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A Randomized Controlled Trial of Gravity-Supported, Computer-Enhanced Arm Exercise for Individuals With Severe Hemiparesis

Sensory Motor Performance Program, Rehabilitation Rehabilitation Institute of Chicago, Chicago, Illinois, shousman{at}ric.org

Kelly M. Scott, MD

Department of Physical Medicine and Rehabilitation Rehabilitation Institute of Chicago, Chicago, Illinois

David J. Reinkensmeyer, PhD

Department of Mechanical and Aerospace Engineering and Department of Biomedical Engineering, University of California, Irvine, California

Background/Objective. The authors previously developed a passive instrumented arm orthosis (Therapy Wilmington Robotic Exoskeleton [T-WREX]) that enables individuals with hemiparesis to exercise the arm by playing computer games in a gravity-supported environment. The purpose of this study was to compare semiautonomous training with T-WREX and conventional semiautonomous exercises that used a tabletop for gravity support. Methods. Twenty-eight chronic stroke survivors with moderate/severe hemiparesis were randomly assigned to experimental (T-WREX) or control (tabletop exercise) treatment. A blinded rater assessed arm movement before and after twenty-four 1-hour treatment sessions and at 6-month follow-up. Subjects also rated subjective treatment preferences after a single-session crossover treatment. Results. All subjects significantly improved ( P .05) upper extremity motor control (Fugl-Meyer), active reaching range of motion (ROM), and self-reported quality and amount of arm use (Motor Activity Log). Improvements were sustained at 6 months. The T-WREX group maintained gains on the Fugl-Meyer significantly better than controls at 6 months (improvement of 3.6 ± 3.9 vs 1.5 ± 2.7 points, mean ± SD; P = .04). Subjects also reported a preference for T-WREX training. Conclusion . Gravity-supported arm exercise, using the T-WREX or tabletop support, can improve arm movement ability after chronic severe hemiparesis with brief one-on-one assistance from a therapist (approximately 4 minutes per session). The 3-dimensional weight support, instant visual movement feedback, and simple virtual reality software provided by T-WREX were associated with modest sustained gains at 6-month follow-up when compared with the conventional approach.

Key Words: Stroke rehabilitation • Hemiparesis • Arm • Motor control • Robotic upper extremity device • Telerehabilitation

This version was published on June 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 5, 505-514 (2009)
DOI: 10.1177/1545968308331148


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