Posts Tagged Hand
[Abstract+References] Development of a tool to facilitate real life activity retraining in hand and arm therapy
Successful recovery of upper extremity function after stroke is more likely when the affected limb is used regularly in daily life. We developed an iPad (Apple) application called the ‘Aid for Decision-Making in Occupation Choice for Hand’ to facilitate daily upper extremity use. This study examined the suitability of items and pictures in the Aid for Decision-Making in Occupation Choice for Hand, and tested a paper prototype of the application (which has since been produced).
We used a Delphi method with 10 expert occupational therapists to refine the items in the aid. Next, we prepared pictures of items in the aid and confirmed their suitability by testing them with 10 patients (seven stroke, three cervical spondylotic myelopathy). Nine occupational therapists conducted field tests with a paper prototype of the aid in clinical practice to examine its utility.
After four Delphi rounds, we selected 130 items representing activities of daily living, organized into 16 categories. Of 130 pictures, 128 were recognizable to patients as representing the intended activities. Based on testing of the paper prototype, we found the Aid for Decision-Making in Occupation Choice for Hand process was suitable for clinical practice, and could be organized into six steps.
The Aid for Decision-Making in Occupation Choice for Hand process may promote daily upper extremity use. This application, since developed, now needs to be clinically tested in its digital form.
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Beginning with a twitch in his fingers about six months ago, a Canadian man has successfully re-animated his paralyzed hand after undergoing a nerve transfer surgery.
Tim Raglin regularly dove, headfirst, into the water at his family’s lake house. The 45-year old Canadian man had done so thousands of times without incident. In 2007, though Raglin hit his head on a rock in the shallow water, shattering a vertebra in his cervical spine.
His family pulled him to safety, saving him from drowning. However, for nine years, both his hands and feet were left paralyzed.
Now though, there’s hope for Raglin and others like him.
Raglin is the first Canadian to ever undergo a nerve transfer surgery. Dr. Kirsty Boyd from the Ottawa Hospital essentially rewired Raglin’s body– rerouting some of his fully-functional elbow nerves to his hand. Although Raglin had to wait several months for the nerves to regrow, this procedure allowed him to regain some control over his right hand.
ROAD TO INDEPENDENCE
After persevering for 18 months, Raglin was finally able to open his fingers during an occupational therapy session at The Ottawa Hospital Rehabilitation Centre.
“It was kind of a shock,” he said in an interview. “And it’s really moving now: There’s a lot of nerves touching muscles that are getting stronger…Every iteration, it just gets more and more exciting.”
It’s still a slow uphill battle for Raglin. The muscles in his hand have deteriorated from lack of use, so they tire easily. In addition, because Raglin is using a different nerve pathway to activate the muscles in his hand, it will take some time for his brain to adjust to the new system.
Despite these challenges, he has learned to close his fingers on something by flexing his bicep. In time, however, it’s expected his brain will figure out how to separate the triggers for his hand and his bicep.
“I’m not quite at the point where I can get a cup off the table, but I can envision myself doing that. I know I will be able to do that eventually—so it’s exciting to see that.”
Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction.
Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%.
Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high.
Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.
[Report] A smart brace to support spasticity management in poststroke rehabilitation – Full Text PDF by Max Lammers
This report covers the design of a product to help stroke survivors who are suffering from chronic spasticity manage their everyday activities.
In the Netherlands alone, 44.000 people suffer from a Cerebro-Vascular Accident (CVA) each year. A CVA, more commonly known as a stroke, results in brain trauma with afflictions such as paralysis, fatigue and spasticity. It is possible to recover some, if not all, motor function though intensive physiotherapy, which requires longterm stay at a rehabilitation clinic in severe cases. Due to limited room and staff, only 12% of stroke survivors end up rehabilitating in a clinic. The remaining survivors are sent home, and will to travel to the clinic 3-5 times per week for therapy as part of the outpatient rehabilitation.
