Posts Tagged Hand
[Abstract + References] A Virtual Reality Serious Game for Hand Rehabilitation Therapy – IEEE Conference Publication
The human hand is the body part most frequently injured in occupational accidents, accounting for one out of five emergency cases and often requiring surgery with subsequently long periods of rehabilitation. This paper proposes a Virtual Reality game to improve conventional physiotherapy in hand rehabilitation, focusing on resolving recurring limitations reported in most technological solutions to the problem, namely the limited diversity support of movements and exercises, complicated calibrations and exclusion of patients with open wounds or other disfigurements of the hand. The system was assessed by seven able-bodied participants using a semistructured interview targeting three evaluation categories: hardware usability, software usability and suggestions for improvement. A System Usability Score (SUS) of 84.3 and participants’ disposition to play the game confirm the potential of both the conceptual and technological approaches taken for the improvement of hand rehabilitation therapy.
1. A. Elnaggar and D. Reichardt, “Digitizing the Hand Rehabilitation Using Serious Games Methodology with User-Centered Design Approach”, 2016 International Conference on Computational Science and Computational Intelligence (CSCI), pp. 13-22, 2016. Show Context View Article Full Text: PDF (1150KB) Google Scholar
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19. R. Proffitt, M. Sevick, C.-Y. Chang and B. Lange, “User-Centered Design of a Controller-Free Game for Hand Rehabilitation”, Games Health J., vol. 4, no. 4, pp. 259-264, Aug. 2015. Show Context CrossRef Google Scholar
20. N. Arman, E. Tarakci, D. Tarakci and O. Kasapcopur, “Effects of Video Games-Based Task-Oriented Activity Training (Xbox 360 Kinect) on Activity Performance and Participation in Patients with Juvenile Idiopathic Arthritis: A Randomized Clinical Trial”, Am. J. Phys. Med. Rehabil., vol. 98, no. 3, pp. 174-181, 2019. Show Context CrossRef Google Scholar
21. S. Cho, W.-S. Kim, N.-J. Paik and H. Bang, “Upper-Limb Function Assessment Using VBBTs for Stroke Patients”, IEEE Comput. Graph. Appl., vol. 36, no. 1, pp. 70-78, Jan. 2016. Show Context View Article Full Text: PDF (4692KB) Google Scholar
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23. Y.-T. Wu, K.-H. Chen, S.-L. Ban, K.-Y. Tung and L.-R. Chen, “Evaluation of leap motion control for hand rehabilitation in burn patients: An experience in the dust explosion disaster in Formosa Fun Coast”, Burns, vol. 45, no. 1, pp. 157-164, Feb. 2019. Show Context CrossRef Google Scholar
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• We examined the role of bimanual force coordination in bimanual dexterity after stroke.
• Stroke group showed impaired dexterity in a bimanual task with a shared goal.
• Stroke group had poor bimanual coordination of forces during dynamic force modulation.
• Reduced bimanual force coordination predicted impaired dexterity in a bimanual task.
The ability to coordinate forces with both hands is crucial for manipulating objects in bimanual tasks. The purpose of this study was to determine the influence of bimanual force coordination on collaborative hand use for dexterous tasks in chronic stroke survivors.
Fourteen stroke survivors (63.03 ± 15.33 years) and 14 healthy controls (68.85 ± 8.16) performed two bimanual tasks: 1) Pegboard assembly task, and 2) dynamic force tracking task using bilateral index fingers. The Pegboard assembly task required collaborative use of both hands to construct a structure with pins, collars, and washers. We quantified bimanual dexterity with Pegboard assembly score as the total number of pins, collars, and washers assembled in one minute. The force tracking task involved controlled force increment and decrement while tracking a trapezoid trajectory. The task goal was to match the target force with the total force, i.e., sum of forces produced by both hands as accurately as possible. We quantified bimanual force coordination by computing time-series cross-correlation coefficient, time-lag, amplitude of coherence in 0 – 0.5 Hz, and 0.5 – 1 Hz for force increment and decrement phases.
In the Pegboard assembly task, the stroke group assembled fewer items relative to the control group (p = 0.004). In the bimanual force tracking task, the stroke group showed reduced cross-correlation coefficient (p = 0.01), increased time-lag (p = 0.00), and reduced amplitude of coherence in 0 – 0.5 Hz (p = 0.03) and in 0.5 – 1 Hz (p = 0.00). Multiple regression analysis in the stroke group revealed that performance on Pegboard assembly task was explained by cross-correlation coefficient and coherence in 0.5 – 1 Hz during force increment (R2 = 0.52, p = 0.00).
