Promoting arm movement practice with a novel wheelchair armrest early after stroke: A randomized controlled trial
Sangjoon J Kim1,2, Vicky Chan2, Niko Fullmer3
1Bionics Research Center, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.
Background:
Chronic upper extremity (UE) impairment is common after stroke. This study evaluated Boost, a novel wheelchair-mounted rehabilitation device designed to assist individuals in UE motor recovery during inpatient rehabilitation.
Method:
Thirty-five stroke inpatients were randomized to perform additional UE exercises alongside standard therapy, using either Boost or a therapist-customized booklet for self-practice. Outcomes included the UE Fugl-Meyer (UEFM) Exam, Box and Block Test, Motor Activity Log, Modified Ashworth Scale, shoulder subluxation, and shoulder pain.
Results:
At baseline, mean days post-stroke were 11.9±4.6 and 13.1±5.9, and UEFM scores were 20.5±10.1 and 21.0±13.5. Intervention durations averaged 11.9±4.0 and 17.2±8.8 days, respectively. Participants in the Boost group completed 3,359±3,137 additional arm movements. No significant between-group differences were found at the three-month follow-up. However, the Boost group showed a trend toward greater UEFM improvement immediately post-intervention (11.8 vs. 6.9 points, p=0.06). Importantly, UEFM gains were predicted by the number of Boost exercises performed (p=0.02, R2=0.34). Subgroup analysis revealed that patients with less severe impairment (baseline UEFM >21) achieved significantly greater UEFM improvements at discharge with Boost compared to controls (15.8 vs. 7.8 points, p=0.01).
Conclusions:
These findings demonstrate the feasibility of achieving thousands of additional UE practice movements while seated in a wheelchair without direct supervision during subacute rehabilitation. The added movement practice was well tolerated and may offer short-term impairment-reduction benefits, particularly in those with less severe impairment. Larger trials are needed to confirm efficacy, establish optimal dosage, and determine long-term clinical and functional benefits of Boost-assisted therapy.This study was registered at ClinicalTrials.gov with the title "Comparing Different Rehabilitation Exercise Strategies for Improving Arm Recovery After Stroke (Boost)" in May 2023; registration number: NCT05880940.