Adjuvo Motion, a young start-up, aims to improve the situation of stroke survivors by bringing the rehabilitation center to their home through the Adjuvo Platform, which allows them to perform exercises in the context of virtual tasks. They proposed an assignment to extend their product portfolio with a Range of Motion assessment device that is suited for those suffering from spasticity.
Spasticity occurs in roughly 60% of stroke survivors with varying degrees of intensity. It is caused by the damaged parts of the brain sending conflicting signals to the muscles, causing them to contract. This inhibits the survivor’s ability to perform daily tasks, but can be solved temporarily with stretching exercises. A solution to compensate for these spastic forces using a passiveassist device was proposed at the start of this project. The project was divided into four stages: Analysis, Synthesis, Embodiment and Evaluation.
During the Analysis stage, interviews with a Physiotherapist and stroke survivor and literature studies regarding anatomy, the state of the art and relevant technologies were used to create a framework for the design of a smart passive-assist glove. Looking at competing products, there is a demand for passive assist and Range of Motion assessment functionalities, yet a combination of these in a single device is not yet present in the market.
During the Synthesis stage, the design problem of the passive assist device was split into three groups: Orthoses; the connections to the body, Passive Assist; the compensation medium, and RoM measurement; the sensing mechanism(s). These three groups were further split into sub-problems, the solutions to which were compiled into a Morphological Chart. By combining the solution within this chart, three promising concept designs were created: One upgrade to the existing sensor glove, one full integration of sensing and passive assist, and one passive assist glove with removable sensors.
To evaluate these concepts, eight criteria were established and weighted with the help of a physiotherapist. In order to create an objective assessment, the criteria were kept strictly quantitative and the three designs were first scored against the Raphael Smart Glove by Neofect using early prototypes. These scores were then used to evaluate the designs relative to each other, which resulted in an overall higher score for the concept with separable electronics. Making the sensor part of the brace removable allowed the product to be used during daily life as well as physiotherapy exercises, and proved a key benefit in keeping the product clean.
Based on the chosen design, four iterations of prototypes were made, which were tested with healthy subject. During this stage, it became clear that flex sensors are be best suited to create a range of motion assessment for spastic stroke patients, since it is less important to know how well they perform a task, and more important to know if they can actually perform it.
Based on a quantified use case, the four sub-assemblies; the Wrist Wrap, Finger Modules and Sensor Module, and their connections were materialized in the Embodiment design stage. When selecting production methods, the main challenge was a small batch size of 1000 units, which made conventional techniques for mass production, such as Injection Molding, less attractive. This stage ended in an assessment of the product’s production price and durability: The product would cost €250 to make, and would last for 2.5 years before the Velcro connection on the Wrist Wrap would become too weak to sustain the spasticity forces.
In the Evaluation stage, the product was evaluated on the seven most important requirements established during the analysis stage. For several of these, a user test was performed, again with healthy subject. While the Adjuvo Auxilius passed most theoretical requirements, the user tests on healthy subjects could not be used to draw any conclusions regarding its effectiveness on spastic stroke patients. However, since the product’s working principle is based on that of existing spasticity compensation products, the prediction is that the Auxilius will be an effective therapy supplement.
The result of this project is the Adjuvo Auxilius; a spasticitycompensation glove with modular sensors, which can be added to allow virtual (stretching) exercises through the Adjuvo Motion’s platform. The results of these exercises are used to create a remote assessment of the patients motor skills, and to adjust the therapy if needed.
[Abstract] The Recovery Glove System- A Sensor Driven Glove with interactive games for Fine Motor Skill Disabilities – Biomedical Engineering Western Regional Conference
Hand mobility is commonly impaired in stroke victims. Treatment for hand impairment range from therapist-guided physical exercises to robotically controlled exoskeletons. However, A more effective treatment which actually restores hand mobility is by encouraging patients to carry out hand movements themselves.We have designed an Arduino based hand therapy device in which the user interacts with a computer graphic interface (CGI) game controlled by a glove was embedded with a force sensing resistor (FSR) at each of the fingertips except for the thumb. The interactive therapy guides the user through exercises and provides live, quantitative information by which the stroke patient can track progress and motivate him or herself.
