Posts Tagged Hand

[ARTICLE] Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges – Full Text


A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections), modulate neural activity (noninvasive brain stimulation), and enhance motivation (virtual reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.

1. Introduction

Significant advances have been made in the management of stroke (including prevention, acute management, and rehabilitation); however cerebrovascular diseases remain the third most common cause of death and the first cause of disability worldwide [16]. Stroke causes brain damage, leading to loss of motor function. Upper limb (UL) function is particularly reduced, resulting in disability. Many rehabilitation techniques have been developed over the last decades to facilitate motor recovery of the UL in order to improve functional ability and quality of life [710]. They are commonly based on principles of motor skill learning to promote plasticity of motor neural networks. These principles include intensive, repetitive, task-oriented movement-based training [1119]. A better understanding of the neural substrates of motor relearning has led to the development of innovative strategies and tools to deliver exercise that meets these requirements. Treatments mostly target the neurological impairment (paresis, spasticity, etc.) through the activation of neural circuits or by acting on peripheral effectors. Robotic devices provide exercises that incorporate key elements of motor learning. Advanced robotic systems can offer highly repetitive, reproducible, interactive forms of training for the paretic limb, which are quantifiable. Robotic devices also enable easy and objective assessment of motor performance in standardized conditions by the recording of biomechanical data (i.e., speed, forces) [2022]. This data can be used to analyze and assess motor recovery in stroke patients [2326]. Since the 1990s, many other technology-based approaches and innovative pharmaceutical treatments have also been developed for rehabilitation, including virtual reality- (VR-) based systems, botulinum neurotoxin (BoNT) injections, and noninvasive brain stimulation (NIBS) (Direct Current Stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS)). There is currently no high-quality evidence to support any of these innovative interventions, despite the fact that some are used in routine practice [27]. By their respective mechanisms of action, each of these treatments could potentiate the effects of robotic therapy, leading to greater improvements in motor capacity. The aim of this paper is to review studies of combined treatments based on robotic rehabilitation and to analyze the rationale behind such approaches.[…]


Continue —> Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges


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[Abstract+References] Greater Cortical Thickness Is Associated With Enhanced Sensory Function After Arm Rehabilitation in Chronic Stroke

Objective. Somatosensory function is critical to normal motor control. After stroke, dysfunction of the sensory systems prevents normal motor function and degrades quality of life. Structural neuroplasticity underpinnings of sensory recovery after stroke are not fully understood. The objective of this study was to identify changes in bilateral cortical thickness (CT) that may drive recovery of sensory acuity. Methods. Chronic stroke survivors (n = 20) were treated with 12 weeks of rehabilitation. Measures were sensory acuity (monofilament), Fugl-Meyer upper limb and CT change. Permutation-based general linear regression modeling identified cortical regions in which change in CT was associated with change in sensory acuity. Results. For the ipsilesional hemisphere in response to treatment, CT increase was significantly associated with sensory improvement in the area encompassing the occipital pole, lateral occipital cortex (inferior and superior divisions), intracalcarine cortex, cuneal cortex, precuneus cortex, inferior temporal gyrus, occipital fusiform gyrus, supracalcarine cortex, and temporal occipital fusiform cortex. For the contralesional hemisphere, increased CT was associated with improved sensory acuity within the posterior parietal cortex that included supramarginal and angular gyri. Following upper limb therapy, monofilament test score changed from 45.0 ± 13.3 to 42.6 ± 12.9 mm (P = .063) and Fugl-Meyer score changed from 22.1 ± 7.8 to 32.3 ± 10.1 (P < .001). Conclusions. Rehabilitation in the chronic stage after stroke produced structural brain changes that were strongly associated with enhanced sensory acuity. Improved sensory perception was associated with increased CT in bilateral high-order association sensory cortices reflecting the complex nature of sensory function and recovery in response to rehabilitation.


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via Greater Cortical Thickness Is Associated With Enhanced Sensory Function After Arm Rehabilitation in Chronic Stroke – Svetlana Pundik, Aleka Scoco, Margaret Skelly, Jessica P. McCabe, Janis J. Daly, 2018

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[ARTICLE] Measurements by A LEAP-Based Virtual Glove for the Hand Rehabilitation – Full Text


