Background: HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke).

Methods: Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2), six weeks post-intervention (T3) and six months post-intervention (T4). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), quality of life (EQ-5D). User satisfaction was measured using the System Usability Scale (SUS) and Dutch- Quebec User Evaluation of Satisfaction with assistive Technology (D-Quest), and motivation was assessed using the Intrinsic motivation inventory (IMI).

Results: Twelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements. Follow-up revealed significant improvement in FMA-UE scores six months after the intervention compared to baseline values. An overall decreasing trend was also visible in the arm/hand function.

Conclusion: Patients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/7535 .

Keywords: Hand; Home training; Rehabilitation; Stroke; Task specific; Telerehabilitation; Training device; Upper limb.

SPSS, 23

Atlas.TI, 9