Stroke as a Clinical Problem
Neurological disorders that affect the motor system, such as stroke, are often devastating for post-stroke individuals and their families. They are the leading cause of disability. Sixty-five percent of individuals post-stroke are unable to incorporate their affected upper extremities effectively into daily activities. Because numerous activities involve the upper extremities 1, even mild impairments can severely impact quality of life 2.
The “drug” of choice in upper extremity neuro-rehabilitation is task-based motor training, which improves function when delivered in high doses in the laboratory 3-6. Because of the redundant arm and trunk biomechanics, improvements can result either from true recovery of normative movements or from compensatory movements (such as reaching with pronounced trunk movements) 7. Compensatory movements can result in sub-optimal function, pain, and further disuse. Conversely, re-training motor skilled movements via reduction in compensation improves recovery on the long term 8.
Current Standard of Care
In the current standard of care, motor training is delivered in one-to-one interaction between a therapist and a patient. Because health insurances reimburse at most 20 sessions, therapists cannot deliver the needed high doses of training, and thus request patients to perform most of the training at home.
In addition, despite spending up to 1/4th of their time on documentation, therapists lack means to accurately and precisely measure and report change in movement quality.
Because of this lack of movement data,
- patients under-appreciate the benefits of therapy, which leads to low compliance of home exercises and reduced clinic visits;
- patients can develop maladaptive patterns, which can worsen outcomes; and
- health insurances, seeing no improvements, reimburse only a few sessions.
Motion Scientific designed MotionReach as a solution to this clinical problem.
The goal of MotionReach is to enhance the current standard of care by improving
arm and hand function following neurological disorders that affect the motor system, particularly stroke.
References
1. Coster, W.J., et al., Refining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain. Med Care, 2004. 42(1 Suppl): p. I62-72.
2. Carr, J.H. and R.B. Shepherd, Stroke Rehabilitation – Guidelines for Exercise and Training to Optimize Motor Skill. 2003: Butterworth-Heinemann.
3. Winstein, C. and S. Wolf, Task-oriented training to promote upper extremity recovery, in Stroke recovery & rehabilitation., J. Stein, et al., Editors. 2008, Demos Medical New York. p. 267-90.
4. Wolf, S.L., et al., Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 2006. 296(17): p. 2095-104.
5. Farley, B.G. and G.F. Koshland, Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res, 2005. 167(3): p. 462-7.
6. Felix, K., et al., Upper Extremity Motor Learning among Individuals with Parkinson’s Disease: A Meta-Analysis Evaluating Movement Time in Simple Tasks. Parkinsons Dis, 2012. 2012: p. 589152.
7. Roby-Brami, A., et al., Motor compensation and recovery for reaching in stroke patients. Acta Neurol Scand, 2003. 107(5): p. 369-81.
8. Michaelsen, S.M., R. Dannenbaum, and M.F. Levin, Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial. Stroke, 2006. 37(1): p. 186-92.