Unsupervised rehabilitation after stroke

Stroke survivors often experience upper limb (arm and hand) impairments, which severely limit their daily lives. High-dose therapy has proven to be crucial for recovery. Currently, most therapies are conducted under the supervision of a therapist, which makes it challenging to achieve high-dose treatment due to the limited number of therapists. Devittori et al. from the Rehabilitation Engineering Lab of ETH Zurich, in collaboration with the Clinica Hildebrand Centro di Riabilitazione Brissago, investigated whether robot-assisted upper limb training could be successful without therapist supervision.

Thirteen stroke patients underwent four weeks of robot-assisted therapy. The first week involved daily supervised therapy, the second week consisted  of minimally supervised therapy (a therapist was present but assisted only when necessary), and the last two weeks were fully unsupervised. The study evaluated the feasibility and dosage of unsupervised therapy, as well as user experience and usability of the therapy device.

The feasibility was high, with 12 out of 13 patients being able to train unsupervised. On average, they engaged in an additional 360 minutes of unsupervised therapy over the last two weeks. Users reported general satisfaction (an average score of 79 on a scale of 0 to 100), and the device showed no deficiencies.

The results indicate that unsupervised robot-assisted therapies can significantly increase therapy dosage with minimal effort from clinical staff. Although tested in a clinic, these findings may pave the way for home-based therapy applications.

Devittori, G., Dinacci, D., Romiti, D. et al. Unsupervised robot-assisted rehabilitation after stroke: feasibility, effect on therapy dose, and user experience. Journal of NeuroEngineering and Rehabilitation (2024) 21:52. https://doi.org/10.1186/s12984-024-01347-4

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Image: ©Stefan Schneller, Rehabilitation Engineering Lab