Posts Tagged Hand

[Conference Paper] Multi-balloon actuator for advanced hand rehabilitation after stroke (PDF Download Available)


We developed a new hand-rehabilitation device,
termed the Digital Mirror Box, by introducing image pro-
cessing and information technology to a traditional mirror-box
therapeutic device. Here we describe the mirror-therapy mode
and the teaching mode, which are for training and evaluation
of the digital mirror box. However, these modes cannot be
applied to patients who have severe post-stroke disorders. To
compensate for this, we have developed a multi-balloon actuator
for application in force-stimulus feedback therapy. The actuator
is made of easily available material, generates large force, and
has characteristics suitable for hand rehabilitation.


When post-stroke paralysis occurs in the upper limbs,
keeping or recovering upper-limb mobility through training
exercise is especially important because arms and hands
are needed for many activities of daily living (ADL). Re-
habilitation systems using robots or virtual reality (VR)
technology have been suggested to be beneficial [1][5], and
are expected to allow quantitative evaluation, reproducible
training, and motivation for training. However, including
functional training for hands results in too many degrees of
freedom in the controller and the structure of the system is
complex and expensive.
In treatment for phantom-limb pain that is often experi-
enced by amputees, mirror therapy [6] has had favorable
outcomes. In mirror therapy, a mirror is set to hide the
amputated point and to show an image of the non-amputated
limb in its place. During therapy, the intended motion of the
amputated limb is thus given visually via the motion of the
non-amputated limb, as shown in Fig. 1. For patients with
cerebrospinal diseases like stroke, this method uses visual
feedback for relearning motor function, and is expected to
compensate for the mismatch between the physical model
in the brain and the real physical construction of the body.
Studies have reported the practical outcome [7] and that of
electrical stimulation to the paralytic hand [8] during mirror
therapeutic treatment, however the mechanism of recovery
is not clear. Another issue is that the simple mirror method
cannot quantitatively evaluate hand and finger motion. Never-
theless, because the major aspect of the therapy only requires
Mirror box 

Fig. 1. Mirror box

visual stimuli, highly practical systems can be constructed,

which are simpler than robot-aided motion-training systems.
Kaneko et al. has proposed another system that applies a
computer to mirror therapy, without a large-scale robotic
system [9]. Their study used a simple personal computer and
monitor, and suggested a vection function for recovery [10].
Ono et al. developed a brain-machine interface system that
includes monitoring electroencephalographic signals and an
active hand orthosis [11]. However, they could not quantita-
tively evaluate hand and finger motion.
Our research aimed to improve on the simple mirror
box by developing a digital version –the digital mirror box
(DMB)– which utilizes image processing and information
technology, and that has an actuation function for fingers
[12]. This approach targets novel and rich functional re-
habilitation of the hand and fingers, including functions
that conventional devices cannot address, such as motion
induction or assistance.
Here, we report three ways in which the DMB can be used
for therapy. The first two are the mirror therapy mode and the
teaching mode, which are ways in which the DMB prototype
can be used for training and evaluation. However, patients
with severe paralysis who cannot readily make spontaneous
movements and who experience joint separations will not be
able to benefit from these therapy modes alone. Therefore,
we also report a third therapy mode, haptic stimulus mode,
which uses a multi-balloon actuator (MBA) that induces
or assists with finger motion. We think the DMB can be
introduced to hospitals or daycare centers, and the MBA can
be added as an option for increasing the range of motor
disabilities to which the DMB can be applied.
Digital mirror box 

Fig. 2.  Digital mirror box


Mirror image and overlaying 

Fig. 3. Mirror image and overlaying.

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via Multi-balloon actuator for advanced hand rehabilitation after stroke (PDF Download Available)


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


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.


via Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography. – PubMed – NCBI

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[ARTICLE] Soft robotic devices for hand rehabilitation and assistance: a narrative review – Full Text



The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To combat the shortcomings of previous traditional robotics, soft robotics are rapidly emerging as an alternative due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design’s therapeutic abilities. Therefore, a global review of devices that have been previously attempted could facilitate the development of new and improved devices in the next step towards obtaining clinical proof of the rehabilitative effects of soft robotics in hand dysfunction.


A literature search was performed in SportDiscus, Pubmed, Scopus, and Web of Science for articles related to the design of soft robotic devices for hand rehabilitation. A framework of the key design elements of the devices was developed to ease the comparison of the various approaches to building them. This framework includes an analysis of the trends in portability, safety features, user intent detection methods, actuation systems, total DOF, number of independent actuators, device weight, evaluation metrics, and modes of rehabilitation.


