Posts Tagged hand function

[BLOG POST] SaeboFlex Helps Client Regain Hand Function 23 Years After Stroke

SaeboFlexStroke survivor exhibits remarkable improvement in hand function more than two decades after stroke, disproving theories that recovery window is limited to 6 months. 

Charlotte, N.C. – Tuesday, July 25, 2017 – Until recently, researchers believed that if a stroke survivor exhibited no improvement within the first 6 months, then he or she would have little to no chance of regaining motor function in the future. This assumed end of recovery is called a plateau. However, a groundbreaking new article published in the Journal of Neurophysiology discusses a stroke patient’s remarkable improvement decades after suffering a stroke at the age of 15. Doctors Peter Sörös, Robert Teasell, Daniel F. Hanley, and J. David Spence formally dismiss previous theories that stroke recovery occurs within 6 months, reporting that the patient experienced “recovery of hand function that began 23 years after the stroke.”

The patient’s stroke resulted in paralysis on the left side of his body, rendering his left hand completely nonfunctional, despite regular physical therapy. More than twenty years after his stroke, the patient took up swimming when his doctor recommended he lose weight. A year later, he began to show signs of movement on his affected side and returned to physical therapy. Therapists fitted the patient with the SaeboFlex, a mechanical device shown to improve hand function and speed up recoveryand, after only a few months of therapy, he began picking up coins with his previously nonfunctional hand. He also saw notable improvement in hand strength and control with the SaeboGlove, a low-profile hand device recently patented by Saebo.

Functional MRI studies showed the reorganization of sensorimotor neurons in both sides of the patient’s brain more than two decades after his stroke, resulting in a noticeable recovery in both hemispheres and improved motor function. “The marked delayed recovery in our patient and the widespread recruitment of bilateral areas of the brain indicate the potential for much greater stroke recovery than is generally assumed,” the doctors reported. “Physiotherapy and new modalities in development might be indicated long after a stroke.”

“This article highlights what we have seen for the last 15 years with many of our clients,” states Saebo co-founder, Henry Hoffman. “Oftentimes, stroke survivors are told that they have plateaued and no further progress is possible. We believe it is not the client that has plateaued but failed treatment options have plateaued them. In other words, traditional therapy interventions that lack scientific evidence can be ineffective and can actually facilitate the plateau.”

“The SaeboFlex device is a life-changing treatment designed for clients that lack motor recovery and function,” Hoffman continues. “Whether the client recently suffered a stroke or decades later, they can immediately begin using their hand with this device and potentially make significant progress over time. I agree with the authors that the neurorehabilitation community needs to take a hard look at traditional beliefs with respect to the window of recovery following stroke. It is my hope that this article will spark more interest by researchers to investigate upper limb function with clients at the chronic stage using Saebo’s hand technology.”

The abstract and article in its entirety can be viewed at the Journal of Neurophysiology’s website, jn.physiology.org.

If you are suffering from limited hand function or have been told you have plateaued, then schedule a call with a Saebo Specialist or click here to get started on the road to recovery.

via SaeboFlex Helps Client Regain Hand Function 23 Years After Stroke | Saebo

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[Abstract] The effect of kinesiotaping on hand function in stroke patients: A pilot study

Abstract

Upper extremity motor impairment is one of the most prevalent problems following stroke. Considering the functional importance of the upper extremity in the daily life, the purpose of this study was to investigate the effect of kinesiotaping (KT) on hand function and spasticity in individuals following a stroke. Eight individuals who had experienced a stroke, with their age ranging from 47 to 66, participated in this pretest-posttest clinical study. An I- strip of tape was placed on the extensor muscles of the forearm. Primary outcome measures were the Modified Modified Ashwoth Scale, Box and Block test, and Nine Hole Peg test. At the immediate assessment, there were significant differences between two hand function tests scores. Secondary assessment was done after one week and the results showed significant differences between two hand function test scores. There was no significant change in flexor muscles spasticity after the intervention. This pilot study indicated that KT in the direction of the extensor muscles could result in better hand function in stroke patients.

Source: The effect of kinesiotaping on hand function in stroke patients: A pilot study – Journal of Bodywork and Movement Therapies

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[Abstract] Design and Test of a Closed-Loop FES System for Supporting Function of the Hemiparetic Hand Based on Automatic Detection Using the Microsoft Kinect Sensor

Abstract
This paper describes the design of a FES system automatically controlled in a closed loop using a Microsoft Kinect sensor, for assisting both cylindrical grasping and hand opening. The feasibility of the system was evaluated in real-time in stroke patients with hand function deficits. A hand function exercise was designed in which the subjects performed an arm and hand exercise in sitting position. The subject had to grasp one of two differently sized cylindrical objects and move it forward or backwards in the sagittal plane. This exercise was performed with each cylinder with and without FES support. Results showed that the stroke patients were able to perform up to 29% more successful grasps when they were assisted by FES. Moreover, the hand grasp-and-hold and hold-and-release durations were shorter for the smaller of the two cylinders. FES was appropriately timed in more than 95% of all trials indicating successful closed loop FES control. Future studies should incorporate options for assisting forward reaching in order to target a larger group of stroke patients.

