Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system

Background: the effect of rehabilitative training after stroke is dose-dependent. out-patient rehabilitation training is often limited by transport logistics,financial resources and a lack of motivation/compliance. we studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients' homes. methods: an open-label,single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. the patients trained with an inertial measurement unit (imu)-based virtual reality system (armeosenso) in their homes for six weeks. the self-selected dose of training with armeosenso was the principal outcome measure whereas the fugl-meyer assessment of the upper extremity (fma-ue),the wolf motor function test (wmft) and imu-derived kinematic metrics were used to assess arm function,training intensity and trunk movement. repeated measures one-way anovas were used to assess differences in training duration and clinical scores over time. results: all subjects were able to use the system independently in their homes and no safety issues were reported. patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. the weekly training duration did not change over the course of six weeks (p = 0.146). the arm function of these patients improved significantly by 4.1 points (p = 0.003) in the fma-ue. changes in the wmft were not significant (p = 0.552). armeosenso based metrics showed an improvement in arm function,a high number of reaching movements (387 per session),and minimal compensatory movements of the trunk while training. conclusions: self-directed home therapy with an imu-based home therapy system is safe and can provide a high dose of rehabilitative therapy. the assessments integrated into the system allow daily therapy monitoring,difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching. trial registration: unique identifier: nct02098135. © 2016 the author(s).