Posts Tagged Hand

[Abstract+References] A therapy-driven gamification framework for hand rehabilitation

Abstract

Rehabilitative therapy is usually very expensive and confined to specialized rehabilitation centers or hospitals, leading to slower recovery times for corresponding patients. Therefore, there is a high demand for the development of technology-based personalized solutions to guide and encourage patients towards performing online rehabilitation program that can help them live independently at home. This paper introduces an innovative e-health framework that develops adaptive serious games for people with hand disabilities. The aim of this work is to provide a patient-adaptive environment for the gamification of hand therapies in order to facilitate and encourage rehabilitation issues. Theoretical foundations (i.e., therapy and patient models) and algorithms to match therapy-based hand gestures to navigational movements in 3D space within the serious game environment have been developed. A novel game generation module is introduced, which translates those movements into a 3D therapy-driven route on a real-world map and with different levels of difficulty based on the patient profile and capabilities. In order to enrich the user navigation experience, a 3D spatio-temporal validation region is also generated, which tracks and adjusts the patient movements throughout the session. The gaming environment also creates and adds semantics to different types of attractive and repellent objects in space depending on the difficulty level of the game. Relevant benchmarks to assess the patient interaction with the environment along with a usability and performance testing of our framework are introduced to ensure quantitative as well as qualitative improvements. Trial tests in one disability center were conducted with a total number of five subjects, having hand motor controls problems, who used our gamified physiotherapy solution to help us in measuring the usability and users’ satisfaction levels. The obtained results and feedback from therapists and patients are very encouraging.

Source: A therapy-driven gamification framework for hand rehabilitation | SpringerLink

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[Abstract] Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

Abstract

Study Design

Cross-sectional.

Purpose of the Study

This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients.

Methods

Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non-paretic arm.

Results

Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19-40] vs 15% [95% CI: 5-25] and FDS (37% [95% CI: 27-48] vs 24% [95% CI: 13-35]). For the musculature of both the FDS and ED, no dose-response association was observed for resistance and muscle activity during the flexion exercise (P > .05).

Conclusion

The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control.

Level of Evidence

4b.

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[Abstract] Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

Abstract

Study Design

Cross-sectional.

Purpose of the Study

This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients.

Methods

Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non-paretic arm.

Results

Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19-40] vs 15% [95% CI: 5-25] and FDS (37% [95% CI: 27-48] vs 24% [95% CI: 13-35]). For the musculature of both the FDS and ED, no dose-response association was observed for resistance and muscle activity during the flexion exercise (P > .05).

Conclusion

The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control.

Level of Evidence

4b.

Source: Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography – Journal of Hand Therapy

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[WEB SITE] Regain Use of Arm After Stroke – National Stroke Association

Regain Use of Arm After Stroke
Technology Now Widely Available Means Moderately to Severely Weakened Arms and Hands May Function Again

Experiencing a stroke can be devastating.  Many are left with an arm so weak it seems useless.  The biggest loss can be your independence.

But for many, regaining use of your arm and hand and your independence is possible.  Myomo, a medical robotics company, has developed the MyoPro—a lightweight, non-invasive powered brace (orthosis). It is the only orthosis that, sensing a patient’s own neurological signals through sensors on the surface of the skin, can restore their ability to use their arms and hands so that they can return to work, live independently and reduce their cost of care.

Hundreds of patients have used it successfully.  It is recommended by clinicians at leading rehabilitation facilities and 20 VA hospitals. (MyoPro is not for everyone and your results may vary.)

Read the whitepaper Technology Giving Hope to Stroke Patients Now Widely Available and see videos of patients and physicians describing their experience with MyoPro.

LEARN MORE

Source: National Stroke Association

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[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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Source: Development of a tool to facilitate real life activity retraining in hand and arm therapy – Mar 28, 2017

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[WEB SITE] Paralyzed Man Regains Hand Movement, Thanks to First-Ever Nerve-Transfer Surgery

IN BRIEF

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.

HEADFIRST

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.

Raglin can now unfold his fingers from the palm of his right hand and grip onto items such as a fork, a shaver and a toothbrush.
Ottawa Citizen

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.”

Source: Paralyzed Man Regains Hand Movement, Thanks to First-Ever Nerve-Transfer Surgery

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[VIDEO] This wearable glove helps disabled patients regain control of their hands – YouTube

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[Abstract] Delivering occupational therapy hand assessment and treatment sessions via telehealth

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.

Source: Delivering occupational therapy hand assessment and treatment sessions via telehealth – Feb 13, 2017

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[Report] A smart brace to support spasticity management in poststroke rehabilitation – Full Text PDF by Max Lammers

Executive Summary

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.

Full Text PDF

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[Abstract] The Recovery Glove System- A Sensor Driven Glove with interactive games for Fine Motor Skill Disabilities – Biomedical Engineering Western Regional Conference

Description

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 [1], [2]. 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 [3]. 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.

Source: BYU ScholarsArchive – Biomedical Engineering Western Regional Conference: The Recovery Glove System- A Sensor Driven Glove with interactive games for Fine Motor Skill Disabilities

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