Poststroke Reductions in Impairment and Functional Limitation Using a FaceTime-Based Upper-Extremity Protocol

PURPOSE: The purpose of this study was to determine the impact of an upper-extremity (UE) motor rehabilitation protocol administered to a stroke survivor exhibiting moderate UE impairment using commercially available, Internet-based communication technology (FaceTime). The 8-wk UE therapy regimen incorporated an electromyography (EMG)-triggered myoelectric brace providing repetitive, task specific practice.

RATIONALE: Poststroke UE hemiparesis significantly undermines valued activities and continues to be prevalent among the rapidly increasing stroke survivor population. Conventional UE therapies offer limited efficacy and require matriculation to a clinical site, which may be challenging for some clients. Previously, we have shown that repetitive use of an EMG-triggered myoelectric brace can “reteach” paretic UE movement and significantly reduce UE impairment and functional limitation.

Given the above challenges and successes using FaceTime in acute stroke neurology settings, we examined the feasibility and impact of myoelectric brace use when administered remotely using FaceTime. To our knowledge this was the first occupational therapy study to examine the use of FaceTime for service delivery.

DESIGN: Pre–post case study.

PARTICIPANT: A 35-year old, female stroke survivor exhibiting moderate, stable, UE hemiparesis from a stroke occurring ≈16 mo ago was recruited from a local outpatient rehabilitation clinic in the Midwestern United States. At time of study enrollment, she exhibited no active movement in the paretic wrist or fingers, ≈20° of active flexion at the paretic elbow, and shoulder movement within functional limits.

METHOD: Following consent, the participant was administered the UE section of the Fugl-Meyer Assessment (FMA), the Motor Activity Log (MAL), the Stroke Impact Scale (SIS), and the Arm Motor Ability Test (AMAT) approximately 1 wk before intervention. After providing the client with a half-hour education session on donning/doffing and use of the myoelectric brace, therapy was delivered remotely 2 days/wk with compliance visits (checking on device use and fit) occurring 1 day/wk, in half-hour increments over an 8-wk period. All of the measures were then readministered 1 wk after the intervention period had concluded, and again 2 mo after the intervention had concluded.

ANALYSIS: Data were analyzed in tabular format by examining the client’s scores before, after, and 2 mo after intervention.

RESULTS: After intervention, the participant exhibited score increases on all measures (FMA, pretest = 19, posttest = 23; MAL Activity scale, pretest = 1.067, posttest = 2.6; MAL How Well scale, pretest = .833, posttest = 2.5; SIS, pretest = 15–68.75, posttest = 35–143.5). Score increases approached or exceeded minimally clinically important differences on all measures.

DISCUSSION: It appears feasible to deliver UE therapy remotely using commercially available technology. The client did not miss any sessions and experienced no difficulties with setup or use of this approach. Moreover, myoelectric brace use reduced UE impairment and functional limitation.

IMPACT STATEMENT: This case study importantly corroborates a growing body of literature suggesting that EMG-triggered myoelectric bracing drives neuroplasticity and motor changes, even months postictus. Given the large treatment effect, larger trials are now underway. Concurrently, study results provide the first evidence of the feasibility of using commercially available technologies to effectively deliver occupational therapy services remotely. This is expected to positively affect the use of such approaches for future service delivery across diagnoses.