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[Abstract] Applying a soft-robotic glove as assistive device and training tool with games to support hand function after stroke: Preliminary results on feasibility and potential clinical impact

Published in: Rehabilitation Robotics (ICORR), 2017 International Conference on

Abstract:

Recent technological developments regarding wearable soft-robotic devices extend beyond the current application of rehabilitation robotics and enable unobtrusive support of the arms and hands during daily activities. In this light, the HandinMind (HiM) system was developed, comprising a soft-robotic, grip supporting glove with an added computer gaming environment. The present study aims to gain first insight into the feasibility of clinical application of the HiM system and its potential impact. In order to do so, both the direct influence of the HiM system on hand function as assistive device and its therapeutic potential, of either assistive or therapeutic use, were explored. A pilot randomized clinical trial was combined with a cross-sectional measurement (comparing performance with and without glove) at baseline in 5 chronic stroke patients, to investigate both the direct assistive and potential therapeutic effects of the HiM system. Extended use of the soft-robotic glove as assistive device at home or with dedicated gaming exercises in a clinical setting was applicable and feasible. A positive assistive effect of the soft-robotic glove was proposed for pinch strength and functional task performance ‘lifting full cans’ in most of the five participants. A potential therapeutic impact was suggested with predominantly improved hand strength in both participants with assistive use, and faster functional task performance in both participants with therapeutic application.

Source: Applying a soft-robotic glove as assistive device and training tool with games to support hand function after stroke: Preliminary results on feasibility and potential clinical impact – IEEE Xplore Document

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[ARTICLE] Role of Practice And Mental Imagery on Hand Function Improvement in Stroke Survivors – Full Text

Abstract

Objective: The purpose of this study was to evaluate the Role of Practice and Mental Imagery on Hand function improvement in stroke survivors

Method: We conducted systematic review of the previous studies and searched electronic databases for the years 1995 to 2016, studies were selected according to inclusion criteria, and critical appraisal was done for each study and summarized the use of mental practice for the improvement in hand function in stroke survivors.

Results: Studies differed in the various aspects like intervention protocols, outcome measures, design, and patient’s characteristics. The total number of practice hours to see the potential benefits from mental practice varied widely. Results suggest that mental practice has potential to improve the upper extremity function in stroke survivors.

Conclusion: Although the benefits of mental practice to improve upper extremity function looks promising, general guidelines for the clinical use of mental practice is difficult to make. Future research should explore the dosage, factors affecting the use of Mental Practice, effects of Mental Therapy alone without in combination with other interventions.

Introduction

Up to 85% stroke survivors experience hemi paresis resulting in impaired movement of the arm, and hand as reported by Nakayama et al. Loss of arm function adversely affects quality of life and functional motor recovery in affected upper extremity.

Sensorimotor deficits in the upper limb, such as weakness, decreased speed of movement, decreased angular excursion and impaired temporal coordination of the joints impaired upper-limb and trunk coordination.

Treatment interventions such as materials-based occupations constraint-induced movement therapy modified constraint-induced movement therapy and task-related or task-specific training are common training methods for remediating impairments and restoring function in the upper limb.

For the improvement of upper and lower functions, physical therapy provides training for functional improvement and fine motor. For most patients such rehabilitation training has many constraints of time, place and expense, accordingly in recent studies, clinical methods such as mental practice for improvement of the upper and lower functions have been suggested.

Mental practice is a training method during which a person cognitively rehearses a physical skill using motor imagery in the absence of overt, physical movements for the purpose of enhancing motor skill performance. For example, a review of the duration of mental movements found temporal equivalence for reaching; grasping; writing; and cyclical activities, such as walking and running.

Evidence for the idea that motor imagery training could enhance the recovery of hand function comes from several lines of research: the sports literature; neurophysiologic evidence; health psychology research; as well as preliminary findings using motor imagery techniques in stroke patients.

Much interest has been raised by the potential of Motor Practice of Motor task, also called “Motor Imagery” as a neuro rehabilitation technique to enhance Motor Recovery following Stroke.

Mental Practice is a training method during which a person cognitively rehearsals a physical skill using Motor Imagery in the absence of Physical movements for the purpose of enhancing Motor skill performance.

The merits of this intervention are that the patient concentration and motivation can be enhanced without regard to time and place and the training is possible without expensive equipment.

