Brendan W Smith1, Joan Lobo-Prat2,3, Daniel K Zondervan4, Christopher Lew3, Vicky Chan5, Cathy Chou5, Spencer Toledo6, David J Reinkensmeyer3,7, Susan Shaw6,8, Steven C Cramer9,10. 1. Department of Mechanical Engineering, Loyola Marymount University, Los Angeles, CA, USA. 2. Institut de Robòtica i Informàtica Industrial, CSIC-UPC, Barcelona, Spain. 3. Department of Mechanical and Aerospace Engineering, University of California at Irvine, Irvine, CA, USA. 4. Flint Rehabilitation Devices, LLC, Irvine, CA, USA. 5. Rehabilitation Services, UC Irvine Medical Center, Irvine, CA, USA. 6. Rehabilitation Services, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA. 7. Departments of Anatomy and Neurobiology, Biomedical Engineering, and Physical Medicine and Rehabilitation, University of California, Irvine, CA, USA. 8. Department of Neurology, University of Southern California, Los Angeles, CA, USA. 9. Department of Neurology, University of California, Los Angeles, CA, USA. 10. California Rehabilitation Institute, Los Angeles, CA, USA.
Abstract
OBJECTIVE: Many patients with subacute stroke rely on the nonparetic arm and leg to propel manual wheelchairs. We designed a bimanual, lever-driven wheelchair (LARA) to promote overground mobility and hemiparetic arm exercise. This study measured the feasibility of using LARA to increase arm movement, achieve mobility, and improve arm motor recovery (clinicaltrials.gov/ct2/show/NCT02830893). DESIGN: Randomized, assessor-blind, controlled trial. SETTING: Two inpatient rehabilitation facilities. SUBJECTS: Nineteen patients with subacute stroke (1 week to 2 months post-stroke) received 30 minutes extra arm movement practice daily, while admitted to inpatient rehabilitation (n = 10) or before enrollment in outpatient therapy (n = 9). INTERVENTIONS: Patients were randomized to train with the LARA wheelchair (n = 11) or conventional exercises with a rehabilitation therapist (n = 8). MAIN MEASURES: Number of arm movements per training session; overground speed; Upper Extremity Fugl-Meyer score at three-month follow-up. RESULTS: Participants who trained with LARA completed 254 (median) arm movements with the paretic arm each session. For three participants, LARA enabled wheelchair mobility at practical indoor speeds (0.15-0.30 m/s). Fugl-Meyer score increased 19 ± 13 points for patients who trained with LARA compared to 14 ± 7 points with conventional exercises (P = 0.32). Secondary measures including shoulder pain and increased tone did not differ between groups. Mixed model analysis found significant interaction between LARA training and treatment duration (P = 0.037), informing power analysis for future investigation. CONCLUSIONS: Practising arm movement with a lever-driven wheelchair is a feasible method for increasing arm movement early after stroke. It enabled wheelchair mobility for a subset of patients and shows potential for improving arm motor recovery.
OBJECTIVE: Many patients with subacute stroke rely on the nonparetic arm and leg to propel manual wheelchairs. We designed a bimanual, lever-driven wheelchair (LARA) to promote overground mobility and hemiparetic arm exercise. This study measured the feasibility of using LARA to increase arm movement, achieve mobility, and improve arm motor recovery (clinicaltrials.gov/ct2/show/NCT02830893). DESIGN: Randomized, assessor-blind, controlled trial. SETTING: Two inpatient rehabilitation facilities. SUBJECTS: Nineteen patients with subacute stroke (1 week to 2 months post-stroke) received 30 minutes extra arm movement practice daily, while admitted to inpatient rehabilitation (n = 10) or before enrollment in outpatient therapy (n = 9). INTERVENTIONS: Patients were randomized to train with the LARA wheelchair (n = 11) or conventional exercises with a rehabilitation therapist (n = 8). MAIN MEASURES: Number of arm movements per training session; overground speed; Upper Extremity Fugl-Meyer score at three-month follow-up. RESULTS: Participants who trained with LARA completed 254 (median) arm movements with the paretic arm each session. For three participants, LARA enabled wheelchair mobility at practical indoor speeds (0.15-0.30 m/s). Fugl-Meyer score increased 19 ± 13 points for patients who trained with LARA compared to 14 ± 7 points with conventional exercises (P = 0.32). Secondary measures including shoulder pain and increased tone did not differ between groups. Mixed model analysis found significant interaction between LARA training and treatment duration (P = 0.037), informing power analysis for future investigation. CONCLUSIONS: Practising arm movement with a lever-driven wheelchair is a feasible method for increasing arm movement early after stroke. It enabled wheelchair mobility for a subset of patients and shows potential for improving arm motor recovery.
Authors: H M Feys; W J De Weerdt; B E Selz; G A Cox Steck; R Spichiger; L E Vereeck; K D Putman; G A Van Hoydonck Journal: Stroke Date: 1998-04 Impact factor: 7.914
Authors: Yasemin Sarigul-Klijn; Joan Lobo-Prat; Brendan W Smith; Sage Thayer; Daniel Zondervan; Vicky Chan; Oliver Stoller; David J Reinkensmeyer Journal: IEEE Int Conf Rehabil Robot Date: 2017-07
Authors: Brendan W Smith; Diana R Bueno; Daniel K Zondervan; Luis Montano; David J Reinkensmeyer Journal: Disabil Rehabil Assist Technol Date: 2019-06-28