Telerehabilitation for Stroke

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

40 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this study is to advance upper limb robot-mediated tele-rehabilitation for patients recovering from stroke by empowering them through active science participation. By varying the tasks' features and affordances of a platform that combines a low-cost haptic device on one hand, and an online citizen science platform on the other, investigators will evaluate different strategies for social telerehabilitation. the two fundamental modes of social interaction - competition and cooperation - in addition to a control condition. Specifically, citizen science activities will be performed by competing, cooperating, or isolated users, and their rehabilitation effectiveness examined. Such effectiveness will be measured by (i) participants' rehabilitation performance (inferred from sensorimotor data acquired through the platform and directly quantified by a supervising therapist); (ii) participants' motivations to contribute (measured through surveys administered online); and (iii) participants' emotional well-being and sense of self-esteem (measured through online surveys).

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 data supports the effectiveness of the treatment Telerehabilitation for Stroke?

Research shows that telerehabilitation can improve physical function and reduce disability in stroke patients, and it has been effective in enhancing upper limb function and balance in individuals recovering from a stroke. ^{1 2 3 4 5}

Is telerehabilitation safe for stroke patients?

Telerehabilitation for stroke patients has been generally safe, with no significant adverse events reported in studies. However, some participants without disabilities experienced dizziness and nausea, and stroke patients needed assistance for balance and fall prevention during certain activities. ^{1 3 4 6 7}

How is telerehabilitation for stroke different from other treatments?

Telerehabilitation for stroke is unique because it allows patients to receive rehabilitation exercises and therapy remotely, often from their own homes, using technology like video calls and virtual reality. This approach can be more convenient and accessible compared to traditional in-person therapy sessions, and it enables continuous rehabilitation even after patients leave acute care. ^{2 3 4 8 9}

Research Team

Preeti Raghavan, MD

Principal Investigator

Johns Hopkins University

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

Group I: Stroke Patients Experimental Treatment 2 Interventions

Group II: Healthy Controls Active Control 2 Interventions

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+

Findings from Research

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]

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 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]

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]

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]

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 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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial. [2022]

3. Sweden pubmed.ncbi.nlm.nih.gov

Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

A feasibility study to assess the effectiveness of Muvity: A telerehabilitation system for chronic post-stroke subjects. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Safety and Feasibility of a First-Person View, Full-Body Interaction Game for Telerehabilitation Post-Stroke. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians. [2020]

8. Sweden pubmed.ncbi.nlm.nih.gov

Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Complex versus simple ankle movement training in stroke using telerehabilitation: a randomized controlled trial. [2021]