In this study, a total of 62 articles representing 44 unique devices were identified and summarized according to the framework we developed to compare different design aspects. By far, the most common type of device was that which used a pneumatic actuator to guide finger flexion/extension. However, the remainder of our framework elements yielded more heterogeneous results. Consequently, those results are summarized and the advantages and disadvantages of many design choices as well as their rationales were highlighted.


The past 3 years has seen a rapid increase in the development of soft robotic devices for hand rehabilitative applications. These mostly preclinical research prototypes display a wide range of technical solutions which have been highlighted in the framework developed in this analysis. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. It is our goal that this review will guide future developers through the various design considerations in order to develop better devices for patients with hand impairments.


Imagine tying your shoes or putting on a pair of pants while having limited use of your hands. Now imagine the impact on your daily life if that limitation was permanent. The ability to perform activities of daily living (ADL) is highly dependent on hand function, leaving those suffering with hand impairments less capable of executing ADLs and with a reduced quality of life. Unfortunately, the hand is often the last part of the body to receive rehabilitation.

According to a 2015 National Health Interview Survey, there were approximately 4.7 million adults in the United States that found it “Very difficult to or cannot grasp or handle small objects” [1]. Hand impairments are commonly observed in neurological and musculoskeletal diseases such as arthritis, Cerebral Palsy, Parkinson’s Disease, and stroke. A summary of motor impairment prevalence associated with these diseases may be seen in Table 1. Fortunately, physical rehabilitation has been shown to promote motor recovery through repetitive isolated movements [2345]. This is largely due to neuroplasticity – the ability for the brain to reorganize itself by establishing new neural connections. Occupational and physical therapists thus attempt to take advantage of neuroplasticity in order to re-map motor function in the brain through repeated exercise. Currently, however, there is no consensus on the best mode and dosing to facilitate neuroplasticity [6]. Additionally, recovery success relies heavily on a patient’s ability to attend therapy, which can be deterred by the frequency, duration, or cost of the therapy. Robotic devices could enhance access to repeated exercise. As such, they have been developed and investigated for their utilization as an adjunctive therapy to improve patient access, compliance and subsequent outcomes of rehabilitation efforts. An overview of the designs with comparisons between the different approaches will help future development of these tools.[…]

Continue —> Soft robotic devices for hand rehabilitation and assistance: a narrative review | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 5Methods of detection along motor pathway [81]

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[Abstract] Interventions for Improving Upper Limb Function after Stroke – Cochrane Database Syst Rev.


Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well asdifferent doses and settings of interventions. The main results were:

  1. Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions;
  2. Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living;
  3. Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality and repetitive task practice;
  4. Unilateral arm training may be more effective than bilateral arm training;
  5. Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs;
  6. There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies.

Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed.


via [Analysis of the Cochrane Review: Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820]. – PubMed – NCBI

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


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

I. Introduction

Neurorehabilitation research has shown that training programs for patients after stroke should ideally consist of high intensity, task-specific and functional exercises with active contribution of the patient, to have the best chance for improving arm/hand function [1], [2]. Conventional rehabilitation involves predominantly one-to-one attention of a therapist for each patient, which is a challenge when aiming to provide high intensity training and involves high costs [3], [4]. This is impeded further by an increased ageing of the population, associated with a higher prevalence of stroke patients and less healthcare professionals available to provide such intensive training.


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

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[Abstract] Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study

Objective: To evaluate the feasibility and safety of home rehabilitation of the hand using a robotic glove, and, in addition, its effectiveness, in hemiplegic patients after stroke.

Methods: In this non-randomized pilot study, 21 hemiplegic stroke patients (Ashworth spasticity index ≤ 3) were prescribed, after in-hospital rehabilitation, a 2-month home-program of intensive hand training using the Gloreha Lite glove that provides computer-controlled passive mobilization of the fingers. Feasibility was measured by: number of patients who completed the home-program, minutes of exercise and number of sessions/patient performed. Safety was assessed by: hand pain with a visual analog scale (VAS), Ashworth spasticity index for finger flexors, opponents of the thumb and wrist flexors, and hand edema (circumference of forearm, wrist and fingers), measured at start (T0) and end (T1) of rehabilitation. Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip test) were also measured at T0 and T1.

Results: Patients performed, over a mean period 56 (49–63) days, a total of 1699 (1353–2045) min/patient of exercise with Gloreha Lite, 5.1 (4.3–5.8) days/week. Seventeen patients (81%) completed the full program. The mean VAS score of hand pain, Ashworth spasticity index and hand edema did not change significantly at T1 compared to T0. The MI, NHPT and Grip test improved significantly (p = 0.0020, 0.0156 and 0.0024, respectively) compared to baseline.