Hand rehabilitation is fundamental after stroke or surgery. Traditional rehabilitation requires a therapist and implies high costs, stress for the patient, and subjective evaluation of the therapy effectiveness. Alternative approaches, based on mechanical and tracking-based gloves, can be really effective when used in virtual reality (VR) environments. Mechanical devices are often expensive, cumbersome, patient specific and hand specific, while tracking-based devices are not affected by these limitations but, especially if based on a single tracking sensor, could suffer from occlusions. In this paper, the implementation of a multi-sensors approach, the Virtual Glove (VG), based on the simultaneous use of two orthogonal LEAP motion controllers, is described. The VG is calibrated and static positioning measurements are compared with those collected with an accurate spatial positioning system. The positioning error is lower than 6 mm in a cylindrical region of interest of radius 10 cm and height 21 cm. Real-time hand tracking measurements are also performed, analysed and reported. Hand tracking measurements show that VG operated in real-time (60 fps), reduced occlusions, and managed two LEAP sensors correctly, without any temporal and spatial discontinuity when skipping from one sensor to the other. A video demonstrating the good performance of VG is also collected and presented in the Supplementary Materials. Results are promising but further work must be done to allow the calculation of the forces exerted by each finger when constrained by mechanical tools (e.g., peg-boards) and for reducing occlusions when grasping these tools. Although the VG is proposed for rehabilitation purposes, it could also be used for tele-operation of tools and robots, and for other VR applications.

1. Introduction

Hand rehabilitation is extremely important for recovering from post-stroke or post-surgery residual impairments and its effectiveness depends on frequency, duration and quality of the rehabilitation sessions [1]. Traditional rehabilitation requires a therapist for driving and controlling patients during sessions. Procedure effectiveness is evaluated subjectively by the therapist, basing on experience. In the last years, several automated (tele)rehabilitation gloves, based on mechanical devices or tracking sensors, have been presented [2,3,4,5,6,7,8,9,10]. These gloves allow the execution of therapy at home and rehabilitation effectiveness can be analytically calculated and summarized in numerical parameters, controlled by therapists through Internet. Moreover, these equipment can be easily interfaced with virtual reality (VR) environments [11], which have been proven to increase rehabilitation efficacy [12]. Mechanical devices are equipped with pressure sensors and pneumatic actuators for assisting and monitoring the hand movements and for applying forces to which the patient has to oppose [13,14]. However, they are expensive, cumbersome, patient specific (different patients cannot reuse the same system) and hand specific (the patient cannot use the same system indifferently with both hands). Tracking-based gloves consist of computer vision algorithms for the analysis and interpretation of videos from depth sensing sensors to calculate hand kinematics in real time [10,15,16,17,18,19]. Besides depth sensors, LEAP [20] is a small and low-cost hand 3D tracking device characterized by high-resolution and high-reactivity [21,22,23], used in VR [24], and has been recently presented and tested with success in the hand rehabilitation, with exercises designed in VR environments [25]. Despite the advantages of using LEAP with VR, a single sensor does not allow accurate quantitative evaluation of hand and fingers tracking in case of occlusions. The system proposed in [10] consisted on two orthogonal LEAPs designed to reduce occlusions and to improve objective hand-tracking evaluation. The two sensors were fixed to a wood support that maintained them orthogonal each other. The previous prototype was useful to test the robustness of each sensor, in presence of the other, to the potential infra-red interferences, to evaluate the maintenance of the maximum operative range of each sensor and, finally, to demonstrate the hand tracking idea. However, it was imprecise, due to the usage of raw VG support and positioning system, the non-optimal reciprocal positioning of the sensors, and the impossibility of performing a reciprocal calibration independent of the sensors measurements. This fact did not allow the evaluation of the intrinsic precision of the VG and to perform accurate, real-time quantitative hand tracking measurements. In this paper, we present a method for constructing an engineered version of the LEAP based VG, a technique for its accurate calibration and for collecting accurate positioning measurements and high-quality evaluation of positioning errors, specific of VG. Moreover, real-time experimental hand tracking measurements were collected (a video demonstrating its real-time performance and precision was also provided in the Supplementary Materials), presented and discussed.[…]


Continue —>  Measurements by A LEAP-Based Virtual Glove for the Hand Rehabilitation

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Figure 1
VG mounted on its aluminium support.

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[ARTICLE] Automatic Control of Wrist Rehabilitation Therapy (WRist-T) device for Post-Ischemic Stroke Patient – Full Text PDF


Since a decade, the wrist rehabilitation services in Malaysia has been operated by the physiotherapist (PT). Throughout the rehabilitative procedure, PT commonly used a conventional method which later triggered some problems related to the effectiveness of the rehab services. Timeconsuming, long-waiting time, lack of human power and all those leading to exhaustion, both for the patient and the provider. Patients could not commit to the therapy session due to logistic and domestic problems. This problem can be greatly solved with rehabilitation robot, but the current product in the market is expensive and not affordable especially for lowincome earners family. In this paper, an automatic control of wrist rehabilitation therapy; called WRist-T device has been developed. There are based on three different modes of exercises that can be carried out by the device which is the flexion/extension, radial/ulnar deviation and pronation/supination. By using this device, the patient can easily receive physiotherapy session with minor supervision from the physiotherapist at the hospital or rehabilitation centre and also can be conducted at patient home.

