Implementation Study on Hospital-to-home Advanced Rehabilitation Technologies (ART)

Prior treatment

• tDCS: Presence of cranial surgery, cochlear implant, ventriculoperitoneal (VP) shunt

Other illness

• Uncontrolled medical conditions (e.g., Unstable angina, untreated hypertension, sepsis/fever)
• Presence of seizures within 6 months of screening or a history of epilepsy or anti-epileptic medications
• End stage organ failure (e.g. renal failure, cardiac failure) on organ replacement therapy
• Psychiatric conditions precluding safe use of ART
• Pressure sores (decubitus ulcers) or wounds /poor skin conditions at point of contact with ART
• Presence of known contact allergies to ART interfaces

Other

• (I) General Exclusion Criteria
• Sitting or orthostatic intolerance \<30 minutes (unless device can be performed supine)
• Anticipated life expectancy \< 6 months.
• Severe spasticity (spasticity Modified Ashworth Scale (MAS \>2)
• Presence of contractures, joint or limb limitations of range of movement to preclude safe and effective application of robotics/ FES (joint replacements allowed)
• Significant pain (Visual Analogue Scale VAS\>5/10) deemed to potentially worsen with ART
• Unhealed /active fractures
• Presence of lower motor neuron causes of weakness / myopathies /myositis
• Pregnancy or Lactation status
  • (II) ART-Specific Exclusion Criteria
• TrainFES (upper or lower limb): Presence of pacemaker, defibrillator or other implanted metallic or electronic device.

• (I) General Inclusion Criteria
• Aged 16 years to 90 years. For participants age 16-20, an assent form will be used and the legally authorized representative (LAR) will be consented
• \>3 weeks from incident event
• Diagnosis of as stroke, brain injury or SCI confirmed by neuroimaging and admitting specialists
• Assessed by treating clinician to be able to understand and comply to programme requirements (e.g. safe use of ART and purpose)
• Availability of suitable carer to ensure safety of participants during home ART training and follow up, if needed
• Suitable and stable home environment to allow for use of ART (minimum of 1.5m x1.5m space if robots or VR exergames used)\*
• Being able to follow instruction and give consent.
  • Home environment assessment by therapist may be needed to ensure appropriate training environment
  • (II) ART-Specific Inclusion Criteria (using Oxford Medical Research Counicl MRC scale 0-5/5)
• HMAN(arm): MRC grade ≥ 2/5 shoulder/elbow
• ReHandyBot (hand): MRC grade ≥ 1/5 finger flexion or extension
• Esoglove (hand): MRC grade ≥ 1/5 finger flexion or extension
• EzyGain: either UE/LE MRC grade ≥3/5 (antigravity)
• TrainFES (upper or lower limb): MRC grade \<4, targeted impairments are not due to lower motor neuron lesions
• ezyGain (VR): UL and LL MRC grade≥3/5 MRC grade (subject to clinician evaluation)
• Transcranial direct current stimulation (tDCS): Sum of Medical Research Council grades for shoulder abduction and finger Extension (SAFE) ≤ 8, prescribed with functional training tasks during tDCS