In-home stroke rehabilitation comparable to clinic-based therapy to improve mobility

UCI-led research advances potential for decreasing post-stroke disability

February 11, 2019

Home-based telerehabilitation is just as effective as clinic-based therapy at restoring arm function among stroke survivors, according a research presented by UCI Health stroke neurologist Steven C. Cramer MD, MMSc, at the American Stroke Association’s 2019 International Stroke Conference in Honolulu.

“Many patients receive suboptimal rehabilitation therapy doses after stroke due to limited access to therapists and difficulty with transportation,” said Cramer, the study’s lead author and professor of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation at the University of California, Irvine. “This can be addressed by telehealth, which enables patients to access high doses of rehabilitation therapy in their home.”

Researchers conducted a randomized, assessor-blinded, non-inferiority trial with 124 stroke survivors, average age 61, at 11 U.S. StrokeNet Clinical Trial Network sites. Survivors underwent six weeks of intensive rehabilitation therapy targeting arm weakness. Each was randomized to receive therapy either in the clinic using traditional methods or in their home using a telerehabilitation system.

“A computer-based telerehabilitation system delivered to patient’s homes uses ‘game-ified’ therapy activities, exercises and educational sessions, such as ‘Stroke Jeopardy,’ ” Cramer said. “Therapists can assess progress via videoconference. In clinic-based therapy, patients drive to the clinic and perform standard exercises and therapeutic activities with a therapist without a computer and without ‘game-ification’ of these activities.”

Compliance was high and similar between both groups. Arm function improved substantially and equivalently in both groups.

“We demonstrated that home-based telehealth methods provide comparable benefits to traditional in-clinic methods,” Cramer said. “In the future, telehealth approaches to post-stroke rehabilitation might help patients reduce disability by accessing large doses of therapy.”

Co-authors are from The NIH StrokeNet Telerehab. The National Institutes of Health funded the study. 

Cramer’s research has had a longstanding focus on neural plasticity and stroke rehabilitation.

“Stroke remains a major source of human disability and new treatments are needed that can reduce this,” Cramer said. “Approved therapies such as tPA are only accessed by a small percentage of patients, in part due to the narrow time window when they are eligible to receive it. We need therapies that have a wide time window that can be accessed by most patients and that reduce disability.”

He said increased attention has been paid to restorative therapies, which aim to promote brain repair and neural plasticity and thereby reduce disability.  

In 2017, Cramer received the received the International Stroke Conference Stroke Rehabilitation Award for research into the use of monoclonal antibodies in stroke rehabilitation.

“One category of brain repair therapy is monoclonal antibodies, a therapeutic class that has changed the face of therapy for arthritis, inflammatory bowel disease, many cancers, psoriasis, and more,” Cramer said. The objective is to change activity in a key biochemical pathway after stroke as has been successful in these diseases, he said.

According to the American Stroke Association stroke is the No. 2 cause of death worldwide and a leading cause of serious disability. The Association’s annual International Stroke Conference in is the premier meeting dedicated to the science and treatment of cerebrovascular disease for researchers and clinicians.

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