Telerehabilitation for Post-Stroke Hand Function

Telerehabilitation for Post-Stroke Hand Function

This pilot randomized controlled trial will evaluate the feasibility and preliminary effects of a home-based, technology-enabled hand telerehabilitation program for adults with chronic stroke. Participants will receive either remotely guided hand training or a standard home exercise program matched for duration and intensity. Outcomes will include measures of hand function, adherence, and feasibility to assess the potential of telerehabilitation for improving access to structured post-stroke hand rehabilitation.

Persistent hand impairment after stroke is common and can substantially limit independence in daily activities. Access to intensive, task-specific hand therapy is often constrained by travel, cost, and availability of rehabilitation services, leading many individuals to rely on unsupervised home exercise programs. Telerehabilitation supported by low-cost technology may improve access to structured hand training while allowing remote supervision, but its feasibility and implementation in the home setting require systematic evaluation. This study aims to evaluate the feasibility and preliminary effects of a hand telerehabilitation program for individuals with chronic stroke. The study will be conducted as a single-center pilot randomized controlled trial comparing two home-based interventions: (i) telerehabilitation and (ii) a standard home-advice exercise program matched for duration and intensity. Participants randomized to the telerehabilitation group will complete supervised home training sessions using technology-assisted activities to target hand function, delivered remotely via video conferencing. Participants in the control group will follow a home exercise plan similar to that used in typical post-stroke therapy. Outcome measures will be collected before and after the intervention and will include standardized assessments of hand function, as well as measures of adherence and feasibility. This study (i) involves adult stroke survivors, (ii) presents minimal risk, (iii) does not involve deception, (iv) does not collect sensitive health information, and (v) includes brief, noninvasive, and nonpainful interactions consistent with standard rehabilitation activities.

Inclusion Criteria:

• Unilateral cortical or subcortical stroke
• Chronic stroke (≥ 6 months since stroke)
• No significant cognitive deficits as determined by the Mini Mental State Examination (MMSE) score (score≥ 22)

Exclusion Criteria:

• Cerebellar stroke
• Unstable heart condition, uncontrolled diabetes or hypertension
• Recent trauma or fracture in the upper extremities
• History of significant orthopedic or neurological conditions that could affect hand function (e.g., multiple sclerosis)
• Recent history of significant spatial neglect
• Joint contractures or significant spasticity in the hand
• History of a recent Botulinum Toxin (Botox) injection to the upper-extremity muscles (≤ 3 months)
• Pregnant or actively planning to become pregnant (self-reported)
• Inability to communicate or unable to consent

Exclusion Criteria for subjects exposed to Transcranial Magnetic Stimulation (TMS):

• Unable to obtain reliable motor evoked potentials
• Recent history of repeated fainting spells or syncope.
• Recent history of seizure while on anti-seizure medication
• Recent history of skull fracture/head injury
• Ferromagnetic metal implants in the skull
• Cochlear implant
• Implanted deep brain stimulator
• Implanted vagus nerve stimulator
• Implanted cervical spine epidural stimulator
• Ventriculoperitoneal shunt
• Skull defect related to the current stroke
• Previous serious adverse reaction to TMS
• Implanted electronic cardiac device (e.g., cardiac pacemaker)