Conclusion: Gloreha Lite is feasible and safe for use in home rehabilitation. The efficacy data show a therapeutic effect which need to be confirmed by a randomized controlled study.


via Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study: Topics in Stroke Rehabilitation: Vol 0, No 0

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[ARTICLE] Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Task-Oriented Mirror Therapy Training on Hand Rehabilitation of Acute Stroke Patients – Full Text PDF

BACKGROUND: Impairments of hand function make it difficult to perform daily life activities and to return to work. The aim of this study was to investigate the effect of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with task-oriented mirror therapy (TOMT) on hand rehabilitation in acute stroke patients.
MATERIAL AND METHODS: Twenty subacute stroke patients in the initial stages (<3 months) participated in the study. Subjects were allocated to 2 groups: the experimental group received HF-rTMS + TOMT and the control group received HF-rTMS. TOMT training was conducted in 10 sessions over 2 weeks for 30 min. rTMS was applied at a 20 Hz frequency over the hand motor area in the cortex of the affected hemisphere for 15 min. Outcomes, including motor-evoked potential (MEP), pinch grip, hand grip, and box and block test, were measured before and after training.
RESULTS: Significant improvements in the MEP and hand function variables were observed in both groups (p<0.05). In particular, hand functions (pinch grip and box and block test) were significantly different between the 2 groups (p<0.05).
CONCLUSIONS: HF-rTMS combined with TOMT had a positive effect on hand function and can be used for the rehabilitation of precise hand movements in acute stroke patients.

Link to Full Text PDF —>  Get your full text copy in PDF | Medical Science Monitor


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[Abstract] Effect of task specific training and wrist-fingers extension splint on hand joints range of motion and function after stroke


via Effect of task specific training and wrist-fingers extension splint on hand joints range of motion and function after stroke – IOS Press

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[WEB SITE] Virtual Reality Training Rivals Conventional Therapy After Stroke

Virtual reality training was as effective as, but not superior to, conventional therapy for improving arm and hand function after stroke when both were added to standard rehabilitation in the subacute phase of stroke recovery, researchers found.

In the phase III VIRTUES study, conducted at five rehabilitation hospitals in Europe, similar and significant improvements from baseline assessments of arm and hand mobility were seen at the end of the 4-week intervention and at 3-month follow-up, but there was no difference between the two groups in the results for any endpoints (P<0.001), Iris Brunner, PhD, of Aarhus University, Hammel Neurocenter in Denmark, and colleagues reported online in Neurology.

“These results suggest that either type of training could be used, depending on what the patient prefers,” Brunner said in a statement. “Virtual reality training may be a motivating alternative for people to use as a supplement to their standard therapy after a stroke.”

Improvement of upper extremity motor function performance on the Action Research Arm Test (ARAT) was similar with the virtual reality and conventional training after the 4-week intervention and at follow-up. Patients in virtual reality training improved their ARAT scores an average of 12 points (21%) from baseline to the postintervention assessment, and 17 points (30%) at 3-month follow-up, while those receiving conventional training improved 13 points (21%) at those respective assessments.

Likewise, no differences were seen between the virtual reality and conventional training groups in secondary endpoints, including the Box and Blocks Test, Functional Independence Measure, and Patient Global Impression of Change assessment.

The study involved 120 patients (average age 62) enrolled between March 2014 and April 2016 who had mild-to-severe upper extremity impairment in their wrists, hands, or upper arms as a result of suffering a stroke an average of one month before the study started.

For the add-on conventional or virtual reality therapy, participants had four to five hour-long training sessions per week for four weeks: 62 received conventional physical and occupational therapy, and 58 received virtual reality training that involved using a screen and gloves with sensors to play games that could be adapted to the person’s abilities.

Level of impairment had no differential effect on outcomes, which were similar for patients with mild/moderate impairment – defined as the ability to extend the wrist at least 20 degrees and the fingers at least 10 degrees from drop hand position – or severe impairment. On ARAT, improvements at 3-month follow-up in the mild/moderate group were 14 points (25%) with virtual reality (VR) training and 13 points (23%) with conventional therapy, while the severe group improved 23 points (40%) with VR and 23 points (40%) with conventional therapy.

While active training time was considerably increased among severely impaired participants using virtual reality training compared to those using conventional training, this was not reflected in a larger improvement in arm motor function, authors wrote. This reflects a study design limitation, they wrote: The addition of a third arm receiving only standard rehabilitation would have helped identify potential benefits of more intensive training and increased training time, as previously reported.

Danielle Levac, MD, PhD, PT, of Northeastern University in Boston, who was not involved in the study, agreed with Brunner and colleagues that future study should apply outcome measures that differentiate between recovery on an impairment level and compensation, given that training intensity within the first few months of a stroke is crucial for maximally exploiting the window of increased plasticity.

