Portable Neurorobotics for the Severely Affected Arm in Chronic Stroke: A Case Study

Background and Purpose: Few motor therapies increase active movement in the severely impaired arm of individuals with chronic stroke. Existing robotic devices to address this need are large and expensive. This case study describes the application and reports outcomes associated with a repetitive task-specific training (RTP) program incorporating a portable robotic device. We assessed outcomes related to affected arm impairment, ability to perform valued activities, satisfaction with movement performance, and quality of life in a participant with chronic stroke exhibiting severe arm hemiparesis. Case Description: The participant was a 53-year-old man, 30 months after hemorrhagic stroke. At the time of enrollment, he exhibited some active shoulder and elbow flexion, but no active elbow extension, and no active movement at any joint below the elbow. Intervention: The participant engaged in RTP incorporating a portable, electromyography-triggered neurorobotic device in 1-hour sessions, 3 days/week for 8 weeks using the affected arm. Outcomes: The upper extremity section of the Fugl-Meyer Impairment scale (FM), the Canadian Occupational Performance Measure (COPM), and the Stroke Impact Scale (SIS) were administered before and after training. After intervention, the subject exhibited reduced affected arm impairment (+2 points on the FM), increased ability to perform valued activities, increased satisfaction with performance of these activities (indicated by score increases of +2 and +1.8 points on the COPM Performance and Satisfaction scales, respectively), improved strength, performance of activities of daily living, hand function, participation, and physical function (as indicated by increases in respective SIS scores). Discussion: The RTP incorporating the neurorobotic device appears promising. To our knowledge, this is the first study documenting a portable robotic-based RTP strategy in a person exhibiting this severity of hemiparesis.