Home Exercise Programs for Adults With Neurological Injuries: A Survey

Self-Reported Home Program Adherence by People With Aphasia: Exploring Construct Validity

PURPOSE

The study purpose was to compare the practice patterns captured by self-reported logbook data and those recorded by a computerized home program application. The current study is part of a larger single-case research design study aimed at investigating the effect of logbook use on home program adherence in people with aphasia poststroke.

METHOD

Data from six adults with chronic aphasia with interest in improving their reading were used in this secondary analysis. Participants completed reading comprehension therapy tasks using a mobile application and tablet. The activities were self-directed and designed for people with aphasia to complete independently. We created an aphasia-friendly logbook based on best practices to allow participants to record their estimated total minutes practiced. Participants received instructions to practice the reading therapy application 80 min a day 7 days a week for the duration of the study. We calculated the difference in the total time per day recorded by each participant to the application data collected.

RESULTS

All participants used the logbook to record their practice. There was a strong relationship between self-reported logbook practice and application-recorded practice for four of the six participants. Individual differences were noted and explored.

CONCLUSION

These results suggest that some people with aphasia can use logbooks with aphasia-friendly modifications to accurately estimate the amount of practice completed outside of therapy sessions.

Occupational Therapy Practitioners' Implementation of Home Programs for Individuals Post Burn: An Initial Cross-Sectional Survey

Occupational therapy practitioners who care for individuals post burn often prescribe home programs to facilitate continued progress toward occupational therapy goals. This study identified the components included in home programs, how practitioners create and prescribe home programs, and perceived supports and barriers to adherence in this population. Thirty-nine practitioners employed at American Burn Association-verified centers completed an online survey. Results suggest that home programs are primarily designed to address range of motion with less emphasis on function. The highest-ranked barriers to adherence were pain and lack of motivation while the highest-ranked supports were client motivation and family/caregiver support. Practitioners reported using handouts and demonstration frequently for delivery, with infrequent use of technology. Recommendations for incorporating evidence-based strategies into home program creation and administration are included.

Automatic Generation of Labeled Data for Video-Based Human Pose Analysis via NLP applied to YouTube Subtitles

With recent advancements in computer vision as well as machine learning (ML), video-based at-home exercise evaluation systems have become a popular topic of current research. However, performance depends heavily on the amount of available training data. Since labeled datasets specific to exercising are rare, we propose a method that makes use of the abundance of fitness videos available online. Specifically, we utilize the advantage that videos often not only show the exercises, but also provide language as an additional source of information. With push-ups as an example, we show that through the analysis of subtitle data using natural language processing (NLP), it is possible to create a labeled (irrelevant, relevant correct, relevant incorrect) dataset containing relevant information for pose analysis. In particular, we show that irrelevant clips (n = 332) have significantly different joint visibility values compared to relevant clips (n = 298). Inspecting cluster centroids also show different poses for the different classes.

Optimized Home Rehabilitation Technology Reduces Upper Extremity Impairment Compared to a Conventional Home Exercise Program: A Randomized, Controlled, Single-Blind Trial in Subacute Stroke

BACKGROUND

Upper extremity (UE) stroke rehabilitation requires patients to perform exercises at home, yet patients show limited benefit from paper-based home exercise programs.

OBJECTIVE

To compare the effectiveness of 2 home exercise programs for reducing UE impairment: a paper-based approach and a sensorized exercise system that incorporates recommended design features for home rehabilitation technology.

METHODS

In this single-blind, randomized controlled trial, 27 participants in the subacute phase of stroke were assigned to the sensorized exercise (n = 14) or conventional therapy group (n = 13), though 2 participants in the conventional therapy group were lost to follow-up. Participants were instructed to perform self-guided movement training at home for at least 3 hours/week for 3 consecutive weeks. The sensorized exercise group used FitMi, a computer game with 2 puck-like sensors that encourages movement intensity and auto-progresses users through 40 exercises. The conventional group used a paper book of exercises. The primary outcome measure was the change in Upper Extremity Fugl-Meyer (UEFM) score from baseline to follow-up. Secondary measures included the Modified Ashworth Scale for spasticity (MAS) and the Visual Analog Pain (VAP) scale.

RESULTS

Participants who used FitMi improved by an average of 8.0 ± 4.6 points on the UEFM scale compared to 3.0 ± 6.1 points for the conventional participants, a significant difference (t-test, P = .029). FitMi participants exhibited no significant changes in UE MAS or VAP scores.

CONCLUSIONS

A sensor-based exercise system incorporating a suite of recommended design features significantly and safely reduced UE impairment compared to a paper-based, home exercise program.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03503617.

Occupational Therapists' Perceptions of Home Program Provision for Stroke Survivors in a Lower- and Middle-Income Country: An Exploratory Study

This qualitative study aimed to understand occupational therapists' experiences of providing home programs to stroke survivors in India. Using an interpretative phenomenological approach, eight practicing occupational therapists were interviewed in depth about home programs for individuals recovering from stroke. Two broad themes with subthemes emerged describing the organizational factors, sociocultural and economic influences on home program provision as well as describing how the occupational therapists addressed the challenges to facilitate home program provision and adherence. The findings can inform occupational therapy practice in lower- and middle-income countries like India and other countries where existing practice recommendations for stroke rehabilitation and core professional tenets may be challenged.

