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

Sarah J. Housman, Kelly M. Scott, David J. Reinkensmeyer

Research output: Contribution to journalArticle

206 Citations (Scopus)

Abstract

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 ĝ‰Currency sign.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.

Original languageEnglish (US)
Pages (from-to)505-514
Number of pages10
JournalNeurorehabilitation and Neural Repair
Volume23
Issue number5
DOIs
StatePublished - Jun 2009

Fingerprint

Gravitation
Paresis
Arm
Randomized Controlled Trials
Therapeutics
Video Games
Exercise Therapy
Orthotic Devices
Sensory Feedback
Investigational Therapies
Aptitude
Articular Range of Motion
Exoskeleton Device
Upper Extremity
Motor Activity
Software
Stroke
Weights and Measures

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Rehabilitation
  • Neurology

Cite this

A randomized controlled trial of gravity-supported, computer-enhanced arm exercise for individuals with severe hemiparesis. / Housman, Sarah J.; Scott, Kelly M.; Reinkensmeyer, David J.

In: Neurorehabilitation and Neural Repair, Vol. 23, No. 5, 06.2009, p. 505-514.

Research output: Contribution to journalArticle

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abstract = "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 ĝ‰Currency sign.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.",
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