Individuals with stroke show impaired bimanual dexterity and diminished bimanual force coordination. Importantly, stroke-related deterioration in bimanual force coordination is associated with poor performance on dexterous bimanual tasks that require collaboration between hands. Re-training bimanual force coordination in stroke survivors could facilitate a higher degree of participation in daily activities through improved bimanual dexterity.
[Abstract] Motiv’Handed, a New Gamified Approach for Home-Based Hand Rehabilitation for Post-stroke Hemiparetic Patients – Conference paper
This document summarizes a master thesis project trying to bring a new solution to hemiplegia rehabilitation, one of the numerous consequences of strokes. A hemiplegic patients observe paralysis on one side of their body, and as so, loses autonomy and their quality of life decreases. In this study, we decided to only focus on the hand rehabilitation aspect. However, there is a clear tendency in stroke patients to stop training regularly when returning home from the hospital and the first part of their rehabilitation is over. They often experience demotivation, having the feeling that they will never get back to a fully autonomous person ever again and tend to put their training aside, especially when they do not see clear and visible results anymore. This is also due to the supervised training becoming sparser. All of this results in patients stagnating or even worse, regressing. Thus, we decided to offer a motivating solution for hand rehabilitation at home through gamification.
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[Conference Paper] HandMATE: Wearable Robotic Hand Exoskeleton and Integrated Android App for At Home Stroke Rehabilitation – Full Text
We have developed HandMATE (Hand Movement Assisting Therapy Exoskeleton); a wearable motorized hand exoskeleton for home-based movement therapy following stroke. Each finger and the thumb is powered by a linear actuator which provides flexion and extension assistance. Force sensitive resistors integrated into the design measure grasp and extension initiation force. An assistive therapy mode is based on an admittance control strategy. We evaluated our control system via subject and bench testing. Errors during a grip force tracking task while using the HandMATE were minimal (<1%) and comparable to unassisted healthy hand performance. We also outline a dedicated app we have developed for optimal use of HandMATE at home. The exoskeleton communicates wirelessly with an Android tablet which features guided exercises, therapeutic games and performance feedback. We surveyed 5 chronic stroke patients who used the HandMATE device to further evaluate our system, receiving positive feedback on the exoskeleton and integrated app.
Stroke is the leading cause of severe long-term disability in the US . The probability of regaining functional use of the impaired upper extremity is low . At 6 months post stroke, 62% of survivors failed to achieve some dexterity . Such impairments can inhibit the individual’s ability to perform activities of daily living (ADL). Subsequently, upper limb rehabilitation recovery to improve ADL is one of the main self-reported goals of stroke survivors .
Outpatient rehabilitation is recommended for survivors that have been discharged from inpatient rehabilitative services . However, outpatient rehabilitation in general is largely underutilized, with only 35.5% of stroke survivors using services . Factors inhibiting outpatient therapy include cost, lack of resources and transportation. Wearable robotics that enable home-based therapy have the potential to overcome these barriers. They provide assistive movement forces which enable task-specific training in real-life situations that patients are often unable to practice without a clinician. See  for wearable hand robots for rehabilitation review.
At home therapy is not without its limitations. The inability to motivate oneself and fatigue are the most common reported factors resulting in failure to adhere to home based exercise programs for stroke recovery . While wearable robotics can reduce fatigue during exercise, it does not directly address lack of motivation. Research has shown incorporating games into home therapy can encourage compliance . Zondervan et al. showed that use of an instrumented sensor glove, named the MusicGlove, improved self-reported use and quality of movement, greater than convention at home exercises . Other studies showed increased motivation to complete the therapeutic exercises and optimized movement when the user is given feedback of their performance via the Microsoft Kinect . Wearable robotic systems that offer feedback and gaming capability may optimize at home stroke therapy.
Such a system was presented by Nijenhuis et al. in which stroke survivors showed motor improvements after completing a 6 week self-administered training program comprised of a dynamic hand orthosis and gaming environment . However, the hand device was passive, assisting only with extension, which limits the range of stroke survivors who could utilize such a system. Research groups have proposed combining their powered take-home wearable hand devices with custom integrated gaming systems , or guided exercises ; however, they have yet to conduct clinical trials. Notably, Ghassemi et al., have developed an integrated multi-user VR system to use with their X-Glove actuated orthosis, which will allow for client-therapist sessions without the patient having to travel .
