Cerebral Vascular Accident, Cerebral Vascular Accident (CVA)/Stroke, Stroke, Stroke, Acute
Conditions
Keywords
BURT, Upper extremity function, Inpatient rehabilitation, Upper extremity robotics
Brief summary
The Barrett Upper Extremity Robot (BURT) is an FDA-approved upper extremity robot that assists patients with both passive and active range of motion while providing adjustable resistance (Barrett\_Medical. Robotic Assist Rehabilitation Made Easy. https://medical.barrett.com/). Activities are directed by therapists and encourage patient involvement through video game activities providing active proprioceptive, vibrational, visual and auditory feedback. Engaging and colorful games are beneficial in holding patients' interest, and gravity assistance may also allow for increased repetition in the face of patient fatigue. In this prospective study, the investigators will determine if a standardized BURT Upper Extremity (UE) program can be consistently implemented within an acute inpatient rehabilitation facility (IRF). In addition, the investigators will see if patients who receive BURT have improved UE mobility and function as a result. The investigators will also study the perceived enjoyment and value of the intervention by patients, and perceived value by therapists. Because BURT therapy is able to provide more repetitions of upper extremity movement in a shorter length of time than conventional therapy, the investigators hypothesize that patients who participate in neuro re-education activities using BURT will achieve greater improvements in strength, upper extremity function, fine motor coordination, activities of daily living and mobility during their time in an IRF than patients receiving conventional therapy. In this study, eligible patients admitted to Sunnyview Rehabilitation Hospital (SRH) for rehabilitation following stroke will be randomized to receive conventional or BURT therapy. Meaningful clinical benchmarks for upper extremity function, tone, fine motor coordination, activities of daily living and mobility will be assessed using the Upper Extremity Motor Assessment Scale (UE-MAS)(Zelter, 2010), manual muscle testing (MMT), Modified Ashworth Scale (MAS) (Figueiredo, 2011) and the 9-hole peg test (9HPT)(Figueiredo, 2011). The investigators also hypothesize that patients in the BURT cohort will report greater value/usefulness and interest/enjoyment.
Interventions
DEVICEBURT
Use of Barrett Upper extremity Robot (BURT) to improve strength and mobility of hemiplegic upper extremity.
PROCEDUREOther Occupational Therapy
Standard occupational therapy sessions will be 60-90 minutes a day and are UE neuroeducation sessions are typically focused on improving strength and mobility of the hemipelagic arm.
Sponsors
Gaylord Hospital
Sunnyview Rehabilitation Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 115 Years
Healthy volunteers
No
Inclusion criteria
* Inpatient at Sunnyview Rehabilitation Hospital * \>/= 18 years * Unilateral stroke * UE paresis affected arm with 3-/5 or less manual muscle testing throughout
Exclusion criteria
\>30 days post stroke * Severe Neglect * Bilateral stroke * Prior stroke with residual deficits * Patients receiving prism adaptation treatment * Comorbid neurological disorders * Upper limb comorbidities that could limit functional improvement (UE arthritis pain, UE fracture, fixed contracture not allowing for proper device alignment) * Severe shoulder subluxation that cannot be accommodated by the device * Severe osteoporosis * Unable to follow simple directions * Unable to tolerate sitting 30 minutes * Expected length of stay (LOS) \< 15 days.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| UE Motor Assessment Scale (UE-MAS) | T2(Day 20-23) - T0 (Day 4-6) | Used to assess motor functions in the affected upper extremity following a stroke. This evaluation uses task-oriented techniques instead of isolated movement patterns. |
| Manual Muscle Testing (MMT) | T2(Day 20-23) - T0 (Day 4-6) | Used to assess the strength in a persons upper extremity based on various planes of movement. This is the most commonly used strength assessment. |
| Modified Ashworth Scale (MAS) | T2(Day 20-23) - T0 (Day 4-6) | The modified Ashworth Scale is the primary measure for muscle spasticity in the upper extremities for patients with neurological conditions. |
| 9 Hole Peg Test (9HPT) | T2(Day 20-23) - T0 (Day 4-6) | The 9HPT is a standardized test that measures manual dexterity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| GG Scores for Self-Care Items | Change from admission to discharge, up to 55 days | standardized assessments of functional independence for feeding, bathing, toileting, footwear, upper and lower body dressing and oral hygiene. |
| GG Scores for Mobility items | Change from admission to discharge, up to 55 days | standardized assessments of functional independence for bed mobility and transfers. |
Countries
United States
Outcome results
None listed