Posts Tagged hand function
[Abstract] Occupational therapists’ evaluation of the perceived usability and utility of wearable soft robotic exoskeleton gloves for hand function rehabilitation following a stroke
To evaluate the perceived usability and utility of using a soft robotic glove to rehabilitate hand function following a stroke.
A convergent parallel mixed-methods design was used to consult a convenience sample of 14 experienced occupational therapists (OTs) practicing within a specialised stroke rehabilitation program. All OTs participated in one 60-to-90-minute individual consultation during which the attributes of a recently-developed soft robotic glove (ExoGlove) were presented before they could test it on themselves. After this consultation, OTs completed the System Usability Scale (SUS) questionnaire and answered open-ended questions focussing on the usability and utility of soft robotic gloves framed according to the Unified Theory of Acceptance and Use of Technology (UTAUT).
The OTs perceived the glove’s usability as being moderate-to-good on the SUS (median score= 63.75 on a scale of 100). Thematic analysis revealed the importance of specifically considering elements such as ease of use (e.g. simplicity and speed), cost, movement precision, durability, and safety, when developing soft robotic gloves such as the ExoGlove.
Engagement in a continuous improvement process is essential to maximise the perceived usability and utility of soft robotic gloves, particularly of the ExoGlove, through their final development phase before pilot testing their effects and effectiveness for post-stroke hand rehabilitation.
- Implications for rehabilitation
- All occupational therapists anticipate that a soft robotic glove such as the ExoGlove will allow them to increase treatment intensity and best aligns with principles of neuroplasticity.
- The clinical judgement and guidance of OTs, developed through practice, experience, and knowledge, remain essential to safely and efficiently exercise with a soft robotic glove.
- Achieving a balance between effort and performance expectancies is essential in developing and improving the functionality of soft robotic gloves, as with each additional functionality comes new challenges that impact its successful transition to a clinical setting.
[Abstract] The Effectiveness of Music Therapy on Hand Function in Patients With Stroke: A Systematic Review of Randomized Controlled Trials
Objective: This study aims to evaluate the efficacy of music-supported therapy for stroke patients’ hand function.
Methods: The databases used included Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Embase, Music Index, and Google Scholar. Studies published between January 2010 and August 2020 were included. The searching key terms included “music-supported therapy,” “music therapy,” “hand function,” “hand dysfunction,” “stroke,” “ischemic,” and “hemorrhagic.” Randomized controlled trials or controlled trials involving adults who have hand function problems caused by stroke are included in this study. The methodological quality and risk of bias of the included studies were rated by two independent assessors under the guidance of Cochrane collaboration’s risk of bias tool.
Results: Twelve studies that met the inclusion criteria were included in this study. Totally, the data included 598 stroke patients (345 male, 253 female) with recruited time from 1.7 months to 3 years, and the mean age of the participants were 61.09 years old. Based on the Cochrane risk of bias tool, study quality ranged from three to seven out of seven points. Compared with the control group, outcomes including hand strength, range of joint motion, dexterity of hands, arm function, and quality of life were significantly superior with music-supported therapy. Five studies reported improved dexterity of hands, and one study reported the improvement of range of motion and strength of patients’ hands, which supported the therapy has positive effects on patients’ hand function and improving their quality of life after the therapy. The therapy ranged over a period of 4-8 weeks, with an average duration of 30 min/session and an average of three times per week.
Conclusion: Based on the results, music-supported therapy could be a useful treatment for improving hand function and activities of daily living in patients with stroke, especially for patients within 6 months after stroke. However, the low certainty of evidence downgrades our confidence to practice in hospital. More and more randomized controlled trials and larger sample sizes are required for a deeper review.
[POSTER Abstract] Rehabilitation With Brain Computer Interface to Improve Hand Function After Stroke
Background: Stroke is the third cause of disability and the first cause of motor impairment of the upper limb, which significantly reduces independence in activities of daily living. Therefore, the development and use of new therapeutic approaches is needed. Brain-computer interfaces (BCI) based on movement intention (MI) have the potential to improve hand function and brain plasticity after stroke.
Purpose: Improve hand function after stroke with BCI with MI.
Methods: 8 patients with subacute stroke, left or right hemiparesis was divided in two groups. The first received conventional therapy followed by BCI-MI therapy and the second was given BCI-MI therapy and then conventional therapy. The outcome variables were sensory-motor recovery, hand function, spasticity, level of disability, grip strength, change in motor threshold and amplitude of motor evoked potentials (MEP) and changes in desynchronization/synchronization event-related (EDR/EDS).