Also, neither patient engagement nor motivation — attributes through which VR systems are thought to increase adherence and potentially enhance motor learning — were “subjectively or objectively measured here, which seriously detracts from the author’s conclusions that VR constitutes ‘motivating’ training,” Levac told MedPage Today.

The numerous small studies that have demonstrated benefits of virtual reality training have used specially engineered rehab-specific systems, whereas a recent larger trial in subacute stroke patients that did not find superiority over conventional training used a commercial gaming system.

“It is the low cost and easy accessibility of off-the-shelf gaming systems that have made them so pervasive and attractive in clinical practice, despite the disadvantages for tailoring to individual patient needs noted by the authors,” Levac said.

Robert Teasell MD, of Western University in London, Ontario, and head of the Stroke Rehabilitation Writing Group for the Canadian Stroke Best Practice Recommendations, told MedPage Today that many small trials of virtual reality training have demonstrated a benefit in stroke patients.

“This study is important because it is comparatively larger, employs a multisite design, and has an active control group which gets an equal amount of ‘conventional’ therapy and not just ‘usual care,'” said Teasell, who was not involved in the study. “It demonstrates effectiveness – although not superiority – of virtual reality as a promising adjunct treatment.”

via Virtual Reality Training Rivals Conventional Therapy After Stroke | Medpage Today

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[WEB SITE] New wireless sleeve to help people recover arm use after stroke – ScienceDaily

Summary: Scientists are intending to develop and trial a new wearable technology to help people who have had a stroke recover use of their arm and hand. The team will create a wireless sleeve, which will provide automatic, intelligent information about muscle movement and strength while patients practice every-day tasks at home. The data will be available on a computer tablet to enable patients to review their progress as well as to allow therapists to tailor their rehabilitation program.

Scientists at the University of Southampton are to develop and trial a new wearable technology to help people who have had a stroke recover use of their arm and hand.

Led by Professor Jane Burridge, the team will create a wireless sleeve, which will provide automatic, intelligent information about muscle movement and strength while patients practice every-day tasks at home.

The data will be available on a computer tablet to enable patients to review their progress as well as to allow therapists to tailor their rehabilitation programme.

The two-year project has been funded with a grant of just under £1 million from the National Institute for Health Research (NIHR) through its Invention for Innovation (i4i) programme and is a collaboration between the University of Southampton and Imperial College London, two medical technology consultancies; Maddison and Tactiq and NHS Trusts in Bristol and Portsmouth.

Jane Burridge, Professor of Restorative Neuroscience at Southampton, comments: “About 150,000 people in the UK have a stroke each year and, despite improvements in acute care that results in better survival rates, about 60 per cent of people with moderate to severe strokes fail to recover useful function of their arm and hand.

“Stroke rehabilitation is increasingly home-based, as patients are often discharged from hospital after only a few days. This policy encourages independence and avoids problems associated with prolonged hospital stays. However, some patients struggle to carry out the exercises and they may question whether what they are doing is correct. Similarly therapists don’t have objective measurements about their patients’ muscle activity or ability to move. Rehabilitation technologies like our sleeve will address problems faced by both patients and therapists.”

The wearable technology is the first to incorporate mechanomyography (MMG) microphone-like sensors that detect the vibration of a muscle when it contracts, and inertial measurement units (IMU), comprising tri-axial accelerometers, gyroscopes and magnetometers that detect movement. Data from the two types of sensors will be put together and then data that is not needed, for example outside noise, will then be removed from the muscle signal.

The feedback to patients will be presented on a user-friendly computer interface as an accurate representation of their movement, showing them how much they have improved.

The same sleeve and computer tablet technology, but using different software and user-interfaces, will provide therapists with information to help them diagnose specific movement problems, and inform their clinical decision-making, monitor progress and therefore increase efficiency and effectiveness of therapy.

Professor Burridge adds: “We hope that our sleeve will help stroke patients regain the use of their arm and hand, reduce time spent with therapists and allow them to have the recommended 45 minutes daily therapy more flexibly.. It will also be used to assess patients’ problems accurately as well as more cheaply and practically than using laboratory-based technologies.”

The team, which includes members who themselves have suffered strokes, are working with medical device consultancies, Maddison and Tactiq to develop wearable prototypes and graphical user interfaces which can then be trialled with patients from two NHS sites. They will test the user interfaces, wireless connectivity and examine how easy the sleeve is to wear. The potential cost savings to the NHS will also be examined.

Story Source: Materials provided by University of SouthamptonNote: Content may be edited for style and length.


via New wireless sleeve to help people recover arm use after stroke — ScienceDaily

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