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N. Bayona,“The role of task-specific training in rehabilitation therapies,”Topics in Stroke Rehabilitation, vol. 12, 2005,pp. 58–65.

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via Automatic Control of Wrist Rehabilitation Therapy (WRist-T) device for Post-Ischemic Stroke Patient | Mohd Adib | Journal of Telecommunication, Electronic and Computer Engineering (JTEC)

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[BOOK] New Vibratory Device for Wrist Rehabilitation – Innovation, Engineering and Entrepreneurship – Google Books

New Vibratory Device for Wrist Rehabilitation

H Puga – Innovation, Engineering and Entrepreneurship, 2018
Wrist injuries are very common in most of the population, specially bone fractures,
but also other pathologies such as tendinitis and neurological diseases. When the
wrist is injured, their flexion-extension and radial-ulnar deviation and pronation …


via Innovation, Engineering and Entrepreneurship – Google Books

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[ARTICLE] Assessing Hand Muscle Structural Modifications in Chronic Stroke – Full Text

The purpose of the study is to assess poststroke muscle structural alterations by examining muscular electrical conductivity and inherent electrophysiological properties. In particular, muscle impedance and compound muscle action potentials (CMAP) were measured from the hypothenar muscle bilaterally using the electrical impedance myography and the electrophysiological techniques, respectively. Significant changes of muscle impedance were observed in the paretic muscle compared with the contralateral side (resistance: paretic: 27.54 ± 0.97 Ω, contralateral: 25.46 ± 0.91 Ω, p < 0.05; phase angle: paretic: 8.81 ± 0.61°, contralateral: 10.79 ± 0.69°, p< 0.05). In addition, impedance changes correlated moderately with the CMAP amplitude in the paretic hand (phase angle: r = 0.66, p < 0.05; reactance: r = 0.58, p < 0.05). The study discloses significant muscle rearrangements as a result of fiber loss or atrophy, fat infiltration or impaired membrane integrity in chronic stroke.


Muscle weakness is a remarkable symptom in stroke and contributes significantly to impaired motor functions. To understand mechanisms underlying weakness, studies can focus on assessing changes in neural control and muscular properties. In particular, intramuscular electromyography (EMG) and morphological techniques have been applied to examine muscle structural rearrangements poststroke. Increased motor unit fiber density, larger and complex motor unit action potentials (13), small angular fibers, as well as fiber type grouping (45) have been observed in the acute and chronic stages of stroke suggesting the process of muscle denervation and reinnervation. While these studies characterize structural alterations in the paretic muscles, most approaches involve invasive recording and are limited by sampling only small selective areas of the muscle.

Electrical impedance myography (EIM) is an emerging technique for noninvasive evaluation of muscle electrical conductive properties. It applies weak, high-frequency alternating current to the muscles and produces raw bio-impedance data without causing neuronal and muscular depolarization (67). EIM measures three impedance parameters in terms of resistance (R), reactance (X), and phase angle [θ = arctan (X/R)] (78), which represent the inherent resistivity of skeletal muscle relative to extracellular and intracellular fluid, the integrity of cell membranes, tissue interfaces and non-ionic substances, and membrane oscillation properties of the muscle respectively (912).

Electrical impedance myography has been used to examine muscle structural alterations in a number of neuromuscular diseases including amyotrophic lateral sclerosis (ALS), muscular dystrophy, and spinal muscular atrophy (671319). It is sensitive to muscle structural modifications in terms of atrophy, increased fat infiltration or connective tissue growth (2022). In addition, the technique demonstrates strong correlations with standard measures of ALS including ALS functional rating scale-revised, handheld dynamometry, and motor unit number estimation in tracking the progression of the disease (131723).

Applications of EIM to assess poststroke muscle conditions are relatively limited in the literature. In a previous study, we examined muscle impedance properties in the biceps brachii and found significant changes of muscle structural properties in the paretic side (24). Since proximal muscles demonstrate different extents of impairment from distal muscles (25), it remains unknown whether findings from biceps brachii are applicable to hand muscles. In this study, we applied EIM technique to examine impedance changes in the hypothenar muscle poststroke. In addition, we measured the compound muscle action potentials (CMAP) of the muscle, to assess inherent electrical properties. CMAP is evoked by electrical activation of all functioning motor units and represents summation of all action potentials in spatial distribution. Application of the two different techniques to the same muscle may disclose different features of the muscle and improve current knowledge on structural changes in the paretic hand muscle.[…]


Continue —> Frontiers | Assessing Hand Muscle Structural Modifications in Chronic Stroke | Neurology

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[Abstract] The effect of robot therapy assisted by surface EMG on hand recovery in post-stroke patients. A pilot study


