Posts Tagged Hand

[Abstract] The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive training that is needed to trigger neuroplasticity following a stroke. However, the lack of fully adaptive assist-as-needed control of the robotic devices and an inadequate immersive virtual environment that can promote active participation during training are obstacles hindering the achievement of better training results with fewer training sessions required. This study thus focuses on these research gaps by combining these 2 key components into a rehabilitation system, with special attention on the rehabilitation of fine hand motion skills. The effectiveness of the proposed system is tested by conducting clinical trials on a chronic stroke patient and verified through clinical evaluation methods by measuring the key kinematic features such as active range of motion (ROM), finger strength, and velocity. By comparing the pretraining and post-training results, the study demonstrates that the proposed method can further enhance the effectiveness of fine hand motion rehabilitation training by improving finger ROM, strength, and coordination.

Source: The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

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[ARTICLE] Reorganization of finger coordination patterns through motor exploration in individuals after stroke – Full Text

 

Abstract

Background

Impairment of hand and finger function after stroke is common and affects the ability to perform activities of daily living. Even though many of these coordination deficits such as finger individuation have been well characterized, it is critical to understand how stroke survivors learn to explore and reorganize their finger coordination patterns for optimizing rehabilitation. In this study, I examine the use of a body-machine interface to assess how participants explore their movement repertoire, and how this changes with continued practice.

Methods

Ten participants with chronic stroke wore a data glove and the finger joint angles were mapped on to the position of a cursor on a screen. The task of the participants was to move the cursor back and forth between two specified targets on a screen. Critically, the map between the finger movements and cursor motion was altered so that participants sometimes had to generate coordination patterns that required finger individuation. There were two phases to the experiment – an initial assessment phase on day 1, followed by a learning phase (days 2–5) where participants trained to reorganize their coordination patterns.

Results

Participants showed difficulty in performing tasks which had maps that required finger individuation, and the degree to which they explored their movement repertoire was directly related to clinical tests of hand function. However, over four sessions of practice, participants were able to learn to reorganize their finger movement coordination pattern and improve their performance. Moreover, training also resulted in improvements in movement repertoire outside of the context of the specific task during free exploration.

Conclusions

Stroke survivors show deficits in movement repertoire in their paretic hand, but facilitating movement exploration during training can increase the movement repertoire. This suggests that exploration may be an important element of rehabilitation to regain optimal function.

Background

Stroke often results in impairments of upper extremity, including hand and finger function, with 75% of stroke survivors facing difficulties performing activities of daily living [12]. Critically, impairments after stroke not only include muscle- and joint-specific deficits such as weakness, and changes in the kinetic and kinematic workspace of the fingers [34], but also coordination deficits such as reduced independent joint control [5] and impairments in finger individuation and enslaving [6789]. Therefore, understanding how to address these coordination deficits is critical for improving hand rehabilitation.

Typical approaches to hand rehabilitation emphasize repetition [10] and functional practice based on evidence that such experience can cause reorganization in the brain [11]. Although this has proven to be reasonably successful, functional practice (such as repetitive grasping of objects) does not specify the coordination pattern to be used when performing the tasks. As a result, because of the redundancy in the human body, there is a risk that stroke survivors may adopt atypical compensatory movements to perform tasks [12]. These compensatory movements have been mainly identified during reaching [1314], but there is evidence that they are also present in finger coordination patterns during grasping [15]. Although there is still debate over the role of compensatory movements in rehabilitation [16], there is at least some evidence both in animal and humans that continued use of these compensatory patterns may be detrimental to true recovery [171819].

To address this issue, there has been a greater focus on directly facilitating the learning of new coordination patterns. Specifically, in hand rehabilitation, virtual tasks (such as playing a virtual piano) have been examined as a way to train finger individuation [2021]. In these protocols, individuation is encouraged by asking participants to press a particular key with a finger, while keeping other fingers stationary. A similar approach to improve hand dexterity was also adopted by developing a glove that could be used as a controller for a popular guitar-playing video game [22]. However, directly instructing desired coordination patterns to be produced becomes challenging as the number of degrees of freedom involved in the coordination pattern increase. For example, the hand has approximately 20 kinematic degrees of freedom, and providing verbal, visual or auditory feedback for simultaneously controlling all these degrees of freedom would be a major challenge. A potential solution that has been suggested is not to directly instruct the coordination pattern itself, but rather let participants explore different coordination patterns [23]. This idea of motor exploration is based on dynamical systems theory that suggests that variability and exploration may help participants escape sub-optimal pre-existing coordination patterns and potentially settle in more optimal coordination patterns [24252627]. Such exploration has been shown to be important in adapting existing movement repertoire [28], and has also been shown to be associated with faster rates of learning [29].

