Arm Motor Rehabilitation Entertainment and Cognition System for the Elderly

PROJECT SUMMARY OBJECTIVES Americans experience a CVA yearly More intensive rehabilitation early sub acute post CVA was found to produce better recovery The first objective is the development of a relatively low cost medical device with small clinical footprint The BrightArm C BAC is a compact robotic table with bimanual hand controllers that track full D arm movement measure finger grasp and extension arm pronation supination and monitor health through biosensors UE movements will be induced during interaction with virtual games The second objective is to determine the efficacy of BAC for the in patient and outpatient therapy continuum compared to standard of care We expect that the new integrative therapy when added to conventional rehabilitation will result in higher functioning individuals for the same time period SPECIFIC AIMS Develop the BrightArm C robotic table with novel UE controllers and custom integrative games Conduct a usability and a feasibility study with Roosevelt Care Center on inpatients sub acute post CVA Longitudinal randomized clinical study of subjects sub acute post CVA inpatients and then outpatients at Kessler Institute for Rehabilitation Enroll caregivers and obtain their periodic feedback METHODS Complete mechanical and electronic design of the robotic table construct a prototype preform operational testing and validate UE tracking over the entire table Design and fabricate forearm controllers measuring grasp strength and finger extension forearm pronation supination and integrated biosensors Develop arm position modeling and conduct reliability testing Interface UE movements captured by hand controllers with an enhanced game library Integrative games will train motor function and cognitive domains of executive function memory focusing and language comprehension Conduct a usability evaluation on elderly volunteers Conduct a feasibility study with inpatients early sub acute post CVA showing good technology acceptance and clinical benefit Build and deploy two BrightArm C systems at Kessler Institute for Rehabilitation one for subjects in the sub acute phase post CVA training weeks inpatient and one for outpatients training months x week Compare outcomes of experimental n and control groups n both undergoing standardized evaluations in the motor cognitive and quality of life domains Evaluate pre post inpatient and pre post follow up outpatient therapy Success means better outcomes for experimental group with an average of points larger increase in Fugl Mayer assessment average point more in CAHAI larger increase in executive function memory and a point larger reduction in depression Periodically collect caregiver feedback to determine generalization to independence in real life activities NIH RELEVANCE Nationwide annual costs of CVAs are expected to grow to $ billion by This project will reduce these costs by improving ADL function cognition and quality of life through early intensive intervention post CVA Individuals post TBI cerebral palsy or post shoulder surgery may also benefit PROJECT NARRATIVE Public Health Relevance Americans experience a CVA yearly CDC and more intensive rehabilitation in the sub acute early phase was found to produce better recovery Chen et al A compact robotic table that uses bimanual therapeutic VR games to induce a high number of active arm repetitions improve finger grasp and extension promote forearm pronation supination adapt to motor and cognitive impairments and track performance for clinicians will benefit multiple patient populations those post CVA traumatic brain injury cerebral palsy and post shoulder surgery The BCI system facilitates a continuity of sub acute care from inpatient to outpatient while reducing health care costs through integrative rehabilitation