A randomized controlled trial of gravity-supported, computer-enhanced arm exercise for individuals with severe hemiparesis

• Published in: Neurorehabilitation and neural repair Vol. 23; no. 5; p. 505
• Main Authors: Housman, Sarah J, Scott, Kelly M, Reinkensmeyer, David J
• Format: Journal Article
• Language: English
• Published: United States 01.06.2009
• Subjects: Aged; Arm - innervation; Arm - physiopathology; Computers - trends; Exercise Therapy - instrumentation; Exercise Therapy - methods; Feedback - physiology; Female; Gravitation; Humans; Male; Middle Aged; Movement - physiology; Movement Disorders - etiology; Movement Disorders - physiopathology; Movement Disorders - rehabilitation; Muscle, Skeletal - innervation; Muscle, Skeletal - physiopathology; Orthotic Devices - trends; Paresis - etiology; Paresis - physiopathology; Paresis - rehabilitation; Psychomotor Performance - physiology; Robotics - instrumentation; Robotics - methods; Stroke - complications; Stroke - physiopathology; Stroke Rehabilitation; User-Computer Interface
• ISSN: 1545-9683
• DOI: 10.1177/1545968308331148

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. 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. All subjects significantly improved ( P < or = .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. 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.