In-Home Tele-Rehabilitation Improves Tetraplegic Hand Function

Background. Spinal cord injury (SCI) survivors with tetraplegia have great difficulty performing activities of daily living (ADLs). Functional electrical stimulation (FES) combined with exercise therapy (ET) can improve hand function, but delivering the treatment is problematic. Objective. To compare 2 ET treatments delivered by in-home tele-therapy (IHT). Methods. Each treatment involved ET, tele-supervised 1 h/d, 5 d/wk for 6 weeks. Treatment 1: "conventional ET" comprised strength training, computer games played with a trackball, and therapeutic electrical stimulation (TES). Treatment 2: "ReJoyce ET" comprised FES-ET on a workstation, the Rehabilitation Joystick for Computerized Exercise (ReJoyce) with which participants played computer games associated with ADLs. Participants were block-randomized into group 1 receiving conventional ET first, followed by 1-month washout, and then ReJoyce ET and group 2 in reverse order. In all, 13 participants took part, 5 completing the study with both hands, such that both groups had a sample size of 9. Primary outcome measure: Action Research Arm Test (ARAT). Secondary outcome measures: grasp and pinch forces and the ReJoyce automated hand function test (RAHFT). Results. ARAT scores improved more after ReJoyce ET (13.0% +/- 9.8%) than after conventional ET (4.0% +/- 9.6%; F = 10.6, P < .01). RAHFT scores also improved more after ReJoyce ET (16.9% +/- 8.6%) than conventional ET (3.3% +/- 10.2%; F = 20.4, P < .01). Conclusions. FES-ET on a workstation, supervised over the Internet, is feasible and may be effective for patients who can meet the residual motor function requirements of our study.