Stroke
Conditions
Keywords
hand, upper extremity, stroke survivors, arm, hemiparesis, weakness, finger, individuation
Brief summary
This pilot randomized controlled trial will evaluate the feasibility and preliminary effects of a home-based, technology-enabled hand telerehabilitation program for adults with chronic stroke. Participants will receive either remotely guided hand training or a standard home exercise program matched for duration and intensity. Outcomes will include measures of hand function, adherence, and feasibility to assess the potential of telerehabilitation for improving access to structured post-stroke hand rehabilitation.
Detailed description
Persistent hand impairment after stroke is common and can substantially limit independence in daily activities. Access to intensive, task-specific hand therapy is often constrained by travel, cost, and availability of rehabilitation services, leading many individuals to rely on unsupervised home exercise programs. Telerehabilitation supported by low-cost technology may improve access to structured hand training while allowing remote supervision, but its feasibility and implementation in the home setting require systematic evaluation. This study aims to evaluate the feasibility and preliminary effects of a hand telerehabilitation program for individuals with chronic stroke. The study will be conducted as a single-center pilot randomized controlled trial comparing two home-based interventions: (i) telerehabilitation and (ii) a standard home-advice exercise program matched for duration and intensity. Participants randomized to the telerehabilitation group will complete supervised home training sessions using technology-assisted activities to target hand function, delivered remotely via video conferencing. Participants in the control group will follow a home exercise plan similar to that used in typical post-stroke therapy. Outcome measures will be collected before and after the intervention and will include standardized assessments of hand function, as well as measures of adherence and feasibility. This study (i) involves adult stroke survivors, (ii) presents minimal risk, (iii) does not involve deception, (iv) does not collect sensitive health information, and (v) includes brief, noninvasive, and nonpainful interactions consistent with standard rehabilitation activities.
Interventions
BEHAVIORALTechnology-Supported Hand Training
Participants will undergo a remotely delivered, technology-supported hand training program that involves guided hand activities. These activities will target finger coordination, finger individuation, and performance in activities of daily living. Participants may interact with virtual or real passive items to supplement program activities. Activities will be guided remotely by a study team member using video conferencing.
BEHAVIORALPamphlet-Supported Hand Activity
Participants will follow a home advice plan to improve hand function. The plan will be created based on the participant's ability and typical occupational therapy guidance. Activities may resemble typical hand rehabilitation activities performed in a therapy clinic and may involve passive items to supplement program activities. Participants will record their adherence to the program.
Sponsors
University of Michigan
American Heart Association
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants will be randomized to one of two parallel intervention groups: a technology-enabled telerehabilitation program or a standard home exercise program matched for duration and intensity. Outcomes will be assessed before and after the intervention to compare feasibility, adherence, and changes in hand function between groups.
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Unilateral cortical or subcortical stroke * Chronic stroke (≥ 6 months since stroke) * No significant cognitive deficits as determined by the Mini Mental State Examination (MMSE) score (score≥ 22)
Exclusion criteria
* Cerebellar stroke * Unstable heart condition, uncontrolled diabetes or hypertension * Recent trauma or fracture in the upper extremities * History of significant orthopedic or neurological conditions that could affect hand function (e.g., multiple sclerosis) * Recent history of significant spatial neglect * Joint contractures or significant spasticity in the hand * History of a recent Botulinum Toxin (Botox) injection to the upper-extremity muscles (≤ 3 months) * Pregnant or actively planning to become pregnant (self-reported) * Inability to communicate or unable to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hand Spread | Pre-intervention (an average of up to 1 week before the first intervention session) and post-intervention (an average of up to 1 week after completion of the 6-week intervention) | Change in voluntary ability to open the more-impaired hand from before the intervention (pre-intervention) to after the intervention (post-intervention). Hand spread will be measured with motion capture equipment. Hand Spread values range from 0 to no upper limit, with a greater value indicating improved voluntary hand opening ability |
| Box and Block Test Score | Pre-intervention (an average of up to 1 week before the first intervention session) and post-intervention (an average of up to 1 week after completion of the 6-week intervention) | Change in a measure of arm ability from before the intervention (pre-intervention) to after its completion (post-intervention) using publicly available scoring sheets. The Box and Block test is scored based on how many blocks a patient can move between two adjacent boxes in 1 minute with their more-impaired hand. Box and Block scores range from 0 to no upper limit, with a higher score indicating greater arm ability |
| Stroke Impact Scale-Hand Score | Pre-intervention (an average of up to 1 week before the first intervention session) and post-intervention (an average of up to 1 week after completion of the 6-week intervention) | Change in the hand function component of the Stroke Impact Scale, a participant-reported measure of hand participation in daily life from before the intervention (pre-intervention) to after its completion using publicly available scoring sheets. Stroke Impact Scale-Hand Scores can range from 0 to 100, with a higher score indicating better self-reported hand function in daily life. |
Countries
United States
Contacts
CONTACTThomas E Augenstein, MSE, PhD
CONTACTChandramouli Krishnan, PT, PhD
PRINCIPAL_INVESTIGATORThomas E Augenstein, MSE, PhD
University of Michigan
PRINCIPAL_INVESTIGATORChandramouli Krishnan, PT, PhD
University of Michigan
Outcome results
None listed