In order to test the hypothesis that exploration of novel coordination patterns can improve overall movement repertoire, I used a body-machine interface [3031] to examine how stroke survivors explore and reorganize finger coordination patterns with practice. A body-machine interface maps body movements (in this case finger movements) to the control of a real or virtual object (in this case a screen cursor), which can provide a way to elicit different coordination patterns in the context of an intuitive task. Specifically I examined: (i) how stroke survivors reorganize their finger coordination patterns, (ii) how training to explore novel coordination patterns affects their ability to reorganize their coordination pattern, and (iii) if training to explore novel coordination patterns has an effect on their overall movement repertoire. In this context, I use the term “novel” to indicate coordination patterns that require finger individuation. This assumption is motivated by the finding that stroke survivors have difficulty producing finger individuation even under explicit instruction [69], and therefore it is highly likely that they would not use coordination patterns requiring finger individuation frequently in activities of daily living.[…]

Continue —>  Reorganization of finger coordination patterns through motor exploration in individuals after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 a Experimental setup – participants wore a data glove and moved their fingers to control a screen cursor b Schematic of task – participants moved a cursor between two targets using movements of four fingers (thumb excluded). c Experimental protocol. Participants came in for 5 total sessions – an initial assessment phase, followed by a learning phase. d Weighting coefficients of the index and middle (blue), and ring and little (red) fingers during the initial assessment phase, and e weighting coefficients during the learning phase

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[VIDEO] Pablo Product Film – YouTube

 

Δημοσιεύτηκε στις 18 Ιουλ 2017

The PABLO is the latest in a long row of clinically tried and tested robotic- and computer-assisted therapy devices for arms and hands. The new design and the specially developed tyroS software make the PABLO more flexible and offer an expanded spectrum of therapy options.

 

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[ARTICLE] A novel generation of wearable supernumerary robotic fingers to compensate the missing grasping abilities in hemiparetic upper limb – Full Text PDF

Abstract

This contribution will focus on the design, analysis, fabrication, experimental characterization and evaluation of a family of prototypes of robotic extra fingers that can be used as grasp compensatory devices for hemiparetic upper limb.

The devices are the results of experimental sessions with chronic stroke patients and consultations with clinical experts. All the devices share a common principle of work which consists in opposing to the paretic hand/wrist so to restrain the motion of an object.

Robotic supernumerary fingers can be used by chronic stroke patients to compensate for grasping in several Activities of Daily Living (ADL) with a particular focus on bimanual tasks.

The devices are designed to be extremely portable and wearable. They can be wrapped as bracelets when not being used, to further reduce the encumbrance. The motion of the robotic devices can be controlled using an Electromyography (EMG) based interface embedded in a cap. The interface allows the user to control the device motion by contracting the frontalis muscle. The performance characteristics of the devices have been measured through experimental set up and the shape adaptability has been confirmed by grasping various objects with different shapes. We tested the devices through qualitative experiments based on ADL involving a group of chronic stroke patients in collaboration with by the Rehabilitation Center of the Azienda Ospedaliera Universitaria Senese.

The prototypes successfully enabled the patients to complete various bi-manual tasks. Results show that the proposed robotic devices improve the autonomy of patients in ADL and allow them to complete tasks which were previously impossible to perform.

