Researchers at the University of Michigan are finding ways to provide easier access to care using home-based programs that use the Internet to monitor changes in performance.
U-M School of Kinesiology professor Susan Brown and colleague Dr. Edward Hurvitz, the chair of the Department of Physical Medicine and Rehabilitation at the U-M Medical School, have completed a study that looked at the effectiveness of a home and internet-based upper limb training program for adults with CP. Their research effort, “Upper Limb Training and Assessment Program,” or ULTrA program, was designed to aid adults with cerebral palsy who have upper limb and hand impairments. Until now, no study has ever looked at changes in upper limb coordination and the potential impact on everyday tasks in adults with CP.
The concept was simple: Allow patients to complete regular therapy exercises from the comfort of their home using the Internet, an at-home computer interface, and trainers on the other end of the computer. The goal was also simple: Make movement-based training more convenient and accessible for adults with cerebral palsy. This particular intervention was unique because it used low-cost technology to monitor participants while collecting invaluable, movement-related home training data.
The study tested 12 adults with CP who had pronounced arm and hand mobility issues. Participants completed a series of arm reaching and hand manipulation tasks in their homes for 40 minutes a day, five days a week for a period of eight weeks. Using the Internet and streaming video, the ULTrA program allowed participants to interact with research personnel at the School of Kinesiology’s Motor Control Laboratory. Each participant’s home was equipped with a computer-based upper limb training unit, a high-speed Internet connection, and a training guide.
“One of our major goals of the study was to incorporate a variety of arm reaching and hand movements exercises that we hoped would improve mobility and do it at a time that was convenient for them,” Brown said.
In one of the most notable training sessions, a participant was asked to slide, or turn, as many playing cards (from a casino-style card slider/holder) as possible in 30 seconds. The number of cards a person was able to turn was recorded—part of the larger data collection effort that would help determine how well the in-home therapy was working. The data showed a 64 percent improvement in task performance by the affected hand, and a 41 percent improvement in the less affected hand. Significant improvement in the ability to grasp and manipulate common objects was also seen, providing evidence that training led to improved hand and arm function.
Participants were able to receive coaching and encouragement via web cameras—which also allowed the staff to modify programs as needed without having participants coming into the research lab or clinic.
“We believe home-based therapy shows great promise for patients who otherwise have limited access to interventions due to insurance coverage, travel barriers and time constraints,” Hurvitz said.
Apart from rehabilitation, the researchers said, there is real potential to use this technology beyond adults with CP. A variety of populations with neurological problems could benefit from this type of therapy including stroke, multiple sclerosis, and spinal cord injury. These populations could potentially improve movement speed and hand manipulation skills similar to the gains seen in the participants in this study. Brown and Jeanne Langan, a research fellow at the Motor Control Laboratory, have recently begun studies examining the effectiveness of the home and Internet-based training in individuals with stroke.
The study will appear in an upcoming issue of Neurorehabilitation and Neural Repair, the leading journal in the field of rehabilitation.
Contact: Christina Camilli-Whisenhunt
Phone: (734) 647-3079