Task-oriented arm training for stroke patients based on remote handling technology concepts: Results of a pilot study

Improving arm-hand skill performance is a major goal in the rehabilitation of patients who suffered a stroke. Technology-assisted training may enrich training content and variation. We developed a new task-oriented arm training approach (ReHab-TOAT) based on 'remote handling concept' technology from nuclear industry (DexterTM, Veolia Nuclear Solutions, Abingdon, UK) to provide enriched proprioceptive feedback. Aim was to investigate the potential order of magnitude the ReHab-TOAT concept may have additional to therapy-as-usual on improving arm-hand function (AHF) and arm-hand skill performance (AHSP) in both subacute and chronic stroke patients. This study included five subacute and five chronic hemiparetic stroke patients suffering from moderate to severe arm-hand problems. Over a six-weeks period, participants received 18 sessions of ReHab-TOAT additional to therapy-as-usual. Outcome measures were taken pre- and post-intervention. Clinical relevant overall improvements regarding AHF (mean improvement on the FuglMeyer Assessment: 15.3 points (+-9.6 SD, p=0.007)) and AHSP (mean improvement on the Action Research Arm Test: 6.8 points (+- 9.0 SD, p=0.036)), which also exceeded the minimal detectable change (MDC), were found. When differentiating between subacute and chronic stroke patients, analyses showed clinically relevant improvements in AHF in the chronic and subacute stroke groups, while clinical relevant improvements in AHSP were only found in the subacute group. This pilot study provided data for a power analysis for an ensuing randomized clinical trial.