None listed
Conditions
Brief summary
With improving developments in technology rehabilitation, use of technology devices and modalities are becoming more integrated into clinical practice. While there is good evidence for robotics and virtual reality in rehabilitation for improvement of sensorimotor outcomes (e.g. strength, range of motion) of the arm, evidence gaps persist for translation to functional outcomes which continue to be poor. Further, majority of research to date has focused on single-technology modality use (e.g. stand-alone robotics or virtual reality focus only) with little comparative research on sensor-based therapy as an emerging technology enabler for upper limb rehabilitation. This randomized controlled trial will test efficacy of a combination of robotics, virtual reality and sensor-based therapy used for upper limb rehabilitation for inpatients with neurological deficits compared to usual care and will explore feasibility in a hospital setting. It is hypothesized that hybrid technology-enabled upper limb rehabilitation is feasible within a hospital setting, will lead to better therapy intensity and functional outcomes for the upper limb compared to usual care and that participants will show satisfaction for this novel therapy.
Interventions
RCT feasibility study with comparison of dose-matched upper limb therapy using a combination of robotics, virtual reality and sensor-based therapy (referred to as hybrid technology-enabled upper limb therapy) with usual care versus usual care alone.
Robotics will be used for distal hand retraining using Tyromotion Amadeo and / or elbow and shoulder retraining using Tyromotion Diego based on individual patient upper limb impairment. Upper limb retraining using virtual reality may involve use of
RCT feasibility study with comparison of dose-matched upper limb therapy using a combination of robotics, virtual reality and sensor-based therapy (referred to as hybrid technology-enabled upper limb therapy) with usual care versus usual care alone. Robotics will be used for distal hand retraining using Tyromotion Amadeo and / or elbow and shoulder retraining using Tyromotion Diego based on individual patient upper limb impairment. Upper limb retraining using virtual reality may involve use of immersive virtual reality using Tyromotion Diego and Occulus Rift googles or non-immersive virtual reality using Nintendo Wii. Sensor-based therapy may include a range of devices including Tyromotion Pablo, E-Link or AbleX devices with capability of sensor placement across all areas of the upper limb (fingers, hand, wrist, forearm or upper arm) or through linked response of device haptic end point (e.g. AbleX controller) with the therapeutic game software. All participants will be orientated to each device prior to use including set-up requirements, how they interact with therapeutic games / session and the related therapeutic purpose. While fitted with each device, participants may be asked to complete a set of passive or active movements, or to participate in a game requiring specific upper limb movements. Therapy progress information will be available to participants both within session and across session to session. Hybrid technology-enabled upper limb therapy will be delivered by occupational therapists, clinical assistants and occupational therapy students in face to face individual or within a group therapy program (up to 4 per group) in a rehabilitation inpatient hospital setting. Preferred treatment delivery will be in a group format however patient factors (such as noise tolerance, concentration span, fatigue), infection control factors or staff resource factors may require a need for individual treatment delivery and will be determined on a day-by-day basis. The intervention will be delivered 1 hour x 2 daily x 5 days per week from rehabilitation admission to hospital discharge. As such, the maximum duration of therapy will vary across participants. Participant session attendance, therapy time, therapy engagement and devices used will be collected per session.
Sponsors
The University of Queensland
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Rehabilitation inpatients with neurological upper limb impairment caused by stroke (first or recurrent), traumatic or other acquired brain injury, spinal cord injury or other stable neurological condition with sufficient English to provide informed consent and cognitive function to follow instructions during group therapy sessions and the study.
Exclusion criteria
Admitted rehabilitation inpatients with the following will be excluded - motor neuron disease or other deteriorating neurological conditions, patients in post-traumatic amnesia, patients with upper limb disorders from congenital conditions and people with upper limb amputations.
Outcome results
None listed