Predictors of Response to an Upper Extremity Telerehabilitation-Home Practice Program after Stroke: An Interim Analysis

Research Objectives: To examine whether baseline cognitive and motor impairments influence response to a 5-week paired telerehabilitation-home practice intervention and explore functional neuroimaging features related to motor gains.

Design: Prospective interventional pilot study with intervention delivered over five-weeks including pre- and post- assessments.

Setting: Telerehabilitation

Participants: Adults with chronic ischemic or hemorrhagic stroke and UE motor deficits (Fugl-Meyer (FMA-UE) scores ≤ 56) were eligible to participate. Exclusion criteria included significant physical disability prior to stroke, Botox within 90 days, severe cognitive or language impairments (MoCA < 10, inability to understand instructions), or inability to use the portable fNIRS system.

Interventions: A two-part telerehabilitation intervention: synchronous sessions of task-practice and metacognitive strategy training with an occupational therapist two times per week, and asynchronous app-based exercise sessions while wearing a portable fNIRS device four times per week. Motor impairment was assessed pre- and post- intervention.

Main Outcome Measures: FMA-UE

Results: 10 participants (55.1 +/- 12.4 age, 27.2% female), in this interim analysis, completed the 5-week intervention. In bi-variate analyses, less severe UE motor impairment (t= 5.58, p= < 0.001) and less severe cognitive impairment (t= 2.9, p=.024) at baseline were each associated with greater response to the telerehabilitation-home practice program (i.e., UE motor gains; change in FMA-UE). Increased relative cortical activation (i.e., higher laterality) in the ipsilesional motor cortex (C3-C4) at baseline, as measured by portable fNIRS, was also related to UE motor gains.

Conclusions: Response to an UE motor telerehabilitation-home practice program was greatest for individuals with less severe UE motor and cognitive impairments at baseline. Furthermore, portable functional neuroimaging technologies (i.e., fNIRS) may be useful in determining who would most benefit from therapeutic interventions. Together these factors could assist therapists in developing personalized telerehabilitation programs for patients after stroke.

Author(s) Disclosures: KR is a consultant for Constant Therapeutics and Constant Therapy.
JAD is a consultant for Axem Neurotechnology.
TH is a consultant for Axem Neurotechnology.
CF, TI and ML are co-founders of and have stock ownership in Axem Neurotechnology.
DJL