GripAble, the digital mobile assessment and rehabilitation platform, can increase the amount of arm exercises stroke patients do without professional supervision eightfold, according to a new study.
Victor Yuan
More than five million people in the UK live with arm weakness, with stroke damage accounting for one million of those people.
The only intervention shown to improve arm function is repetitive, task-specific exercise but this is limited by the cost and availability of occupational therapists and physiotherapists.
The GripAble software platform, created by researchers at Imperial College London and clinicians at Imperial College Healthcare NHS Trust, consists of multiple sensors. The first sensor deployed by GripAble is lightweight electronic handgrip that interacts wirelessly with a standard PC tablet to enable the user to play arm-training games.
To use it, patients squeeze, turn, or lift the handgrip, and it vibrates in response to their performance whilst playing. The platform uses a novel mechanism, which can detect the tiny flicker movements of severely paralysed patients and channel them into controlling a computer game.
In a clinical trial of 30 patients, researchers from Imperial College London, the University of Southampton and Imperial College Healthcare NHS Trust found that the device enabled on average 104 upper limb repetitions per day whereas conventional therapy achieved 15 upper limb repetitions per day. The study, which was funded by NIHR Imperial Biomedical Research Centre (BRC), is published in Neurorehabilitation & Neural Repair.
Michelle Broderick, lead author of the study and clinical research therapist in stroke at Imperial College Healthcare NHS Trust, said: “Stroke is a major cause of arm weakness in the UK. It can significantly impact survivors’ lives making it hard for them to do routine daily tasks, limiting their independence. Previous studies have shown that repetitive exercise is vital for improving arm weakness, but this can be difficult due to resource constraints within healthcare settings, as well as the range of challenges faced by stroke survivors during their recovery, which can limit their ability to initiate or engage in independent exercise or rehabilitation activities.
“This study is the first to show that a digital rehabilitation platform – GripAble – can achieve significant increases in the amount of exercise patients do compared to supervised therapy only. Our findings suggest that a significant proportion of stroke survivors may potentially benefit from GripAble alongside conventional therapy. This could improve patient outcomes as well as easing pressure for the NHS in terms of infrastructure and resources. The next steps to fully determine GripAble’s impact is to assess the technology across a wider section of the population over a longer period of time.”
Dr Paul Rinne, GripAble CEO and co-founder, said: “We welcome the findings of this new study which demonstrate clearly how the GripAble platform can help to deliver gold standard care for people with upper limb impairment. The study proves that GripAble’s therapist-driven approach that allows professionals to engage and empower their patients to self-manage beyond standard therapy hours and remotely is effective in increasing the amount of exercise patients do. Our technology can be used by patients to continue their physiotherapy independently, outside of standard treatment and help with their rehabilitation.”
Dr Paul Bentley, co-author of the study and clinical director of the Imperial College Network of Excellence in Rehabilitation Technology at Imperial College London, added: “The findings from this clinical trial provide evidence that GripAble can be adopted to help further support stroke patients with severe arm weakness with their rehabilitation unsupervised. This could have big implications for the NHS, given that recovery from stroke is strongly influenced by exercise intensity.”
Upper limb impairment is the most common physical side effect of stroke, with 75% of stroke survivors experiencing persistent upper limb weakness. Repetitive task- directed exercise improves long-term upper limb recovery, making this a key component of occupational therapy and physiotherapy following a stroke.
In recent years, a growing number of rehabilitation technologies have emerged that boost the potential to provide cost-effective, intensive upper limb exercise. However, studies of rehabilitation technologies to date have typically focussed on high-functioning cohorts of patients, which limits the applicability of their findings. The researchers wanted to see whether the GripAble device could be used to increase exercise dose of inpatient stroke survivors.
Participants were provided with the GripAble platform and taught to use it in a single training session. The participants were then left to use the platform without any supervision over eight days.
The researchers then compared the number of upper limb repetitions patients did because of the platform with conventional therapy at the hospital. The device enabled 104 upper limb repetitions per day, whereas conventional therapy achieved 15 upper limb repetitions per day.
They also found that on average patients used the device for 26 minutes per day to do their upper limb exercises, in addition to 25 minutes daily conventional upper limb therapy, therefore doubling total exercise duration to 51 minutes, which is significantly greater than standard care.
The team will now conduct a further study to access the impact of GripAble on clinical outcomes.
