title: Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system.
abstract: The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients' homes.
  
  
  
  An open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time.
  
  
  
  All subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. The weekly training duration did not change over the course of six weeks (p = 0.146). The arm function of these patients improved significantly by 4.1 points (p = 0.003) in the FMA-UE. Changes in the WMFT were not significant (p = 0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training.
  
  
  
  Self-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching.
  
  
  
  Unique identifier: NCT02098135 .
authors: Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
authors: Frieder
authors: F
authors: Wittmann
authors: Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland. jeremia.held@uzh.ch.
authors: Jeremia P
authors: 0000-0001-5373-2000
authors: JP
authors: Held
authors: Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
authors: Olivier
authors: O
authors: Lambercy
authors: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.
authors: Michelle L
authors: ML
authors: Starkey
authors: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.
authors: Armin
authors: A
authors: Curt
authors: Hocoma AG, Volketswil, Switzerland.
authors: Raphael
authors: R
authors: Höver
authors: Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
authors: Roger
authors: 0000-0002-6373-8518
authors: R
authors: Gassert
authors: Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.|Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.
authors: Andreas R
authors: AR
authors: Luft
authors: Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
authors: Roman R
authors: RR
authors: Gonzenbach
mesh_terms: D000368:Aged; D001132:Arm / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000534:rehabilitation; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation; D020127:Recovery of Function; D012648:Self Care / Q000379:methods*; D000071939:Stroke Rehabilitation / Q000009:adverse effects / Q000379:methods*; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: Arm; Feasibility; Rehabilitation; Stroke; Video games; Virtual reality therapy