Using Tablets for Upper Extremity Rehabilitation Post Acquired Brain Injury

Study Overview
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Brief Summary
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The purpose of the study is to test the effectiveness of training using novel tablet applications for hand function, compared to traditional hand exercises. In addition, we aim to examine brain plasticity following treatment with the new tablet applications. We hypothesize that training with a tablet would prove to be more effective than traditional exercises. We expect to observe neuroplastic changes in the brain in patients who practiced finger movements using the tablet.

Official Title
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Using Tablets for Upper Extremity Rehabilitation Post Acquired Brain Injury

Conditions
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Brain Injury, Stroke

Intervention / Treatment
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* Device: Tablet - self exercise
* Other: GRASP self exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least one week post Brain injury or stroke Partial ability to open and close their hand (fingers) Full function of the hands prior to the injury or event Intact or Corrected vision Cognitively intact or mild impairment Exclusion Criteria: Other neurological conditions besides the brain injury or stroke Orthopedic conditions of the upper extremity

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tablet - self exercise<br>Existing tablet Apps that encourage finger movement in a fun manner while playing a game will be used. The apps will be taught to the participants and then they will be requested to exercise alone (or with family) everyday for one hour in addition to their regular rehabilitation sessions (Occupational, Physical Therapy, speech). The intervention will include 15-20 sessions of 60 minutes of self-training using a tablet. | Device: Tablet - self exercise<br> <br> |
| Active Comparator: GRASP self exercise<br>GRASP (Graded Repetitive Arm Supplementary Program)(Harris et al., 2009)is an arm and hand exercise program developed for individuals with stroke with upper extremity impairments GRASP provides a method for patients to undertake a self-directed arm and hand exercise program. The exercises will be taught to the participants and then they will be requested to exercise alone (or with family) everyday for one hour in addition to their regular rehabilitation sessions (Occupational, Physical Therapy, speech). The intervention will include 15-20 sessions of 60 minutes of self-training | Other: GRASP self exercise<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in score of the Nine Hole Peg Test | To assess dexterity of the affected hand. This test is a assesses dexterity and the time to remove and return nine pegs is measured. The Nine Hole Peg Test is a reliable, valid and responsive measure in clients with stroke | An average of one week before intervention and one week after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Fugl-Meyer Motor Assessment | To quantify the level of the motor impairment. The participants are required to perform different movements. Each movement is rated 0 (inability to perform) to 2 (full movement). The total score ranges from 0 (no active movements) to 60 points (full movements). | An average of one week before intervention and one week after intervention | 
| Grip and pinch strength | Assessed by the Jamar dynamometer. This is a valid and reliable way to assess grip and pinch strength of individuals recovering from stroke. | An average of one week before intervention and one week after intervention | 
| Visual Analogue Scale | Quantifies the perceived level of pain intensity on a scale of 0-10 cm. | An average of one week before intervention and one week after intervention | 
| The System Usability Scale | This questionnaire includes 10 items which provide a global view of subjective assessment of a system's usability. | An average of one week after intervention | 
| Change from baseline in score of the Action Research Arm Test | Assesses the functional ability of the upper extremity by grasping and moving objects of different size and weight. It has four subtests; grasp, grip, pinch and gross movement. The total score is out of 57 points. | An average of one week before intervention and one week after intervention | 
| Self - report compliance | Mean self-training time per day. | An average of one week after intervention | 
| Satisfaction Questionnaire | Developed for the study and will query how much the subjects were satisfied with the self-training intervention they experienced and to what extent they think it can help them to improve their upper extremity function. Responses will be rated on a scale of 1-5. | An average of one week after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Stroke, Brain-injury, Tablet, Hand