Introduction: Currently, stroke is the fifth cause of death and disability among adults, affecting approximately 795,000 people every year in the United States , . Hand mobility is commonly impaired in stroke victims. Treatment for hand impairment range from therapist-guided physical exercises to robotically controlled exoskeletons. Devices that act as a substitute, such as the exoskeletons and neuromuscular electrical stimulation, do not typically rehabilitate hand movements but merely assist movements when the device is donned. A more effective treatment which actually restores hand mobility is by encouraging patients to carry out hand movements themselves . Therefore, our aim was to develop a low cost therapeutic device which better motivated patients to practice their hand exercises themselves without having to wait for their next physical therapy appointment.
Materials and Methods: An Arduino-based hand therapy device was developed to motivate stroke patients to practice movements which aid in rehabilitating range of motion and hand strength. A glove was embedded with a force sensing resistor (FSR) at each of the fingertips except for the thumb. The FSRs were connected to a voltage divider circuit which fed into an analog input of the ATMega 328P microcontroller. Individual finger presses are detected and the force magnitude of these finger presses are determined in the microcontroller code, and then fed to a computer game engine, developed in Scratch. Each finger is associated to a color; the user is required to press by doing a functional pinch grip of the appropriate finger with sufficient strength to play each game. There are 7 interactive games: Simon Says, Crazy Drums, The Color Game, Jetpack Joyride, Don’t Touch the Spikes and Grid Guardian. In the games the user does an action by pressing the correct sensor associated to the color of the character, object or action.
Results and Discussion: A small clinical study was conducted to determine whether our glove and games were useable and playable by people who suffer from hand weakness and limited range of motion, if the use of the gamebased device improves motivation, grip strength and subject ability to carry out a standard block & box test. Coming into the study participants, 83.3% strongly agree and 16.7% agree that traditional hand rehabilitation exercise is unmotivational and boring, 83.3% of participants never played and had no interest in video games, and were unlikely to complete their therapist recommended exercises. Towards the end of the study 83.3% found hand rehabilitation with games to be more motivating than traditional therapy, At the end of the stud and 66.6% of subjects that weren’t interested in video games at the start of the study changed their opinion. Furthermore, they were willing to buy a device similar to the Recovery Glove if it was under $100.
Conclusions: In this study, we were able to test our recovery glove, a description of the games and game interface structure that we developed as well as the lessons learned about how to ensure that our games can be understood and used by patients who suffer from hand impairments. Even though, participant’s changes in grip strength and box & block test scores vary, the Recovery Glove was shown to be a motivating device that assisted with repetitive functional hand motion.
Although various hand assist devices have been commercialized for people with paralysis, they are somewhat limited in terms of tool fixation and device attachment method. Hand exoskeleton robots allow users to grasp a wider range of tools but are heavy, complicated, and bulky owing to the presence of numerous actuators and controllers. The GRIPIT hand assist device overcomes the limitations of both conventional devices and exoskeleton robots by providing improved tool fixation and device attachment in a lightweight and compact device. GRIPIT has been designed to assist tripod grasp for people with spinal cord injury because this grasp posture is frequently used in school and offices for such activities as writing and grasping small objects.
The main development objective of GRIPIT is to assist users to grasp tools with their own hand using a lightweight, compact assistive device that is manually operated via a single wire. GRIPIT consists of only a glove, a wire, and a small structure that maintains tendon tension to permit a stable grasp. The tendon routing points are designed to apply force to the thumb, index finger, and middle finger to form a tripod grasp. A tension-maintenance structure sustains the grasp posture with appropriate tension. Following device development, four people with spinal cord injury were recruited to verify the writing performance of GRIPIT compared to the performance of a conventional penholder and handwriting. Writing was chosen as the assessment task because it requires a tripod grasp, which is one of the main performance objectives of GRIPIT.
