Integrative rehabilitation of elderly stroke survivors: The design and evaluation of the BrightArm™

Purpose: To describe the development of the BrightArm upper extremity rehabilitation system, and to determine its clinical feasibility with older hemiplegic patients. Method: The BrightArm adjusted arm gravity loading through table tilting. Patients wore an arm support that sensed grasp strength and communicated wirelessly with a personal computer. Games were written to improve cognitive, psychosocial and the upper extremity motor function and adapted automatically to each patient. The system underwent feasibility trials spanning 6 weeks. Participants were evaluated pre-therapy, post-therapy, and at 6 weeks follow-up using standardized clinical measures. Computerized measures of supported arm reach and game performance were stored on a remote server. Results: Five participants had clinically significant improvements in their active range of shoulder movement, shoulder strength, grasp strength, and their ability to focus. Several participants demonstrated substantially higher arm function (measured with the Fugl-Meyer test) and two were less-depressed (measured with the Becks Depression Inventory, Second Edition). The BrightArm technology was well-accepted by the participants, who gave it an overall subjective rating of 4.1 on a 5 point Likert scale. Conclusions: Given these preliminary findings, it will be beneficial to evaluate the BrightArm through controlled clinical trials and to investigate its application to other clinical populations. Implications for Rehabilitation It is possible to improve arm function in older hemiplegic patients many years after stroke. Integrative rehabilitation through games combining cognitive (memory, focusing, executive function) and physical (arm movement, hand-eye coordination, grasping, dual-tasking) elements is enjoyable for this population. The severity of depression in the elderly can be reduced through virtual reality games, as long as games adapt to the patient, are winnable and provide rewards for success.

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