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Internet of Things (IoT) Enables Robot-Assisted Therapy as a Home Program for Training Upper Limb Functions in Chronic Stroke: A Randomized Control Crossover Study

  • Li-Chieh Kuo
    Affiliations
    Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan

    Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
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  • Kang-Chin Yang
    Affiliations
    Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
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  • Yu-Ching Lin
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Yu-Chen Lin
    Affiliations
    Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Occupational Therapy, Da-Yeh University, Changhua, Taiwan
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  • Chien-Hsien Yeh
    Affiliations
    Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
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  • Fong-Chin Su
    Affiliations
    Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan

    Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
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  • Hsiu-Yun Hsu
    Correspondence
    Corresponding author Hsiu-Yun Hsu, PhD, Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, University Road, Taiwan.
    Affiliations
    Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Published:September 16, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.976

      Abstract

      Objective

      To compare the effects of using an Internet of things (IoT)-assisted tenodesis-induced-grip exoskeleton robot (TIGER) and task-specific motor training (TSMT) as home programs for the upper-limb (UL) functions of patients with chronic stroke to overturn conventional treatment modes for stroke rehabilitation.

      Design

      A randomized 2-period crossover study.

      Setting

      A university hospital.

      Participants

      Eighteen chronic stroke patients were recruited and randomized to receive either the IoT-assisted TIGER first or TSMT first at the beginning of the experiment (N=18).

      Intervention

      In addition to the standard hospital-based therapy, participants were allocated to receive a 30-minute home-based, self-administered program of either IoT-assisted TIGER first or TSMT first twice daily for 4 weeks, with the order of both treatments reversed after a 12-week washout period. The exercise mode of the TIGER training included continuous passive motion and the functional mode of gripping pegs. The TSMT involved various movement components of the wrist and hand.

      Main Outcome Measures

      The outcome measures included the box and block test (BBT), the Fugl-Meyer assessment for upper extremity (FMA-UE), the motor activity log, the Semmes-Weinstein Monofilament test, the range of motion (ROM) of the wrist joint, and the modified Ashworth scale.

      Results

      Significant treatment-by-time interaction effects emerged in the results for the BBT (F(1.31)=5.212 and P=.022), the FMA-UE (F(1.31)=6.807 and P=.042), and the ROM of the wrist extension (F(1.31)=8.618 and P=.009). The participants who trained at home with the IoT-assisted TIGER showed more improvement of their UL functions.

      Conclusions

      The IoT-assisted TIGER training has the potential for restoring the UL functions of stroke patients.

      KEYWORDS

      List of abbreviations:

      AROM (active range of motion), BBT (box and block test), FMA-UE (Fugl-Meyer assessment for upper extremity), IoT (Internet of things), MAL (motor activity log), MAS (modified Ashworth scale), PCGI-I (Patient Clinical Global Impressions-Improvements), ROM (range of motion), SWM (Semmes-Weinstein monofilament), TIGER (tenodesis-induced-grip exoskeleton robot), TSMT (task-specific motor training), UL (upper-limb)
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