Development of a home-based Computer Assisted Arm Rehabilitation (hCAAR) device for upper limb exercises in stroke patients

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The aim of this research project was to develop and evaluate a robotic device hCAAR that can be used independently at home by stroke survivors with upper limb weakness. The project had two stages: Stage 1, hCAAR development using a user-centred design process; Stage 2, A feasibility clinical study in the home setting. Stage 1: Nine stroke survivors with upper limb weakness and six healthcare professionals were involved in the concept and design stages of device development. hCAAR consists of a powered joystick with a computer interface, which is used to direct the movement of the upper limb to perform therapeutic movements as directed by tasks on the screen. hCAAR also provides controlled assistance when the user’s voluntary upper limb movement is insufficient to complete the prescribed task. Stage 2: In the feasibility study, 19 participants (stroke survivors with upper limb weakness) were recruited and 17 participants used hCAAR in their homes for eight weeks. No serious adverse events were reported. All 17 participants were able to use the device independently. A statistically significant improvement was observed in the kinematic and clinical outcomes. Three participants showed clinically significant improvement in all clinical outcomes. Five participants reported improvement in functional ability in daily activities. Participants, family members and therapists were satisfied with the usability of hCAAR in the home setting. This research project also demonstrated that the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for stroke provides a useful basis to structure interviews to gather feedback from end-users and healthcare professionals in different stages of the rehabilitation device development. In summary, hCAAR is a home-based rehabilitation robotic device that can be independently used by stroke survivors with upper limb weakness and has the potential to improve upper limb movement and function