Telerehabilitation for Stroke

No longer recruiting at 1 trial location

Overseen By Preeti Raghavan, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Johns Hopkins University

Disqualifiers: Visual deficit, Neurological conditions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 4 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores ways to improve arm and hand recovery for stroke survivors using online exercises and games. The study tests whether competing or cooperating with others online aids rehabilitation. Participants will join either the Input-Focus Condition or the Output-Focus Condition, which are distinct telerehabilitation approaches. Eligible participants must have experienced a stroke over three months ago, be able to sit or stand independently, and have some movement in the affected arm without full active control. Ideal candidates should also be comfortable using the internet and have no major vision problems or other neurological conditions. As an unphased trial, this study provides a unique opportunity to contribute to innovative rehabilitation methods that could enhance recovery for future stroke patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this telerehabilitation method is safe for stroke patients?

Research has shown that telerehabilitation, used in both the Input-Focus and Output-Focus Conditions, is generally safe for stroke patients. Studies have found that home-based rehabilitation using technology is effective and well-tolerated. A review of multiple studies indicates that telerehabilitation improves the quality of life for stroke patients without significant negative effects, suggesting its safety.

In another study on telerehabilitation services for stroke, communication technologies effectively delivered care without causing harm. These findings support telerehabilitation as a safe and effective method for patient recovery. While these studies do not directly mention side effects, the consistent positive results and lack of reported negative effects suggest the treatment is safe for use. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about telerehabilitation for stroke because it offers a new way to deliver therapy remotely, using technology to bridge the gap in access to care. Unlike traditional rehabilitation, which often requires in-person visits to a clinic, telerehabilitation allows stroke patients to receive personalized exercises and feedback from the comfort of their home. This approach has the potential to increase patient engagement and consistency in therapy, leading to better recovery outcomes. Additionally, by focusing on either input or output conditions, telerehabilitation can be tailored to address specific patient needs, offering a more customized rehabilitation experience.

What evidence suggests that this trial's treatments could be effective for stroke rehabilitation?

Research has shown that telerehabilitation for stroke patients can be as effective as in-person therapy, particularly for enhancing movement and quality of life. One study found that focusing on arm movement through telerehabilitation improved arm function and independence. In this trial, participants will be assigned to either the Input-Focus Condition or the Output-Focus Condition. The Input-Focus Condition may lead to better recovery results, including improved movement and emotional well-being. Meanwhile, the Output-Focus Condition has shown improvements in fine motor skills, arm use, and balance. Overall, telerehabilitation offers a promising and accessible method for aiding stroke recovery, with strong evidence from multiple studies supporting its effectiveness in improving patient outcomes. ^{3 6 7 8 9}

Who Is on the Research Team?

Preeti Raghavan, MD

Principal Investigator

Johns Hopkins University

Are You a Good Fit for This Trial?

This trial is for stroke survivors with hemiparesis for over 3 months, who can sit or stand on their own, have basic cognitive skills and technical interest. They should have limited arm movement but full passive range of motion. The control group requires no learning disabilities and an interest in using internet platforms.

Inclusion Criteria

I had a stroke over 3 months ago, can sit or stand by myself, understand and do exercises, have limited arm movement but can use the internet.

For control group: no history of learning disabilities, technical savvy and interest to use an internet platform

Exclusion Criteria

I have vision problems or other health issues that might affect my participation.

I have a visual problem or a condition that limits my movement for exercises.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in upper limb robot-mediated tele-rehabilitation using a haptic device and an online citizen science platform, focusing on competition, cooperation, or isolation strategies.

4 weeks

Online sessions

Follow-up

Participants are monitored for rehabilitation performance, motivation, and emotional well-being through online surveys and sensorimotor data.

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Input-Focus Condition
• Output-Focus Condition

Trial Overview The study tests upper limb tele-rehabilitation through a haptic device and online platform by comparing competition, cooperation, and isolation strategies in social interaction. It measures rehabilitation performance, motivation to contribute to science tasks, and emotional well-being.

How Is the Trial Designed?

Group I: Stroke Patients Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Johns Hopkins University

Lead Sponsor

Trials

2,366

Recruited

15,160,000+

National Science Foundation

Collaborator

Trials

3

Recruited

60+

Foundation for Physical Medicine and Rehabilitation

Collaborator

Trials

7

Recruited

240+

Published Research Related to This Trial

In a study involving ten chronic post-stroke subjects, the telerehabilitation system Muvity showed potential benefits, with four out of six participants improving their ability to perform daily activities and five reporting less pain compared to conventional therapy.

While the results were promising, indicating that Muvity could be a motivating and effective complement to traditional rehabilitation, the differences were not statistically significant, highlighting the need for further research with a larger sample size.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A feasibility study to assess the effectiveness of Muvity: A telerehabilitation system for chronic post-stroke subjects. Garcia, A., Mayans, B., Margelí, C., et al.[2022]

Telerehabilitation using a virtual reality-based system significantly improved motor performance in post-stroke patients compared to traditional physical therapy, as measured by the Fugl-Meyer Upper Extremity scale.

