single-session crossover treatment.


RESULTS
All subjects significantly improved ( P < or = .05) upper extremity motor control (Fugl-Meyer), active reaching range of motion (ROM), and self-reported quality and amount of arm use (Motor Activity Log). Improvements were sustained at 6 months. The T-WREX group maintained gains on the Fugl-Meyer significantly better than controls at 6 months (improvement of 3.6 +/- 3.9 vs 1.5 +/- 2.7 points, mean +/- SD; P = .04). Subjects also reported a preference for T-WREX training.


CONCLUSIONS
Gravity-supported arm exercise, using the T-WREX or tabletop support, can improve arm movement ability after chronic severe hemiparesis with brief one-on-one assistance from a therapist (approximately 4 minutes per session). The 3-dimensional weight support, instant visual movement feedback, and simple virtual reality software provided by T-WREX were associated with modest sustained gains at 6-month follow-up when compared with the conventional approach.
Housman
Sarah J
SJ
Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois 60660, USA. shousman@ric.org
Scott
Kelly M
KM
Reinkensmeyer
David J
DJ
D000368:Aged; D001132:Arm / Q000294:innervation / Q000503:physiopathology*; D003201:Computers / Q000639:trends*; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods*; D005246:Feedback / Q000502:physiology; D005260:Female; D006112:Gravitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009989:Orthotic Devices / Q000639:trends*; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D011597:Psychomotor Performance / Q000502:physiology; D012371:Robotics / Q000295:instrumentation / Q000379:methods; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D014584:User-Computer Interface