Results: 4 patients were female, the average age 56 ± 12.7 years, and 87% were ischemic stroke. No differences were found between post-conventional therapy and postBCI-MI in the sensorimotor recovery, the spasticity, and the degree of deficiency in the strength. Only in hand function measured with the Action Research Arm Test (ARAT), a statistically significant difference was found in the BCI-MI therapy group (p= 0.0247). Dynamometry grip strength had a tendency to increase the Post-BCI group. A MEP was obtained in the ipsilesional primary motor cortex of 3 patients. A higher EDR was found in the injured hemisphere in favor of the post-BCI group (p= 0.0165).
Conclusions: This study shows that BCI-MI rehabilitation, which combines MI with a robotic hand orthosis as feedback, has a significant improvement in hand function and a greater ERD in the ipsilesional primary motor cortex. It is necessary to carry out controlled clinical trials with a larger sample and with a greater frequency and duration of intervention to measure hand motor and functional improvement of patients after stroke.
[Abstract] Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study
Importance: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown.
Objective: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke.
Design: Randomized, crossover-controlled, assessor-blinded study.
Setting: Rehabilitation clinic.
Participants: Patients (N = 24) with moderate motor and sensory deficits.
Intervention: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period.
Outcomes and Measures: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment–Upper Extremity (FMA–UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes–Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability.
Results: RT resulted in significantly improved FMA–UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants’ EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050).
Conclusions and Relevance: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke.
What This Article Adds: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.
[Abstract] Effects of a Soft Robotic Glove using a High Repetition Protocol in Chronic Stroke: A Pilot Study – Conference Publication
Hand function rehabilitation is one of the most important aspects to improve the quality of life and independence for stroke survivors. Access to therapy is a key factor in one’s ability to perform rehabilitation exercises and recover motor function. The aim of this research is to show the viability of using a soft robotic glove to perform home-based rehabilitation of the hand function of stroke survivors. Soft wearable robotic devices are a promising approach to hand rehabilitation due to their lightweight, compliant, and low-cost design. The goal of this wearable technology is to reduce hyperexcitability of the flexor muscles through cyclic stretching of the fingers, active-assisted exercise, and task-oriented training. In this pilot study, four chronic stroke survivors were provided 300 repetitions of opening and closing their hand with the soft robotic glove over 6 training sessions. This high-intensity, high-repetition protocol was found to be safe and well-tolerated by all subjects. Results demonstrated average increases of 18.5° and 17.3° in the relaxed metacarpophalangeal and proximal interphalangeal joint angles, respectively, of the index finger and an average increase of 33 Newtons in grip strength. This work motivates further development of this home-based soft robotic rehabilitation device and lays the groundwork for a longer term study.
[Abstract] Stretching and Splinting Interventions for Poststroke Spasticity, Hand Function, and Functional Tasks: A Systematic Review
Importance: Spasticity is one of the most common and disabling motor impairments after stroke.
Objective: To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity.
Data Sources: Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017.
Study Selection and Data Collection: Following PRISMA guidelines, we included articles describing Level I–III studies with participants who were adults with upper extremity spasticity and received a stretching intervention.
Findings: Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria.
Conclusion and Relevance: For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices.
What This Article Adds: This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.
[ARTICLE] Effect of mirror therapy on hand functions in Egyptian chronic stroke patients – Full Text
Most stroke survivors (more than 60%) suffer from persistent neurological impairments that significantly affect activities of daily living. Hand functions are essential for doing daily living and working activities. Mirror therapy is shown to be effective in improving hand functional recovery in stroke patients.
This study aimed to determine the effect of mirror therapy on improving hand functions in Egyptian chronic stroke patients.
Subjects and methods
Thirty chronic ischemic stroke patients from both sexes participated in the study. Their ages ranged from 45 to 65 years. They were randomly assigned into two equal groups: the study group that received a selected physical therapy program in addition to the mirror therapy and the control group that received the same selected physical therapy program but without a mirror therapy. Treatment sessions were conducted three times per week for 8 weeks. Range of motion (ROM) of the wrist extension and forearm supination, hand grip strength, and the time of Jebson Hand Function Test (JHFT) were measured before and after the treatment program.
There were statistically significant increases in the range of motion of the wrist extension and forearm supination and hand grip strength with a decrease in the time of Jebson Hand Function Test in both groups post-treatment. Post-treatment improvement was more significant in the study group compared to the control group.
Mirror therapy had a positive effect on improving hand motor functional skills in a sample of Egyptian chronic stroke patients.
