Healthy Brain and Mind Research Centre (HBMRC) and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
J Neuroeng Rehabil. 2021 Nov 25;18(1):165. doi: 10.1186/s12984-021-00956-7.
Home-based rehabilitation of arm function is a significant gap in service provision for adult stroke. The EDNA-22 tablet is a portable virtual rehabilitation-based system that provides a viable option for home-based rehabilitation using a suite of tailored movement tasks, and performance monitoring via cloud computing data storage. The study reported here aimed to compare use of the EDNA system with an active control (Graded Repetitive Arm Supplementary Program-GRASP training) group using a parallel RCT design.
Of 19 originally randomized, 17 acute-care patients with upper-extremity dysfunction following unilateral stroke completed training in either the treatment (n = 10) or active control groups (n = 7), each receiving 8-weeks of in-home training involving 30-min sessions scheduled 3-4 times weekly. Performance was assessed across motor, cognitive and functional behaviour in the home. Primary motor measures, collected by a blinded assessor, were the Box and Blocks Task (BBT) and 9-Hole Pegboard Test (9HPT), and for cognition the Montreal Cognitive Assessment (MoCA). Functional behaviour was assessed using the Stroke Impact Scale (SIS) and Neurobehavioural Functioning Inventory (NFI).
One participant from each group withdrew for personal reasons. No adverse events were reported. Results showed a significant and large improvement in performance on the BBT for the more-affected hand in the EDNA training group, only (g = 0.90). There was a mild-to-moderate effect of training on the 9HPT for EDNA (g = 0.55) and control (g = 0.42) groups, again for the more affected hand. In relation to cognition, performance on the MoCA improved for the EDNA group (g = 0.70). Finally, the EDNA group showed moderate (but non-significant) improvement in functional behaviour on the SIS (g = 0.57) and NFI (g = 0.49).
A short course of home-based training using the EDNA-22 system can yield significant gains in motor and cognitive performance, over and above an active control training that also targets upper-limb function. Intriguingly, these changes in performance were corroborated only tentatively in the reports of caregivers. We suggest that future research consider how the implementation of home-based rehabilitation technology can be optimized. We contend that self-administered digitally-enhanced training needs to become part of the health literacy of all stakeholders who are impacted by stroke and other acquired brain injuries. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001557123. Registered 12 November 2019, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378298&isReview=true.
家庭康复是成人中风服务提供中的一个重大空白。EDNA-22 平板电脑是一种便携式虚拟康复系统，它提供了一种可行的选择，可以使用一系列量身定制的运动任务以及通过云计算数据存储进行性能监测来进行家庭康复。本研究旨在使用平行 RCT 设计，将 EDNA 系统与主动对照组（分级重复手臂补充程序-GRASP 训练）进行比较。
在最初随机的 19 名患者中，有 17 名单侧中风后上肢功能障碍的急性护理患者完成了治疗组（n=10）或主动对照组（n=7）的训练，每组接受 8 周的家庭训练，包括每周 3-4 次 30 分钟的课程。在家中评估运动、认知和功能行为。主要运动测量由一名盲法评估者收集，包括盒子和块任务（BBT）和 9 孔钉板测试（9HPT），认知测量采用蒙特利尔认知评估（MoCA）。功能行为采用中风影响量表（SIS）和神经行为功能量表（NFI）进行评估。
每组各有一名参与者因个人原因退出。没有报告不良事件。结果显示，EDNA 训练组的更受影响的手上 BBT 的表现有显著且较大的提高，仅为（g=0.90）。EDNA（g=0.55）和对照组（g=0.42）组的 9HPT 训练对更受影响的手有轻度至中度的影响。关于认知，EDNA 组的 MoCA 表现有所提高（g=0.70）。最后，EDNA 组在 SIS（g=0.57）和 NFI（g=0.49）上的功能行为有适度（但无统计学意义）的改善。
使用 EDNA-22 系统进行短期家庭训练可以显著提高运动和认知表现，超过了也针对上肢功能的主动对照组训练。有趣的是，这些表现的变化仅在照顾者的报告中得到了初步证实。我们建议未来的研究考虑如何优化家庭康复技术的实施。我们认为，自我管理的数字化增强训练需要成为所有受中风和其他获得性脑损伤影响的利益相关者健康素养的一部分。
澳大利亚和新西兰临床试验注册中心（ANZCTR）编号：ACTRN12619001557123。注册于 2019 年 11 月 12 日，http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378298&isReview=true。
