A Randomized Control Trial of a Virtually Delivered Program for Increasing Upper Limb Activity After Stroke.

Area of Science:

• Neurorehabilitation
• Stroke Recovery
• Digital Health Interventions

Background:

• Limited upper limb activity post-stroke hinders functional recovery.
• Virtual rehabilitation programs offer accessible solutions for community-dwelling individuals.
• Wearable technology can provide objective feedback on motor performance.

Purpose of the Study:

• To evaluate the efficacy of a virtually delivered upper limb program (Virtual Arm Boot Camp [V-ABC]) in increasing arm activity after stroke.
• To assess the impact of V-ABC, incorporating a wearable device with reach-to-grasp feedback, on upper limb function and quality of life.
• To determine if V-ABC can enhance real-world upper limb engagement in individuals less than one year post-stroke.

Main Methods:

• A parallel-group, assessor-blinded, randomized controlled trial (NCT04232163) involving 73 community-living participants with residual arm limitations.
• Participants were randomized to either the V-ABC group (home exercise, wearable feedback, virtual therapist sessions) or a waitlist control group.
• The primary outcome was average daily reach-to-grasp counts measured at 4 weeks post-baseline.

Main Results:

• The V-ABC group showed a statistically significant increase in average daily reach-to-grasp counts compared to the control group (mean difference = 368, P = 0.046).
• Secondary outcomes, including upper limb function and self-reported use, were also positively impacted.
• Tertiary analysis indicated positive within-subject changes from pre-treatment to follow-up assessments.

Conclusions:

• A virtually delivered upper limb program, combining exercise, wearable device feedback, and therapist support, effectively increases real-world upper limb activity post-stroke.
• This intervention demonstrates potential for improving functional outcomes and promoting greater arm engagement in stroke survivors.
• Virtual and technology-assisted rehabilitation represents a viable and effective strategy for stroke recovery.