title: Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors.
abstract: BACKGROUND
  An estimated 750,000 Americans experience a stroke annually. Most stroke survivors require rehabilitation. Limited access to rehabilitation facilities has a pronounced burden on functional outcomes and quality of life. Robotic devices deliver reproducible therapy without the need for real-time human oversight. This study examined the efficacy of using home-based, telerobotic-assisted devices (Hand and Foot Mentor: HM and FM) to improve functional ability and reduce depression symptoms, while improving access and cost savings associated with rehabilitation.
  
  
  METHODS
  Twenty stroke survivors performed three months of home-based rehabilitation using a robotic device, while a therapist remotely monitored progress. Baseline and end of treatment function and depression symptoms were assessed. Satisfaction with the device and access to therapy were determined using qualitative surveys. Cost analysis was performed to compare home-based, robotic-assisted therapy to clinic-based physical therapy.
  
  
  RESULTS
  Compared to baseline, significant improvement in upper extremity function (30.06%, p= 0.046), clinically significant benefits in gait speed (29.03%), moderate improvement in depressive symptoms (28.44%) and modest improvement in distance walked (30.2%) were observed. Participants indicated satisfaction with the device. Home-based robot therapy expanded access to post-stroke rehabilitation for 35% of the people no longer receiving formal services and increased daily access for the remaining 65%, with a cost savings of $2,352 (64.97%) compared to clinic-based therapy.
  
  
  CONCLUSIONS
  Stroke survivors made significant clinically meaningful improvements in the use of their impaired extremities using a robotic device in the home. Home-based, robotic therapy reduced costs, while expanding access to a rehabilitation modality for people who would not otherwise have received care.
authors.affiliation: Department of Physical Therapy, Georgia State University, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Housley
authors.affiliation: Department of Physical Therapy, Georgia State University, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Garlow
authors.affiliation: Department of Physical Therapy, Georgia State University, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ducote
authors.affiliation: Department of Physical Therapy, Georgia State University, USA.
authors.forename: A
authors.initials: A
authors.lastname: Howard
authors.affiliation: Department of Physical Therapy, Georgia State University, USA.
authors.forename: T
authors.initials: T
authors.lastname: Thomas
authors.affiliation: Department of Physical Therapy, Georgia State University, USA.
authors.forename: D
authors.initials: D
authors.lastname: Wu
authors.affiliation: Department of Physical Therapy, Georgia State University, USA.
authors.forename: K
authors.initials: K
authors.lastname: Richards
authors.affiliation: Department of Physical Therapy, Georgia State University, USA; Department of Veteran's Affairs, Atlanta Rehabilitation Research and Development Center of Excellence, USA; Neuroscience Institute, Joint Center for Advanced Brain Imaging, Center for Behavioral Neuroscience, Georgia State University, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Butler
keywords: Home-based; Rural; Stroke; Telerehabilitation; Veterans