New stroke exercise technology popular with remote patients

Associate Professor Michele Callisaya

by Anne Crawford

A new technology system helping stroke patients perform vital rehabilitation exercises remotely, developed by a Monash researcher, has proved not only feasible but successful. Stroke survivors participating in the feasibility study performed more exercises than they were asked – a mean 125% of prescribed sessions – and rated the system highly.

The study, led by physiotherapist/researcher Associate Professor Michele Callisaya from the Peninsula Clinical School, was conducted in collaboration with her PhD student Dawn Simpson from the Menzies Institute for Medical Research, University of Tasmania, and other institutions. It was published in the journal Topics in Stroke Rehabilitation late last year.

The system uses a sensor attached to a chair that monitors the repetitions of exercises, transmitted via a tablet to a therapist overseeing the patient’s progress.

“When we were working in stroke rehabilitation wards we noticed quite a few issues when patients went home,” Associate Professor Callisaya said. “They needed to do high numbers of repetitions and functional training but once they got home they didn’t have much contact with therapists and started to lack motivation to do it on their own,” she said. “Some people didn’t even make it into inpatient or outpatient rehabilitation because they lived too far away.”

Self-reporting to therapists wasn’t always reliable or satisfactory.

“This system provided an objective way of seeing what they were doing,” she said.

It is pitched at the lower functioning patients – those unable to walk across a room for instance – as patients able to walk can use existing devices that measure steps or movement, she said.

Ten participants with stroke aged around 73.6 years completed a four-week sit-to-stand exercise program using the technology at home with the therapist remotely monitoring their exercise adherence and progressed goals, and providing feedback via the app.

“It’s really important to their recovery that people do a high number of repetitions to really make changes in the brain so that neuroplasticity can occur,” Associate Professor Callisaya said.

The participants completed 104% of the prescribed repetitions and rated the system well: system usability (78%), enjoyment (70%) and system benefit (80%). Associate Professor Callisaya said many of them liked the fact that they were connected to a therapist who was monitoring them and could send them messages of encouragement and up the amount of exercise as they achieved their goals.

“Probably the nicest finding was that people did more exercise and sessions than were actually prescribed,” she said. “It seemed to help with their motivation and people did improve over those four weeks.

“It was a small study though, and we have to be careful as it wasn’t a randomised, controlled trial.”

 Associate Professor Callisaya said the researchers were now seeking to approach an IT company to produce the system so that it could be further trialled and the exercises expanded before being rolled out to many more patients living remotely, and potentially to stroke rehabilitation wards.

Simpson DB, Bird ML, English C, Gall SL, Breslin M, Smith S, Schmidt M, Callisaya ML.    Connecting patients and therapists remotely using technology is feasible and facilitates exercise adherence after stroke. Top Stroke Rehabil. 2019 Nov 25:1-10. doi: 10.1080/10749357.2019.1690779. PMID: 31762412