Possibilities of using distance therapy and telerehabilitation in occupational therapy in patients after acquired brain injury - pilot study
Abstract
Background: The study focuses on patients who were discharged from inpatient rehabilitation care to their home environment, but due to the unavailability or impossibility of transport to outpatient rehabilitation, the patients did not have the possibility of follow-up occupational therapy for the upper limbs. The situation is even more strongly emphasised in the field of outpatient occupational therapy, which is minimally available in all regions of the Czech Republic.
Aim: The aim of the study was to evaluate the application of distance therapy in patients with acquired brain injury with the therapy focusing on the upper limbs and to verify whether the fine motor skills of the paretic upper limb are maintained or significantly improved after distance occupational therapy. Methods: The study included seven subacute patients enrolled in distance therapy at home (five females, mean age 40 +- 15.66 years, four haemorrhagic stroke, three left-sided hemiparesis, seven right handedness) who completed therapy with Leap motion sensor and Rehamza software.
The patients were evaluated at baseline (T1) and at the end of distance therapy (T2) by the Motor Assessment Scale (MAS) functional test, the 9 Hole Peg Test (9HPT) and Box and Block test (BBT) coordination and dexterity tests, the Motricity Index (MI) for the upper extremities for muscle strength, the modified Ashworth scale (mAS) for muscle tone, self-sufficiency was assessed by the Barthel Index (BI) and the change in the quality of life was monitored with the SF-36 questionnaire in the first month after discharge from hospitalisation. Results: The results of the motor tests show that there was a statistically significant improvement in fine motor skills, coordination and motor pace according to 9HPT (p = 0.05) and a statistically significant improvement in the upper limb function according to MAS (p = 0.05).
A clinical improvement of 4.28 cubes in average was observed in BBT. In all seven patients, the muscle strength of the hand increased according to MI to the full score (33 b.) The adherence of seven patients to distance occupational therapy was 100%.
Conclusion: The results of the study show that patients with a mild motor deficit on the upper limb after acquired brain damage can positively benefit from distance occupational therapy.