Tablets are relatively inexpensive, portable, and straight forward to use, with 47% of internet users globally already owning one . Furthermore, a recent study demonstrated the success of a tablet based at home exercise program in improving the recovery of stroke survivors . Notably, the study evaluated the accessibility of tablets, concluding every participant used the tablet successfully. Therefore a wearable powered hand robot with a dedicated tablet app which will provide functional games, task-specific guided exercises and feedback of movement, could optimize at home stroke therapy.
The goal of this project was to create a wearable robotic exoskeleton that enables repetitive practice of task-specific and goal orientated movements, which translates into improvements in ADL. Furthermore, for maximum use and successful integration into home-based rehabilitation, we aimed to create an Android application compatible with the robotic exoskeleton.
To meet these goals, the following design objectives were established: 1) Assistance with finger flex/extension. 2) Assistance with thumb carpometacarpal (CMC) add/abduction and thumb metacarpophalangeal (MCP) flex/extension. 3) Independent assistive control of each finger and thumb. 4) Portable for at home use, meaning the device has to be lightweight and wireless. 5) Relatively affordable. 6) Integrated with android tablet app. Specific design goals for the app included: 1) Easy to use. 2) Allow the user to control the exoskeletons assistance mode through the app. 3) Records the user’s data and prompts the user via notifications to complete the allocated daily or weekly recommended activity time.
In this paper we will evaluate if the proposed device and app goals have been achieved via bench and subject testing.
The HandMATE device (Fig. 1) builds upon the Hand Spring Operated Movement Enhancer (HandSOME) devices , , . The HandSOME devices are non-motorized wearable exoskeletons that assists stroke patients with finger and thumb extension movements. The HandSOME I device assists with gross whole hand opening movements, while the HandSOME II assists isolated extension movement of 15 finger and thumb degrees of freedom (DOF), allowing performance of various grip patterns used in ADL. While both devices have been shown to significantly increase range of motion (ROM) and functional ability in chronic stroke subjects ,, the HandSOME devices only assist with extension movements and require enough flexion activity to overcome the assistance of the extension springs. As many stroke patients also suffer finger and thumb flexion weakness, we decided to build upon the work of the high DOF HandSOME II and additionally utilize power actuation so we can assist with both flexion and extension movements.
[ARTICLE] Development of the Home based Virtual Rehabilitation System (HoVRS) to Remotely Deliver an Intense and Customized Upper Extremity Training – Full Text PDF
Background: After stroke, sustained hand rehabilitation training is required for continuous improvement
and maintenance of distal function.
Methods: In this paper, we present a system designed and implemented in our lab: the Home based
Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the
feasibility of the system as well as to rene the design and training protocol to prepare for a future
ecacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least
15 minutes every weekday for 3 months (12 weeks) with limited technical support and remote clinical
Results: All patients completed the study without any adverse events. Subjects on average spent 13.5
hours using the system. Clinical and kinematic data were collected pre and post study. The whole group
improved on the Fugl-Meyer (FM) assessment and on six kinematic measurements. In addition, a
combination of these kinematic measures was able to predict a substantial portion of subjects’ FM
Conclusion: The outcomes of this pilot study warrant further investigation of the system’s ability to
promote recovery of hand function in subacute and chronic stroke[…]
The human brain integrates tactile sensory information from the fingertips to efficiently manipulate objects. Sensory impairments due to neurological disorders, e.g. stroke, largely reduce hand dexterity and the ability to perform daily living activities. Several feedback augmentation techniques have been investigated for rehabilitative purposes with promising outcomes. However, they often require the use of unpractical, expensive, or complex devices. In this work we propose the delivery of vibrotactile feedback based on the Discrete Event-driven Sensory feedback Control (DESC) to promote motor learning in post stroke rehabilitation. For this purpose, we prototyped a novel wearable device, namely the DESC glove. It consisted of a soft glove instrumented with PolyVinylidene Fluoride (PVDF) sensors at the fingertips and eccentric-mass vibration actuators to be worn on the forearm. We proceeded with the characterization of the device, which resulted in promising outcomes. The DESC glove was tested with ten healthy participants subsequently in a pick and lift timed task. The effects of augmented vibrotactile feedback were assessed comparing it to a baseline, consisting of wearing the device unpowered. The results of this pilot study showed a decrease in the time necessary to perform the task, a reduction in the time delay from load force to grip force activation and a diminishing of the grip force applied on the object, which led to a lower breakage rate in the intervention condition. These promising outcomes encourage further experiments with stroke survivors to validate the effectiveness of the device to improve hand dexterity and promote stroke rehabilitation.
