Date Presented 04/06/19
A literature review was completed to examine the efficacy of everyday technology as a treatment modality to improve upper-extremity motor control and motivation for people recovering from stroke. The evidence was promising in support of the use of everyday technology with this population, as indicated by client and clinician reports of satisfaction, motivation, and engagement in poststroke rehabilitation, as well as increased upper-extremity motor control.
Primary Author and Speaker: Tatiana Kaminsky
Contributing Authors: Dillon Oldham, Claire Ferree, Amanda Robert, Alana Yee, George Tomlin
PURPOSE: The purpose of this study was to determine the effectiveness of commercially available everyday technology (ET) for improving upper extremity (UE) motor control and/or motivation to participate in therapy in patients post-stroke. ET in this review focused on smartphones, tablets, computers, and gaming systems. These technologies are widely used by people in their daily lives and have potential to be used as a treatment modality to help people recover from illness and injury. Research on the utilization of ET in rehabilitation can provide evidence about its effectiveness for improving functional abilities and may provide the rationale for allocating funding specifically for technology in rehabilitation settings.
DESIGN/METHOD: A systematic review was conducted to evaluate the evidence that is available about the efficacy of ET as a treatment modality to improve UE motor control and/or motivation in clients undergoing rehabilitation post-stroke. Inclusion criteria included: published in or translated to English, focused on ET as a treatment modality, utilized technology that is off the shelf and commercially available, included outcomes on upper extremity motor control and/or motivation. Exclusion criteria included: robotics and robots, augmented communication, virtual reality with additional equipment/mounts/attachments, gaming devices/gaming systems that are not commercially available. Twelve databases and journals were searched including PubMed, CINAHL, OT Seeker, Google Scholar, and PEDRO, among others. Key search terms included: stroke, post-stroke, cerebrovascular accident (CVA), acquired brain injury (ABI), everyday technology (ET), commercially available technology, iPad, tablet, smartphone, iPhone, upper extremity motor control, and motivation. The research team critically analyzed all articles that met the inclusion and exclusion criteria. Following completion of the systematic review, results were shared with occupational therapists who worked on an acute care unit with clients who were recovering from stroke. The researchers created a decision chart that illustrated how everyday technology could be used to treat both fine and gross UE motor control deficits after stroke. Attendees were given a survey after the presentation to assess the likelihood that they would use everyday technology with their clients.
RESULTS: Nineteen articles met the inclusion and exclusion criteria and were included in the study. The levels of evidence represented across the 19 articles were as follows: 5 Level I, 3 Level II, 5 Level III, 3 Level IV, 1 Level V and 2 qualitative articles. There is promising evidence for the use of ET in increasing client engagement in therapy sessions, decreasing boredom in and out of therapy, and there is support for the effectiveness of mobile based ET for improving upper extremity motor function in individuals post stroke. Common outcome measures included (but were not limited to): Box and Block Test, Fugl-Meyer, 9-hole peg test, and Wolf Motor Function Test. After results were shared with clinicians in the acute care stroke unit, they were asked about the likelihood that they would utilize everyday technology with their clients. Nine of eleven attendees indicated that they were more likely to use technology as a treatment modality after the presentation. The barriers to use were limited treatment time and availability of technology
CONCLUSION: The evidence was promising in support of the use of ET as indicated by client and clinician reports of satisfaction, motivation, and engagement in post-stroke rehabilitation, as well as increased upper extremity motor control. Clinicians should consider the benefits of implementing everyday technology for upper extremity motor recovery with clients post-stroke.
References
Joo, L., Yin, T., Xu, D., Thia, E., Chia, P., Kuah, C., & He, K. (2010). A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. Journal of Rehabilitation Medicine, 42, 437-441. doi:10.2340/16501977-0528
Rand, D., Schejter-Margalit, T., Dudkiewicz, I., Kizony, R., Zeilig, G., & Kizony, R. (2013). The use of the iPad for poststroke hand rehabilitation: A pilot study. 2013 International Conference on Virtual Rehabilitation (ICVR). doi: 10.1109/icvr.2013.6662068
White, J., Janssen, H., Jordan, L., & Pollack, M. (2014). Tablet technology during stroke recovery: A survivor’s perspective. Disability and Rehabilitation, 37, 1186-1192. doi:10.3109/09638288.2014.958620
Yoon-Hee, C., Ku, J., Lim, H, Kim, H., Y., & Paik, N. (2016). Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke. Restorative Neurology and Neuroscience Journal, 34, 455-463. doi: 10.3233/RNN-15062