Background: Hemiparesis caused by a stroke negatively limits a patient’s motor function. Nowadays, innovative technologies such as robots are commonly used in upper limb rehabilitation. The main goal of robot-aided therapy is to provide a maximum number of stimuli in order to stimulate brain neuroplasticity. Treatment applied in this study via the AMADEO robot aimed to improve finger flexion and extension.
Aim: To assess the effect of rehabilitation assisted by a robot and enhanced by surface EMG.
Research project: Before-after study design.
Materials and methods: The study group consisted of 10 post-stroke patients enrolled for therapy with the AMADEO robot for at least 15 sessions. At the beginning and at the end of treatment, the following tests were used for clinical assessment: Fugl-Meyer scale, Box and Block test and Nine Hole Peg test. In the present study, we used surface electromyography (sEMG) to maintain optimal kinematics of hand motion. Whereas sensorial feedback, provided by the robot, was vital in obtaining closed-loop control. Thus, muscle contraction was transmitted to the amplifier through sEMG, activating the mechanism of the robot. Consequentially, sensorial feedback was provided to the patient.
Results: Statistically significant improvement of upper limb function was observed in: Fugl-Meyer (p = 0.38) and Box and Block (p = 0.27). The Nine Hole Peg Test did not show statistically significant changes in motor skills of the hand. However, the functional improvement was observed at the level of 6% in the Fugl-Meyer, 15% in the Box and Block, and 2% in the Nine Hole Peg test.
Conclusions: Results showed improvement in hand grasp and overall function of the upper limb. Due to sEMG, it was possible to implement robot therapy in the treatment of patients with severe hand impairment.

via The effect of robot therapy assisted by surface EMG on hand recovery in pos

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[Abstract + References] A New Approach to Design Glove-Like Wearable Hand Exoskeletons for Rehabilitation – Conference paper


The synthesis of hand exoskeletons for rehabilitation is a challenging theoretical and technical task. A huge number of solutions have been proposed in the literature. Most of them are based on the concept to consider the phalanges of the finger as fixed to some links of the exoskeleton mechanism. This approach makes the exoskeleton synthesis a difficult problem that compels the designer to devise approximate technical solutions which, frequently, reduce the efficiency of the rehabilitation system and are rather bulky.

This paper proposes a different approach. Namely, the phalanges are not fixed to some links of the exoskeleton, but they can have a relative motion, with one or two degrees of freedom when planar systems are considered. An example is presented to show the potentiality of this approach, which makes it possible: (i) to design glove-like exoskeletons that only approximate the human finger motion; (ii) to leave the fingers have their natural motion; (iii) to adapt a wider range of patient hand sizes to a given hand exoskeleton.


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via A New Approach to Design Glove-Like Wearable Hand Exoskeletons for Rehabilitation | SpringerLink

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[Abstract+References] The Use of Image Processing Methods to Improve the Detection of User’s Hand in Vision Based Games Used in Neurological Rehabilitation


Vision based games is a type of software that can become a promising, modern neurorehabilitation tool. This paper presents the possibilities offered for the implementation of this kind of software by the open source vision library. The methods and functions related to the aspect of image processing and analysis are presented in terms of their usefulness in creating programs based on the analysis of the images acquired from the camera. On the basis of the issues contained in the paper, the functionality of the library is presented in terms of the possibilities related primarily to the processing of video sequences, detection, tracking and analysis of the movement of objects.

As part of the work, the software that meets the requirements for modern neurorehablitation games has been implemented. Its main part is responsible for the identification of the current position of the user’s hand and is based on the image captured from the webcam. Whereas the tasks set for the user used among others supporting visual-motor coordination.

The main subject of the research was the analysis of the impact of the applied methods of initial image processing on the correctness of the chosen tracking algorithm. It was proposed and experimentally examined the impact of operations such as morphological transformations or apply an additional mask on a functioning of the CamShift algorithm.  And hence on the functioning of the whole game which analyzing the user’s hand movement.


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via The Use of Image Processing Methods to Improve the Detection of User’s Hand in Vision Based Games Used in Neurological Rehabilitation | Gospodarek | IMAGE PROCESSING & COMMUNICATIONS

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[Abstract] Pain-related psychological issues in hand therapy


  • Pain is a subjective experience that results from the complex modulation of nociception conveyed to the brain via the nervous system.
  • Psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, physical function, and treatment outcomes.
  • Several evidence-based interventions to address pain-related psychological risk factors are available and can be integrated into hand therapy.


Study Design

Literature review.


Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one’s cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients’ psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing.

Purpose of the Study

This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors.

Methods and Results

This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences.

Discussion and Conclusion

Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients’ beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients’ pain is thus essential for hand therapists.

via Pain-related psychological issues in hand therapy – Journal of Hand Therapy

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