Supporting Home-Based Stroke Care with Hybrid Self-Directed and Supervised Tele-Rehabilitation

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Over 100,000 people are affected by stroke in the UK annually, resulting in long-term disability /and dependency. The Covid-19 pandemic is expected to compound this healthcare challenge even further, placing significant additional strain on healthcare resource both during the crisis and in the period that follows as social-isolation restrictions are relaxed. Many new stroke cases are now reluctant to access emergency-care because of fear of infection, resulting in worse stroke outcomes. Conversely, hospitalized stroke patients are currently facing reduced length-of-stay, with rehabilitation curtailed, due to the need to prioritise beds and therapists for critically-ill patients; and to prevent stroke inpatients catching infection given their high risk of complications. As a result, standard in-patient rehabilitation: the current standard of care, is both more difficult to resource and more dangerous to deliver.GripAble comprises of a portable handheld device and interactive software enabling self-directed arm therapy in disabled people. Since arm disability is the commonest impediment caused by stroke (affecting ~70%); and arm- exercises account for ~50% of in-patient physiotherapy sessions, GripAble can provide a cost-effective, home-based therapy substitute in place of a significant fraction of in-hospital therapy time.A broader package of rehabilitation care is now required, to cover multiple physical and psychological needs of stroke patients, which can facilitate early supported discharge. This can be achieved by combining self-directed therapy offered by GripAble, with remote supervised therapy, (via video-streaming). This 'hybrid telerehabilitation' will offer significantly greater opportunities for home-therapy than conventional telerehabilitation (i.e. video alone).With Innovate UK support, a 6-month programme of work will be delivered to develop, and trial, a holistic, home-therapy package that combines GripAble (allowing independent arm exercises); with an approved video-consultation software (allowing specialists to supervise patients where necessary). This combination package will allow a wide range of disabled stroke patients to be discharged from hospital earlier than is currently achieved; and be more effective than video-consultations alone, that lacks features such as interactive-exercise games, or personalised feedback.