Art-Based Rehabilitation Training (ART) for Upper Limb Sensorimotor Recovery Post Stroke: A 2-Phase Pilot Study
Upper limb , Art , Stroke , rehabilitation , Pilot study , Kinarm , Feasibility study , Intervention
High repetitions of task-oriented practice are essential to drive functional recovery of the upper limb (UL) after stroke. Unfortunately, therapy time focused on the upper limb is limited and movement repetitions are low in standard care stroke rehabilitation. Art-based Rehabilitation Training (ART) is a motor training program designed to augment UL functional recovery by engaging stroke survivors in intense, progressive, structured art-based activities delivered outside of conventional therapy sessions. The objectives of this study were to assess the feasibility of delivering ART in an inpatient setting, collecting clinical and robotic-based measures of sensorimotor function, and quantifying UL use during ART sessions. This study was conducted in two phases: Phase Ⅰ and Phase Ⅱ. A convenience sample of patients admitted to a stroke rehabilitation unit with UL motor impairment (n=38) were enrolled in the ART program. The program included 9 sessions of supervised tracing and free-hand drawing tasks completed with both hands, intended to be delivered over a 3-week duration. Feasibility outcomes included ART program adherence, acceptability, safety, and outcome assessment completion. Sensorimotor function was assessed using the Kinarm robot and clinical measures recorded at baseline (pre-ART) and 3-4 weeks follow up (post-ART). Activity intensity was quantified as session time and UL movement time measured by forearm-mounted accelerometers in Phase Ⅱ. A total of 32 (84%) participants completed the ART program within the intended time frame, and 30 were included in the study analysis from Phase Ⅰ and Ⅱ. Task completion rates ranged from 57-100%. Acceptability was high and few adverse events occurred during the intervention. Kinarm and clinical measures were feasible to collect at baseline and follow up with low rates of attrition. ART session duration, recorded from a subset of 13 Phase Ⅱ participants (77 sessions), yielded a median [IQR] session time of 44 [35-53.5] minutes. In-session UL movement time recorded from 6 participants ranged from 15.2-48.1 minutes. The ART program was feasible to implement, acceptable to patients, and resulted in augmented UL activity in patients undergoing stroke rehabilitation. Further research is warranted to explore the impact of this program on sensorimotor function and UL use.