Researchers have speculated about its utility in neurorehabilitation. In fact, several review articles examining the impact of mental practice have been published. Two reviews examined stroke outcomes in general and did not limit their review to upper-extremity–focused outcomes. Both articles included studies that were published in 2005 or earlier.

Previous reviews, however, did not attempt to rate the studies reviewed in terms of the level of evidence. Thus, in this review, we determined whether mental practice is an effective intervention strategy to remediate impairments and improve upper-limb function after stroke by examining and rating the current evidence. […]

Continue –>  Role of Practice And Mental Imagery on Hand Function Improvement in Stroke Survivors | Insight Medical Publishing

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[Abstract] The suitcase packing activity: A new evaluation of hand function

 

Abstract

Study Design

Prospective, repeated-measures study.

Introduction

Understanding individual hand function can assist therapists with the process of determining relevant treatment approaches and realistic therapeutic outcomes. At this point in time, a composite test that assesses both unilateral and bimanual hand function in relation to a functional activity is not available.

Purpose of the Study

To establish the reliability and validity of the suitcase packing activity (SPA).

Methods

An expert panel established face and content validity. Eighty healthy, English-speaking volunteers aged between 18 and 45 years were randomly assigned to either 1 or 2 sessions (test-retest reliability). Relative agreement between 2 examiners using an intraclass correlation coefficient (ICC)3,1 determined interrater reliability. Test-retest reliability was determined by using a repeated-measures analysis of variance and an ICC3,2. Concurrent validity was evaluated against 2 well-established hand evaluations using separate tests of correlational coefficients.

Results

Face and content validity were established across 4 focus groups. Our results demonstrate good to excellent interrater reliability (ICC3,1 ≥ 0.93) and good to excellent test-retest reliability (ICC3,2 ≥ 0.83). SPA scores were moderately correlated with the 2-hand evaluations.

Discussion

Through evaluating hand function during participation in a goal-directed activity (eg, packing a suitcase), the SPA exhibits promise in usefulness as a future viable outcome measure that can be used to assess functional abilities following a hand injury.

Conclusion

The SPA is a valid and reliable tool for assessing bimanual and unilateral hand function in healthy subjects.

Source: The suitcase packing activity: A new evaluation of hand function – Journal of Hand Therapy

 

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[ARTICLE] Design and test of an automated version of the modified Jebsen test of hand function using Microsoft Kinect – Full Text

Abstract

Background

The present paper describes the design and evaluation of an automated version of the Modified Jebsen Test of Hand Function (MJT) based on the Microsoft Kinect sensor.

Methods

The MJT was administered twice to 11 chronic stroke subjects with varying degrees of hand function deficits. The test times of the MJT were evaluated manually by a therapist using a stopwatch, and automatically using the Microsoft Kinect sensor. The ground truth times were assessed based on inspection of the video-recordings. The agreement between the methods was evaluated along with the test-retest performance.

Results

The results from Bland-Altman analysis showed better agreement between the ground truth times and the automatic MJT time evaluations compared to the agreement between the ground truth times and the times estimated by the therapist. The results from the test-retest performance showed that the subjects significantly improved their performance in several subtests of the MJT, indicating a practice effect.

Conclusions

The results from the test showed that the Kinect can be used for automating the MJT.

Background

Deficits in motor function, in the form of hemiparesis or hemiplegia, are a frequent consequence of cerebral stroke [1]. Even though motor function may be regained to some extent through intensive rehabilitative training following acute treatment of stroke, deficits in hand function often remain [23]. Following discharge from the rehabilitation unit, patients are typically asked to perform unsupervised self-training in their own home. The lack of supervision during training at home will likely have an impact on the patient’s training compliance and training quality. Therefore, it is important to perform regular evaluations of the patient’s functional level in order to provide useful supervision and to maintain patient motivation. The patients’ performance in a specific motor function test provides valuable insight into whether the training scheme chosen for a patient is effective or it should be changed. Thus, it is very important that the motor function tests being used are objective and reflect the actual functional level of the patient being tested. Several validated motor function tests including assessment of hand function exist, e.g. Jebsen Test of Hand Function [4], Action Research Arm Test [5], Fugl-Meyer Assessment [6], Wolf Motor Function Test (WMFT) [7], Box and Blocks Test [8] and Nine Hole Peg Test [9]. Common for all these tests is that they must be administered by a therapist, which might be a source for variability in the test results, and cause the test results not always to be completely reproducible and objective. In tests including performance time as an outcome measure, e.g. the WMFT, the reaction time of the subject could introduce a bias to the results, as suggested by previous studies [1011]. Likewise, the end time of the test would likely be subjected to a bias, since the examiner has a finite reaction time. Thus, both the reaction time of the examiner and the subject could be potential sources of bias and variability in timed motor function tests. The sensitivity of a motor function test is affected by sources of bias and variability and therefore it is of interest to minimize these, to make detection of even small changes possible.