Need to Perform Rehabilitation Exercises at Home by Parents of Children with Neurological Diseases to Maintain Performance During COVID-19 Lockdown

With the outbreak of the novel pandemic coronavirus disease 2019 worldwide, numerous pediatric rehabilitation clinics have closed to support social and physical distancing, and therapists similar to other individuals are staying at their homes. There is a common concern of parents and caregivers that how and with what quality children's rehabilitation exercises should proceed. Most children with neurological diseases have problems, such as muscle spasticity, range of motion (ROM) limitation, muscle shortening, balance loss, and mobility and movement impairments. The normalization of muscle tone, preservation of ROM, muscle stretch, and improvement of fine and gross motor skills and balance are essential activities that need to be considered. Therefore, this study aimed to summarize the necessities of a home-based rehabilitation exercise program during the quarantine period.

Relationships between Occupational Therapy Practitioner Characteristics and Home Exercise Program Prescription for Clients with Neurological Injuries

There are no guidelines for the prescription of home exercise programs (HEPs) for clients with neurological injuries. However, 95% of occupational therapy practitioners prescribe HEPs. Two thousand anonymous surveys were distributed to occupational therapy practitioners. Data from the 352 returned, usable surveys were analyzed to determine trends in HEP prescription across practice settings and provider demographics. Occupational therapy practitioners in community-based settings tended to use more functional activities and the number of years in practice did not influence HEP dosage. These findings suggest a need for clear guidelines for varying practice settings to guide HEP prescription.

A resource analysis of the use of the video function of electronic devices for home exercise instruction in rehabilitation

PURPOSE

To compare resources required to provide paper-based versus videoed instructions for home exercises in rehabilitation.

MATERIALS AND METHODS

An observational cohort study included twenty-two allied health professionals (physiotherapists [n = 13], occupational therapists [n = 6] and speech pathologists [n = 3]), providing exercise instructions for n = 110 patients within a community rehabilitation program of a large metropolitan health service. Home exercise instructions were provided to patients with various health conditions. Patients chose between receiving paper-based home exercise instructions, or using their own smart technology to video their home exercises. The primary outcome measure was cost from a health service perspective, based on health professional time, paper used, and printing.

RESULTS

A total of 128 initial home exercise instructions were provided to 110 patients, with 36 patients reviewed at least once. Each initial exercise instruction provided using electronic devices saved 5.5 min (95% CI 0.5 to 10.5) with a cost saving of Australian dollar $4.70 (95% CI -8.89 to -0.52) compared with paper-based instructions. There were no significant cost differences (MD $1.16 95% CI -3.87 to 6.18) between modes for exercise review.

CONCLUSIONS

Home exercise instructions provided on electronic devices cost less than paper-based instructions when patients are using their own smart devices.Implications for rehabilitationCosts are minimised when home exercise instructions are provided using the video function of the patient's own electronic devices compared with paper-based instructions.Since patient outcomes appear to be similar with instructions provided in electronic or paper-based mode, exercise instructions in community rehabilitation should be provided using the video function of electronic devices where these are available.

Participants' perceptions of an aphasia-friendly occupational therapy home program

BACKGROUND

Upper extremity impairments post-stroke impact participation in valued occupations. Home programs are used to extend the frequency and amount of upper extremity practice for people post-stroke, but novel ways of increasing adherence to these programs is needed to ensure intense repetitive practice.

OBJECTIVES

The purpose of this process evaluation, was to examine the perceptions of people with aphasia as it relates to modifications to home programs that could influence participation, specifically listening to music and aphasia-friendly adaptations of written materials.

METHODS

Seven people with chronic aphasia completed an upper extremity home program that included the use of music and aphasia-friendly modified materials (ClinicalTrials.gov ID:2016/06/18). After the home program, participants completed semi-structured interviews to understand their perceptions of the program and the modifications.

RESULTS

Five themes were identified including (1) music, (2) activities, (3) instructions, (4) logistics, and (5) progress. Most participants perceived music as helpful, but a few reported it being distracting. Participants found the variety of activities helpful as well as specific characteristics of the instructions such as photographs and images. Some participants expressed elements of the home program to be barriers to practice such as using the activity monitors and logbook, which required assistance at times. Finally, participants noted their own progress resulting from the program and liked that they could adjust the intensity of the program as they progressed.

CONCLUSIONS

Overall participants in this study with aphasia perceived the modifications to home programs including aphasia friendly written instructions and music to facilitate successful home practice.

Lee Silverman Voice Treatment BIG® for a Person With Stroke

The extant literature suggests the Lee Silverman Voice Treatment BIG^® (LSVT BIG) program is an effective intervention for persons with Parkinson's disease; however, no literature or research on the use of this program as an intervention for persons with stroke exists. We examined the effects of the LSVT BIG program for a 52-yr-old community-dwelling woman with mild to moderate upper extremity hemiparesis 2 yr after a stroke and the feasibility of delivering the home exercise component of the program in a game-based format. We made measurements at pretest, posttest, and 6-wk follow-up. The participant demonstrated self-reported improvements in occupational performance and satisfaction and large improvements in upper extremity motor function. The next step in this research is to deliver LSVT BIG and a home game-based program with a larger, more diverse population of persons with chronic stroke to further determine the effectiveness and appropriateness of this intervention.