title: Integrative rehabilitation of residents chronic post-stroke in skilled nursing facilities: the design and evaluation of the BrightArm Duo.
abstract: To describe the novel BrightArm Duo bimanual upper extremity (UE) rehabilitation system; to determine its technology acceptance and clinical benefit for older hemiplegic participants.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: a Bright Cloud International Corp , Highland Park , NJ , USA .
authors.forename: G
authors.initials: G
authors.lastname: House
authors.affiliation: a Bright Cloud International Corp , Highland Park , NJ , USA .
authors.forename: G
authors.initials: G
authors.lastname: Burdea
authors.affiliation: a Bright Cloud International Corp , Highland Park , NJ , USA .
authors.forename: K
authors.initials: K
authors.lastname: Polistico
authors.affiliation: a Bright Cloud International Corp , Highland Park , NJ , USA .
authors.forename: D
authors.initials: D
authors.lastname: Roll
authors.affiliation: a Bright Cloud International Corp , Highland Park , NJ , USA .
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.affiliation: a Bright Cloud International Corp , Highland Park , NJ , USA .
authors.forename: N
authors.initials: N
authors.lastname: Grampurohit
authors.affiliation: b Roosevelt Care Center , Edison , NJ , USA .
authors.forename: F
authors.initials: F
authors.lastname: Damiani
authors.affiliation: c JFK Hartwyck at Edison Estates , Edison , NJ , USA .
authors.forename: S
authors.initials: S
authors.lastname: Keeler
authors.affiliation: d Hundal Neuropsychology Group , Watchung , NJ , USA .
authors.forename: J
authors.initials: J
authors.lastname: Hundal
authors.affiliation: e Data Driven Innovation , Westhampton , NY , USA , and.|f Computer Information Systems and Decision Sciences, St. John's University , Queens , NY , USA.
authors.forename: S
authors.initials: S
authors.lastname: Pollack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003863:Depression; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012866:Skilled Nursing Facilities; D000071939:Stroke Rehabilitation / Q000295:instrumentation* / Q000379:methods*; D034941:Upper Extremity / Q000502:physiology; D018910:Video Games
keywords: Bimanual interaction; integrative rehabilitation; skilled nursing facility; stroke; virtual reality