Stroke is the leading cause of serious long-term disability. It is estimated that 5.8-6.5 million people currently live with stroke related disability in the US and that this number will increase by 20.5% by 2030. The current US health infrastructure is not prepared for these increasing numbers. Limitations in health insurance coverage and the shortage of rehabilitation practitioners decrease access to rehabilitation. Community-based settings are becoming viable venues for delivering long-term post-stroke care, however, they are plagued by staff with limited expertise, low number of therapists and lack of financial resources for rehabilitation. Because of this, the quality of care is compromised, and functional outcomes of patients are not equal to hospital-based rehabilitation settings. We seek to develop a novel solution to this problem. Implementing affordable design is a fundamental strategy for increasing access to rehabilitation technology for patients regardless of socio-economic status. Doing so, decreases healthcare disparities and reduces long-term healthcare costs. We propose to use affordable robots to improve access to quality rehabilitation care in low-resource, community-based settings. In Phase 1, we leverage a 1 degree of freedom haptic robot with control algorithms to develop a beta version of the robot hardware and software. The new robot have a novel end-effector to allow more diverse arm and hand exercises, be connected to cloud-based gaming, and provide patient-specific therapy that adjusts for motor impairment and cognitive impairment. 15 stroke patients with a wide range of motor impairment levels will complete clinical assessments of motor and cognitive impairment followed by robot-based assessment and therapy games. Subjects will be instrumented with sensors monitoring key upper extremity muscle activity, trunk activity and heart rate during robot tasks. A key milestone will be to identify kinematic metrics from the robot tasks that strongly correlate and predict clinical scores of motor and cognitive impairment. Another milestone will to drive patient-specific strategies by adjusting the robot's control parameters and the game parameters. In Phase 2, we will develop the hardware to allow three haptic robots to dock (a gym) and be configured to allow patients to play therapy games alone or collaboratively. We will test the safety and feasibility of the gym in a community-based rehabilitation setting where stroke patients typically receive 1 hour each of physical therapy (PT), occupational therapy (OT) and speech therapy (SLP). 36 patients will be randomized to either a robot (RT) or a control group (CT). Both groups will receive PT and SLP, but the RT will receive the robot gym therapy targeting the upper limb and the CT will receive a dose-matched hour of OT. Therapy will occur over 4 weeks with two follow-up assessments. Key milestones will be to show that the RT has the same or better functional outcomes, motivation, and adverse events as the CT. Also, to show that the robot gym is a cost-effective solution to increasing access to quality rehabilitation care in low-resource, community-based settings. Success here will validate this potential solution, justify design changes revealed via user-feedback and a larger clinical trial.
Public Health Relevance Statement: NARRATIVE Implementing affordable design is a fundamental strategy for increasing access to rehabilitation technology for stroke patients. We propose the use of multiple, one degree of freedom, affordable robots to augment neurorehabilitation care and delivery for stroke patients seeking care in community-based rehabilitation settings. The success of the proposed effort will validate this potential solution, empower clinicians to use affordable robots for community-based neurorehabilitation, and subsequently, decrease healthcare disparities and long-term healthcare costs for the stroke survivor.
Project Terms: Adult; 21+ years old; Adult Human; adulthood; Algorithms; Clinical Trials; Communities; Control Groups; Exercise; Feedback; Fingers; Freedom; Liberty; Goals; Hand; Health; Health care facility; Health Facilities; Healthcare Facility; care facilities; Heart Rate; Cardiac Chronotropism; Hospitals; Health Insurance; health insurance plan; Intelligence; Lead; Pb element; heavy metal Pb; heavy metal lead; Lower Extremity; Lower Limb; Membrum inferius; Motivation; Movement; body movement; Muscle; Muscle Tissue; muscular; Discipline of Nursing; Nursing; Nursing Field; Nursing Profession; Occupational Therapy; Patients; Play; Play Therapy; Rehabilitation therapy; Medical Rehabilitation; Rehabilitation; rehab therapy; rehabilitative; rehabilitative therapy; Rehabilitation Centers; Resources; Research Resources; Robotics; Safety; Computer software; Software; Speech Therapy; Stroke; Apoplexy; Brain Vascular Accident; Cerebral Stroke; Cerebrovascular Apoplexy; Cerebrovascular Stroke; brain attack; cerebral vascular accident; cerebrovascular accident; Technology; Testing; Time; Health Care Costs; Health Costs; Healthcare Costs; Socioeconomic Status; Socio-economic status; socio-economic position; socioeconomic position; Caring; base; sensor; improved; neurological rehabilitation; Neuro rehabilitation; Neurorehabilitation; neurological rehab; neurorehab; Clinical; Phase; Financial compensation; Compensation; disability; Individual; Rural; Therapeutic; Robot; Cognitive Disturbance; Cognitive Impairment; Cognitive decline; Cognitive function abnormal; Disturbance in cognition; cognitive dysfunction; cognitive loss; Impaired cognition; instrument; Insurance Status; Insurance Coverage; Hour; Frequencies; Clinic; Treatment Period; treatment days; treatment duration; System; Equation; innovative technologies; experience; Performance; success; care delivery; cohort; care seeking; kinematic model; kinematics; novel; Position; Positioning Attribute; QOC; Quality of Care; stroke treatment; treating stroke; stroke therapy; Adverse Experience; Adverse event; Intervention Strategies; interventional strategy; Intervention; Physiatric Procedure; Physical Medicine Procedure; Physical Therapeutics; Physiotherapy; Physical therapy; Membrum superius; Upper Limb; Upper Extremity; Dose; Data; Improve Access; Motor; randomisation; randomization; randomly assigned; Randomized; Patient-Focused Outcomes; Patient outcome; Patient-Centered Outcomes; Monitor; Characteristics; Docking; post stroke; after stroke; poststroke; cost; robot assistance; robot assisted; robotic assistance; design; designing; Clinical assessments; functional outcomes; improved functioning; cost effective; Population; Impairment; community based care; multidisciplinary; rehabilitation technology; rehab technology; haptics; usability; motor impairment; movement impairment; movement limitation; motor control; safety testing; follow up assessment; followup assessment; arm; cloud based; individualized medicine; customized therapy; customized treatment; individualized patient treatment; individualized therapeutic strategy; individualized therapy; individualized treatment; patient specific therapies; patient specific treatment; tailored medical treatment; tailored therapy; tailored treatment; unique treatment; clinical predictors; targeted treatment; targeted drug therapy; targeted drug treatments; targeted therapeutic; targeted therapeutic agents; targeted therapy; robot rehabilitation; robotic rehabilitation; stroke survivor; rehabilitative care; rehabilitation care; exercise rehabilitation; rehabilitative exercise; robot control; robotic control; health care disparity; disparate health care; disparate healthcare; disparity in care; disparity in healthcare; healthcare disparity; safety and feasibility; recruit; stroke patient; Infrastructure; force feedback
