title: Incorporating robotic-assisted telerehabilitation in a home program to improve arm function following stroke.
abstract: OBJECTIVE
  After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function.
  
  
  METHODS
  The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment.
  
  
  METHODS
  The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period.
  
  
  RESULTS
  The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points.
  
  
  CONCLUSIONS
  This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.
authors.affiliation: Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Linder
authors.forename: Aimee
authors.initials: A
authors.lastname: Reiss
authors.forename: Sharon
authors.initials: S
authors.lastname: Buchanan
authors.forename: Komal
authors.initials: K
authors.lastname: Sahu
authors.forename: Anson B
authors.initials: AB
authors.lastname: Rosenfeldt
authors.forename: Cindy
authors.initials: C
authors.lastname: Clark
authors.forename: Steven L
authors.initials: SL
authors.lastname: Wolf
authors.forename: Jay L
authors.initials: JL
authors.lastname: Alberts
mesh_terms: D000203:Activities of Daily Living; D001132:Arm / Q000503:physiopathology*; D005081:Exercise Therapy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology*; D012371:Robotics; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D017216:Telemedicine; D016896:Treatment Outcome