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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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[Thesis] The Effects of Limb Dominance on Cross-Education in a Four Week Resistance Training Program – Full Text PDF

ABSTRACT

Cross-education is known as the phenomenon of strength transfer from the trained side of the body to the untrained side of the body by unilateral resistance training. Research has shown that limb dominance has an effect on the amount of strength that is gained on the untrained side. Studies have found that there is a greater cross over effect in strength from the dominant side of the body to the non-dominant side of the body than vice versa. The present study examined this effect by taking 12 college females and splitting them into three groups: dominant training, nondominant training, and control group. The hypothesis was that the dominant training group would have a greater increase in peak grip strength in the untrained, non-dominant arm than the arm of the untrained, dominant group of the non-dominant training group. The dominant training group only trained their dominant arm with a hand dynamometer, while the non-dominant training group only trained their non-dominant arm with the same hand dynamometer. Both groups went through a 4-week, 13 sessions of grip strength training on the handy dynamometer.
They performed 3 sets of 6 maximal squeezes with a 2-minute rest in between sets. Pre-and post tests were taken of maximum grip strength squeeze. There was no significance difference in peak grip strength between the untrained arms of both groups. Also, there was no significance  difference in peak grip strength between the trained arms of both groups however there was a
trend in data in the untrained arm of the dominant training group showing a slight increase in  strength from baseline measurements. These findings do not directly support the hypothesis however, if the number of subjects’ value was greater, the trend in data in the dominant training group might have found significant effect from limb dominance.

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[Abstract] Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

Abstract:

Introduction: This case study describes the application of a commercially available, custom myoelectric elbow–wrist–hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user’s electromyographic signal. Experience with the MEWHO and associated outcomes are reported.

Materials and Methods: The participant completed 21 outpatient occupational therapy sessions that incorporated the use of a custom MEWHO without grasp capability into traditional occupational therapy interventions. He then upgraded to an advanced version of that MEWHO that incorporated grasp capability and completed an additional 14 sessions. Range of motion, strength, spasticity (Modified Ashworth Scale [MAS]), the Box and Blocks test, the Fugl–Meyer assessment and observation of functional tasks were used to track progress. The participant also completed a home log and a manufacturers’ survey to track usage and user satisfaction over a 6-month period.

Results: Active left upper extremity range of motion and strength increased significantly (both with and without the MEWHO) and tone decreased, demonstrating both a training and an assistive effect. The participant also demonstrated an improved ability to incorporate his affected extremity (with the MEWHO) into a wide variety of bilateral, gross motor activities of daily living such as carrying a laundry basket, lifting heavy objects (e.g. a chair), using a tape measure, meal preparation, and opening doors.

Conclusion: Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices.

Source: EBSCOhost | 123998452 | Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

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[Conference paper] Hand Robotic Rehabilitation: From Hospital to Home – Abstract+References

Abstract

Stroke patients are often affected by hemiparesis. In the rehabilitation of these patients the function of the hand is often neglected. Thus in this work we propose a robotic approach to the rehabilitation of the hand of a stroke patient in hospital and also at home. Some experimental results can be presented here especially for inpatients. Further experimental results on home-patients must be acquired through a telemedicine platform, designed for this application. 

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Source: Hand Robotic Rehabilitation: From Hospital to Home | SpringerLink

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[Abstract] A survey on sEMG control strategies of wearable hand exoskeleton for rehabilitation

Abstract:

Surface electromyographic (sEMG) signals is one most commonly used control source of exoskeleton for hand rehabilitation. Due to the characteristics of non-invasive, convenient collection and safety, sEMG can conform to the particularity of hemiplegic patients’ physiological state and directly reflect human’s neuromuscular activity. By way of collecting, analyzing and processing, sEMG signals corresponding to identify the target movement model would be translated into robot movement control instructions and input into hand rehabilitation exoskeleton controller. Then patients’ hand can be directed to achieve the realization of the similar action finally. In this paper, the recent key technologies of sEMG-based control for hand rehabilitation robots are reviewed. Then a summarization of controlling technology principle and methods of sEMG signal processing employed by the hand rehabilitation exoskeletons is presented. Finally suitable processing methods of multi-channel sEMG signals for the controlling of hand rehabilitation exoskeleton are put forward tentatively and the practical application in hand exoskeleton control is commented also.

Source: A survey on sEMG control strategies of wearable hand exoskeleton for rehabilitation – IEEE Xplore Document

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[VIDEO] Pablo Product Film – YouTube

Δημοσιεύτηκε στις 18 Ιουλ 2017

The PABLO is the latest in a long row of clinically tried and tested robotic- and computer-assisted therapy devices for arms and hands. The new design and the specially developed tyroS software make the PABLO more flexible and offer an expanded spectrum of therapy options.

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