Upper limb paresis is one of the most common and disabling consequences of stroke that significantly limits activity. It has been stated that 85% of stroke patients complain of hemiparesis and that 55 to 75% of them continue to have deficits in the upper extremity activities . Approximately 30–66% of stroke patients never recover hand motor functional skills, which seriously impacts their performance of the activities of daily life .
Numerous rehabilitation techniques for stroke patients have been used to improve hand motor functional skills. These techniques include exercise training for the arm paresis , impairment-oriented training of the arm or Bobath therapy for severe arm paresis after stroke, functional electrical stimulation , robot-assisted rehabilitation , and bilateral arm training  constraint-induced movement therapy [7, 8]. However, most of those rehabilitation techniques for the upper extremity paresis are intensive, involve high equipment costs, and require therapist’s manual interaction for a long time, which makes the administration of those treatments difficult for all patients .
Mirror therapy (MT) is a cheap, easy, and, most importantly, patient-directed treatment that may improve the recovery of hand motor functional skills [10,11,12,13]. MT consists of repeated bilateral, symmetrical movements in which the patient moves the affected body part as much as he/she could while observing the reflection of the same unaffected body part in a mirror placed in between those body parts while obscuring the affected part . Researches of neural activities stated that MT might stimulate the areas within the somatosensory and premotor cortex and/or the mirror neuron system in the fronto-temporal region and superior temporal gyrus. This cortical stimulation might produce motor output in patients with stroke [15, 16].
This study was designed to assess the efficacy of mirror therapy on improving hand motor functions in a sample of Egyptian chronic stroke patients.[…]
Repetitive transcranial magnetic stimulation (rTMS), combined with hand therapy, is currently a research-based treatment. It is intended to help people with stroke achieve greater recovery of hand function. The hand weakness following a stroke stems from brain neurons destroyed by the stroke, as well as from surviving neurons. The surviving neurons become dormant (not active) through inactivity and suppression from the non-stroke hemisphere. In some patients, rTMS can help dormant neurons reactivate and thereby improve voluntary hand function.
More information: https://www.mhealth.org/care/treatmen…
[Abstract] Compensating Hand Function in Chronic Stroke Patients Through the Supernumerary Robotic Finger – Book Chapter
A novel solution to compensate hand grasping abilities is proposed for chronic stroke patients. The goal is to provide the patients with a wearable supernumerary robotic finger that can be worn on the paretic forearm by means of an elastic band. The proposed prototype is a modular articulated device that can adapt its structure to the grasped object shape. The extra-finger and the paretic hand act like the two parts of a gripper cooperatively holding an object. We evaluated the feasibility of the approach with four chronic stroke patients performing a qualitative test, the Frenchay Arm Test. In this proof of concept study, the use of the supernumerary robotic finger has increased the total score of the patients of 2 points in a 5 points scale. The subjects were able to perform the two grasping tasks included in the test that were not possible without the robotic extra-finger. Adding a robotic opposing finger is a very promising approach that can significantly improve the functional compensation of the chronic stroke patient during everyday life activities.
[ARTICLE] Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients – Full Text
Approximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.
To investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.
Patients and methods
Thirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.
There was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.
Combining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.
Stroke is defined as a neurological deficit attributed to an acute vascular focal injury of the central nervous system . It is a worldwide common disease that leads to serious disabilities . Hemiparesis is the most common motor impairment after a stroke and frequently leads to persistent hand dysfunction . Nearly about 50% of stroke patients show impaired upper limb and hand function and up to 74% rely on long-term help to perform their activities of daily living (ADL) [4, 5]. The hand functions are complex as we use our hands in a vast variety of tasks such as grasping, pushing, holding objects, and expressing emotions .
Task-oriented training is a type of physiotherapy that encourages the active participation and focuses on functional tasks rather than simple repetitive training of normal motion patterns . Joint mobilizations are used as an intervention to improve the range of motion (ROM), decreasing pain, and ultimately improving the upper extremity functions . Joint mobilization technique proposed by Maitland is based on a graded system and is intended to restore the accessory movements of the joints by performing passive, rhythmic, and oscillatory movements .
After stroke, reduced ROM at joints occurs and it can be complicated by joint contractures. This occurs due to many factors such as reduced muscle length and increased stiffness of muscle and/or connective tissue. Such post stroke consequences can be solved by moving the joints through a full ROM with pressure at the end of range using the manual therapy . Mobilization may help stroke patients in reducing the joint stiffness . Moreover, it provides afferent input that can be used in facilitating the motor activity [12, 13]. Accordingly, we aimed to investigate the effect of adding joint mobilization to task-oriented training in order to help those patients in reaching a satisfactory level of recovery for their hand functions.[…]
Continue —-> Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text