By automating motor function tests, the objectivity of the tests would be increased. This might also make possible to use the tests at remote sites, without direct supervision, as a part of a tele-rehabilitation service. Finally, automated tests could be administered more frequently. Previous studies have shown that selected parts of the WMFT can be automated by use of motion sensors mounted on the body of healthy subjects [10] and stroke patients [11]. Both systems automated the test by analyzing three-dimensional kinematics data from body-worn sensors (inertial measurement units) mounted on the most affected wrist, arm and shoulder of stroke patients [1011]. Similarly, using inertial measurement unit sensors, Yang et al. (2013) showed that when administering the 10 m walking test, the output from their system was in close agreement with the walking speeds estimated using a stop-watch [12]. These systems require though correct positioning and mounting of the motion sensors [10]. Huang et al. (2012) showed that also a computer vision based approach, consisting of a monitor camera and a Xilinx Virtex II Pro Field Programmable Gate Array (for computation), may be used for automating the WMFT. All participants being tested had to wear a black sweatband on the wrist of the extremity being tested [13]. Another low-price method for capturing the movements of a patient performing a motor function test is the Microsoft Kinect sensor (Kinect). By using a Kinect, the need for body mounted sensors is eliminated, thus lowering the susceptibility to data loss and easing donning and doffing of the system. Furthermore, the Microsoft Kinect sensor is a low-cost commercially available device. In this paper, we describe the design and test of a Kinect based system for automatic evaluation of a standardized, validated motor function test, administered to stroke patients with hand function deficits. The Modified Jebsen Test of Hand Function (MJT) [14], initially proposed by Bovend’Eerdt et al. (2004) as a test for assessment of gross functional dexterity in stroke patients, was selected for automation as this test is easy to administer and takes short time to complete.

Continue —> Design and test of an automated version of the modified Jebsen test of hand function using Microsoft Kinect | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 3 The edge of the table was detected in the binary image (lower) produced by thresholding the depth image (upper) into two parts, one part containing all pixels with a depth value lower than a depth level of 300 mm below the surface of the table and the other part containing pixels with depth values above this threshold

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[Abstract] Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke  

Abstract

Background and objective: Spasticity is one of the problems following stroke. Due to this increase in muscle tone, patients are confronted to problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of Simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period.

Methods: The design of this study was a comparison between 3 groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about 3 months and the evaluations were done monthly. Goniometry was the method to measure range of motion, and Modified Ashworth scale was used to examine the spasticity and the upper extremity function was scored based on Fugl-Meyer assessment.   Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times.  Significance was set at 0.05.

Results: All outcome measures improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p> 0 / 05). The results also showed that the changes in elbow`s spasticity {p= 0.05} and wrist`s spasticity {p= 0.007} and upper extremity function { p = 0.04} were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin and splint was more than other groups.

Conclusion: In this study, the effects of botulinum toxin injection and Volar-Dorsal Wrist/Hand Immobilization splint and the combined use of botulinum injection and splint were obvious in all groups but was not significantly different between the interventions in a 3-month follow-up.

Source: Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke | Shamili | Advances in Bioscience and Clinical Medicine

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[Abstract] Design and Test of a Closed-Loop FES System for Supporting Function of the Hemiparetic Hand Based on Automatic Detection using the Microsoft Kinect sensor

Abstract:

This paper describes the design of a FES system automatically controlled in a closed loop using a Microsoft Kinect sensor, for assisting both cylindrical grasping and hand opening. The feasibility of the system was evaluated in real-time in stroke patients with hand function deficits. A hand function exercise was designed in which the subjects performed an arm and hand exercise in sitting position. The subject had to grasp one of two differently sized cylindrical objects and move it forward or backwards in the sagittal plane. This exercise was performed with each cylinder with and without FES support. Results showed that the stroke patients were able to perform up to 29% more successful grasps when they were assisted by FES. Moreover, the hand grasp-and-hold and hold-and-release durations were shorter for the smaller of the two cylinders. FES was appropriately timed in more than 95% of all trials indicating successful closed loop FES control. Future studies should incorporate options for assisting forward reaching in order to target a larger group of stroke patients.

Source: Design and Test of a Closed-Loop FES System for Supporting Function of the Hemiparetic Hand Based on Automatic Detection using the Microsoft Kinect sensor – IEEE Xplore Document

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[WEB SITE] Overcome loss of Hand Function and Foot Drop. – Bioness FES – Inquiries

Regain Independence, Function, and Mobility.


Regain function with Bioness’ innovative solutions designed to help those living with Foot Drop or Hand Paralysis due to conditions such as Stroke, Multiple Sclerosis, Cerebral Palsy, Traumatic Brain Injury, or Incomplete Spinal Cord Injury.
Visit Site —> Bioness FES | Inquiries

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