title: Combined Clinic-Home Approach for Upper Limb Robotic Therapy After Stroke: A Pilot Study.
abstract: OBJECTIVE
  To investigate the feasibility of a combined clinic-home intervention using a robotic elbow brace and, secondarily, to collect preliminary data on the efficacy of this clinic-home intervention.
  
  
  METHODS
  Nonrandomized pre-/postinterventional study.
  
  
  METHODS
  Outpatient clinic and participants' homes.
  
  
  METHODS
  Individuals at least 6 months after stroke (N=11; 5 women and 6 men; mean age, 51.7y; mean time since stroke, 7.6y; mean Fugl-Meyer Assessment of the Upper Extremity [FMA-UE] score, 22 of 66) were enrolled from the community.
  
  
  METHODS
  Participants received training in an outpatient clinic from an experienced occupational therapist to gain independence with use of the device (3-9 sessions) followed by a 6-week home program using the device at home.
  
  
  METHODS
  Five instruments were administered before and after the study intervention: Modified Ashworth Scale, Box and Blocks test, FMA-UE, Arm Motor Ability Test, and Motor Activity Log-Amount of Use and Motor Activity Log-How Well subscales (MAL-AOU, MAL-HW).
  
  
  RESULTS
  Nine participants completed the study. Participants used the device on average 42.9min/d, 5.3d/wk. The FMA-UE (t=3.32; P=.01), MAL-AOU (t=4.40; P=.002), and MAL-HW (t=4.02; P=.004) scores showed statistically significant improvement from baseline to discharge; the MAL-AOU (t=2.61; P=.035) and MAL-HW (t=2.47; P=.043) scores were also significantly improved from baseline to 3-month follow-up.
  
  
  CONCLUSIONS
  This combined clinic-home intervention was feasible and effective. Participants demonstrated improvements in arm impairment and self-reported use of the arm from baseline to discharge; they continued to report significant improvement in actual use of the arm at 3-month follow-up.
authors.affiliation: Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY. Electronic address: grk9006@nyp.org.
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rivera
authors.affiliation: Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY; Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, NY; Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Joel
authors.initials: J
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D009989:Orthotic Devices; D010291:Paresis / Q000534:rehabilitation*; D010865:Pilot Projects; D020127:Recovery of Function; D012371:Robotics; D000071939:Stroke Rehabilitation; D034941:Upper Extremity
keywords: Paresis; Rehabilitation; Robotics; Stroke