New assessment, which includes six different writing tasks, was devised to measure writing ability from various viewpoints including both qualitative and quantitative methods, while most conventional assessments include only qualitative methods or simple time measuring assessments. Appearance, portability, difficulty of wearing, difficulty of grasping the subject, writing sensation, fatigability, and legibility were measured to assess qualitative performance while writing various words and sentences. Results showed that GRIPIT is relatively complicated to wear and use compared to a conventional assist device but has advantages for writing sensation, fatigability, and legibility because it affords sufficient grasp force during writing. Two quantitative performance factors were assessed, accuracy of writing and solidity of writing. To assess accuracy of writing, we asked subjects to draw various figures under given conditions. To assess solidity of writing, pen tip force and the angle variation of the pen were measured. Quantitative evaluation results showed that GRIPIT helps users to write accurately without pen shakes even high force is applied on the pen.
Qualitative and quantitative results were better when subjects used GRIPIT than when they used the conventional penholder, mainly because GRIPIT allowed them to exert a higher grasp force. Grasp force is important because disabled people cannot control their fingers and thus need to move their entire arm to write, while non-disabled people only need to move their fingers to write. The tension-maintenance structure developed for GRIPIT provides appropriate grasp force and moment balance on the user’s hand, but the other writing method only fixes the pen using friction force or requires the user’s arm to generate a grasp force.
The hand is one of the most essential body parts for independent living because so many tasks of daily life, such as writing, eating, and grasping, require a functional hand. People who suffer from permanent paralysis of the hand owing to cerebral palsy, spinal cord injury (SCI), stroke, and other neurological disorders require assistive or rehabilitation devices in order to regain independence and return to work [1, 2].
[ARTICLE] Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke – Full Text
Background: We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis. Methods: A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy), and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale (MAS), Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks). Results: A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale. Conclusions: In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.
Stroke (or cerebrovascular accident) is a sudden ischemic or hemorrhagic episode which causes a disturbed generation and integration of neural commands from the sensorimotor31 areas of the cortex. As a consequence, the ability to selectively activate muscle tissues for performing movement is reduced.26 Sixty percent of those individuals who survive a stroke exhibit a sensorimotor deficit of one or both hands and may benefit from rehabilitation to maximize recovery of the upper extremity.23,25 Restoration of arm and hand motility is essential for the independent performance of daily activities.23,26 A prompt and effective rehabilitation approach is essential28 to obtain recovery of an impaired limb to prevent tendon shortening, spasticity, and pain.2
Recent technologies have facilitated the use of robots as tools to assist patients in the rehabilitation process, thus maximizing patient outcomes.4 Several groups have developed robotic tools for upper limb rehabilitation of the shoulder and elbow.27 These robotic tools assist the patient with carrying out exercise protocols and may help restore upper limb mobility.22,26 The complexity of wrist and finger articulations had delayed the development of dedicated rehabilitation robots until 2003 when the first tool based on continuous passive motion (CPM) was presented followed by several other solutions, with various levels of complexity and functionality.3
A recent review on the mechanisms for motor relearning reported factors such as attention and stimuli (reinforcement) are crucial during learning which indicates that motor relearning can take place with patients with neurological disorders even when only the sensorial passive stimulation is applied.30 In addition, another review reported the benefits of CPM for stretching and upper limb passive mobilization for patients with stroke but that CPM treatment requires further research.40
Among robotic devices, Gloreha (Figure 1),5,10 with its compliant mechanical transmission, may represent an easily applied innovative solution to rehabilitation, because the hand can perform grasp and release activities wearing the device by mean of a flexible and light orthosis. Our objective of this study was to determine the efficacy of robot-assisted motion in addition to traditional physiotherapy (PT) and occupational therapy (OT) compared with additional time spent in PT and OT on stroke patients with hand paralysis on function, motor strength, spasticity, and pain.