Both telerehabilitation and traditional therapy were effective in enhancing motor function, but the telerehabilitation approach may allow for earlier hospital discharge and better resource utilization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. Piron, L., Turolla, A., Agostini, M., et al.[2022]

Telerehabilitation is a feasible method for improving ankle dorsiflexion in individuals with chronic stroke, with participants receiving complex movement training showing significantly better results than those doing simple movements over a 4-week period.

While brain activation changes were not statistically significant overall, the complex movement training group showed a trend towards decreased cortical activation, suggesting a potential for more efficient brain reorganization compared to the simple movement group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Complex versus simple ankle movement training in stroke using telerehabilitation: a randomized controlled trial. Deng, H., Durfee, WK., Nuckley, DJ., et al.[2021]

The study tested the safety of using Microsoft Kinect® with Oculus Rift® for telerehabilitation in 14 participants without disabilities and 5 post-stroke individuals, finding no significant adverse events overall.

While the technology was safe for most, participants post-stroke required significant physical support for balance, which limits its practical application in telerehabilitation settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and Feasibility of a First-Person View, Full-Body Interaction Game for Telerehabilitation Post-Stroke. Proffitt, R., Warren, J., Lange, B., et al.[2020]

A study involving 49 subacute stroke survivors indicated that telerehabilitation using a guided app for core stability exercises may improve balance and gait compared to usual care, although the differences were not statistically significant.

The findings suggest that home-based telerehabilitation could be a feasible option for enhancing recovery in post-stroke patients, but further research is needed to confirm these effects and improve adherence to the program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial. Salgueiro, C., Urrútia, G., Cabanas-Valdés, R.[2022]

The STeleR intervention, which included home visits and remote support, showed improvements in physical function for veterans post-stroke, with benefits lasting up to 3 months after the intervention, although these improvements were not statistically significant compared to usual care.

Significant enhancements were observed in several disability components of the Late-Life Function and Disability Instrument for the STeleR group, indicating that this telerehabilitation approach could effectively supplement traditional rehabilitation methods for stroke survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Chumbler, NR., Quigley, P., Li, X., et al.[2022]

The pilot study involving seven adults with chronic stroke demonstrated that a home-based telerehabilitation program significantly improved upper limb performance over 6 weeks of training, with participants training 5 days a week for 60 minutes each session.

In addition to physical improvements, there were indications of potential cognitive benefits, suggesting that telerehabilitation may enhance overall recovery in stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study. Langan, J., Delave, K., Phillips, L., et al.[2021]

This scoping review analyzed 28 studies to identify the various outcome measures used in telerehabilitation (TR) and virtual reality (VR) for stroke rehabilitation, highlighting the diversity of measures currently in use.

The findings reveal gaps in the literature regarding outcome measures, providing valuable insights for clinicians, policymakers, and researchers to select the most appropriate measures for future TR and VR studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation. Veras, M., Kairy, D., Rogante, M., et al.[2019]

A low-cost virtual rehabilitation application for cognitive-motor upper limb rehabilitation in sub-acute stroke patients was found to be safe and well-received, with no major adverse events reported during the study.

Both clinicians and patients expressed high satisfaction with the intervention, highlighting its perceived usefulness in reducing arm motor impairment and facilitating the transfer of skills to real-world activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians. Demers, M., Chan Chun Kong, D., Levin, MF.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10744683/

Telerehabilitation for Stroke: A Personalized Multi-Domain ... Our study advocates for a multi-modal approach in TR, emphasizing the potential for improved outcomes in stroke rehabilitation. This study ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12233225/

Effectiveness of telerehabilitation for adults with neurological ... This systematic review indicates a promising potential for telerehabilitation to enhance outcomes for adults with neurological conditions living ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1052305718302313

Tele-Rehabilitation after Stroke: An Updated Systematic ... Tele-rehabilitation for motor and higher cortical deficits as well as poststroke depression appear to be as effective as in-person therapies, if not better.

4. clinicaltrials.gov clinicaltrials.gov/study/NCT06682429

Telerehabilitation In The Home After Stroke (TR-2) The purpose of this research study is to evaluate whether telerehabilitation targeting arm movement, when added to usual care, improves arm function and ...

5. tandfonline.com tandfonline.com/doi/full/10.1080/10833196.2024.2400425

Effectiveness of telerehabilitation on quality of life in stroke ... This systematic review assessed the clinical effectiveness of telerehabilitation (TR) programmes on quality-of-life (QoL) of stroke survivor compared to ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6464866/

Telerehabilitation services for stroke - PMC - PubMed Central Telerehabilitation is an alternative way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9094559/

Factors influencing the delivery of telerehabilitation for stroke This review aimed to explore factors influencing the delivery of stroke telerehabilitation interventions, including platforms, technical requirements, training ...

8. ahajournals.org ahajournals.org/doi/10.1161/STR.0000000000000493

Improving Access to Stroke Rehabilitation and Recovery Assessing patient outcomes after rehabilitation typically relies on administrative data sources, which lack crucial information on prognosis ...

9. sciencedirect.com sciencedirect.com/science/article/pii/S0022399925001485

Telerehabilitation for functional neurological disorders The same study also found positive clinician-provided outcomes (based on data from 29 clinicians), including improved patient knowledge (of functional ...