Stroke survival rates have improved a lot over the last few years. Stroke was once the third leading cause of death in the United States, but it fell to fourth place in 2008 and fifth place in 2013. Today, strokes claim an average of 129,000 American lives every year. Reducing stroke deaths in America is a great improvement, but we still have a long way to go in improving the lives of stroke survivors.
Stagnant recovery rates and low quality of life for stroke survivors are unfortunately very common. Just 10% of stroke survivors make a full recovery. Only 25% of all survivors recover with minor impairments. Nearly half of all stroke survivors continue to live with serious impairments requiring special care, and 10% of survivors live in nursing homes, skilled nursing facilities, and other long-term healthcare facilities. It’s easy to see why stroke is the leading cause of long-term disability in the United States. By 2030, it’s estimated that there could be up to 11 million stroke survivors in the country.
Traditionally, stroke rehabilitation in America leaves much to be desired in terms of recovery and quality of life. There is a serious gap between stroke patients being discharged and transitioning to physical recovery programs. In an effort to improve recovery and quality of life, the American Heart Association has urged the healthcare community to prioritize exercise as an essential part of post-stroke care.
Unfortunately, too few healthcare professionals prescribe exercise as a form of therapy for stroke, despite its many benefits for patients. Many stroke survivors are not given the skills, confidence, knowledge, or tools necessary to follow an exercise program. However, that can change.
With the right recovery programs that prioritize exercise for rehabilitation, stroke survivors can “relearn” crucial motors skills to regain a high quality of life. Thanks to a phenomenon known as neuroplasticity, even permanent brain damage doesn’t make disability inevitable.
A stroke causes loss of physical function because it temporarily or permanently damages the parts of the brain responsible for those functions. The same damage is also responsible for behavioral and cognitive changes, which range from memory and vision problems to severe depression and anger. Each of these changes correspond to a specific region of the brain that was damaged due to stroke.
For example, damage in the left hemisphere of your brain will cause weakness and paralysis on the right side of your body. If a stroke damages or kills brain cells in the right hemisphere, you may struggle to understand facial cues or control your behavior. However, brain damage due to stroke is not necessarily permanent.
MusicGlove: Hand Therapy with a Beat
What Is MusicGlove?
MusicGlove is a hand therapy device that is clinically proven to improve hand function in 2 weeks.
The device is a sensorized “glove” that allows users to perform hundreds of hand and finger exercises while playing a therapy-based musical game.
How does it work?
To use the device, you simply put the MusicGlove on your hand, plug it into your personal laptop or Flint tablet, and press play.
Then, follow along and make the appropriate pinching movements when each musical note floats down the screen.
What’s the Research Behind It?
Exercise with MusicGlove has been clinically proven to:
- Improve hand function in 2 weeks
- Lead to functional gains such as opening a door, washing dishes, typing, and using the restroom independently
- Motivate safe, high-intensity movements that initiate neuroplasticity in the brain
How is it different?
Most assistive hand devices help open your hand but fail to retrain your brain how to use your hand again.
MusicGlove is unique because it’s designed to initiate neuroplasticity, the process that your brain uses to rewire itself after injury. The more you play the game, the better your brain becomes at controlling your hand!
Who Is MusicGlove For?
To use MusicGlove hand therapy actively without assistance, you need the ability to touch your thumb to at least one of your fingertips or side of your index finger.
If you cannot make this movement, then you can try using the device passively. Read this article to learn more.
MusicGlove is intended to treat:
- Spinal Cord Injury
- Cerebral Palsy
- Traumatic Brain Injury
- Neurologic and muscular injury
- Developmental disability
If you have received hand therapy in clinic and want to continue at home, MusicGlove is for you!
Are You a Clinician?
If so, please visit our MusicGlove for Clinic Use page!
Visit Site —> MusicGlove for Stroke Therapy – Flint Rehab