After a stroke, it’s challenging enough to navigate the medical system to find what services you need, let alone the right treatment approach for you.
You’ve probably heard a lot of recommendations on how to recover hand function after stroke, and everyone seems to give different advice. That’s why we sifted through the research for you. We’ll explain the top 5 evidence-based methods for hand rehabilitation, why they work, and who they work for.
The top 5 evidence-based treatments for improving hand function after stroke:
- Constraint‐induced movement therapy (CIMT)
- Mental practice
- Mirror therapy
- Virtual reality
- High dose repetitive task practice
Constraint-Induced Movement Therapy
What it is:
Constraint-Induced Movement Therapy (CIMT) is a neuro-rehabilitation method where the non-affected hand is constrained or restricted in order to force the brain to use the affected hand, thereby increasing neuroplasticity.
There are two key components: constraint and shaping.
Constraint refers to the way in which the hand is restricted. Therapists have used casts, splints, and mitts to restrict the use of the non-affected hand. None of them have been shown to be more effective than the other.
Shaping involves repetitive movements or activities at the patient’s ability level which become progressively harder. Therapists use shaping techniques to avoid overwhelming the motor system.
Why it works:
Our brain automatically completes a task in the easiest way possible. Our brain is more interested in completing a task than in how it is accomplished.
After a stroke, it’s easier for our brain to do tasks one-handed. This leads to “learned non-use”.
When we constrain our non-affected hand, suddenly our stronger hand becomes the weaker, less functional hand and we’re forced to use our affected hand. Our affected hand might not have much movement, but to our brain any movement is better than no movement, and the brain is highly motivated to figure out how to accomplish a task.
This is where the “shaping” piece is so important. If you are presented with rehab tasks that overwhelm the motor system or are higher level than your affected hand can functionally do, you’ll be more likely to knock the table over than to participate in picking up pennies from the table.
If you knock the table over with your affected hand, your occupational therapist might actually be excited about it; but in practical life finding that balance of not being too easy and not being so hard that you give up is an important lesson for every human being, not just those after stroke.
Who it’s for:
This approach is used for people who have at least 10 degrees of active wrist and finger extension, as well as 10 degrees of thumb abduction (the ability of the thumb to move out of the palm).
It’s been shown to be effective even years after stroke. Lower intensity CIMT is better than higher intensity in the very early stages after stroke.
What it is:
Mental practice, sometimes called motor imagery or mental imagery, is a training method for improving your hand and arm function without moving a muscle!
Mental practice is typically done by listening to pre-recorded audio that describes in detail the motor movement of a specific task. The listener imagines their hand and arm moving in a “typical” way, and the instructor provides cues to extend their arm or open their fingers, as well as the entire sensory experience of the task.
While it’s true that you can do mental practice on its own, it’s best combined with physical practice immediately following.
Why it works:
Brain scans show that similar parts of the brain are activated whether movement is actual, observed or imagined.
It’s a separate area of the brain that’s responsible for actually triggering the muscle movement, but it goes to show that there’s a lot more required of the brain to complete a task than just sending a signal to the muscle.
Who it’s for:
Mental practice has been shown to improve arm movement and functional use in patients after stroke of all levels of abilities and as a treatment approach for people months or years after stroke!
What it is:
Mirror therapy is another voodoo-seeming approach that has a lot of scientific evidence to back it up. It essentially tricks your brain into thinking your affected hand is moving.
You position a mirror to reflect your non-affected hand, while hiding your affected hand. Any movement of your non-affected hand will be reflected in the mirror and make it seem as though you are actually moving your affected hand.
Why it works:
The approach is centered around mirror neurons, which fire in your brain when you see your arm move. Typically, we think about motor neurons being sent from the brain to the muscle, but we don’t realize that mirror neurons are connected to the motor neurons.
After a stroke you lose the ability to access your motor neurons, but not your mirror neurons. By accessing your mirror neurons through seeing your movement (even if the movement is fake), you are tapping into the network between the neurons.
It’s like trying to reconnect with an old friend on Facebook by finding the friends they’re connected with. It might not be the most direct approach in a real life situation, but in stroke rehab that friend of a friend might be your strongest connection.
Who it’s for:
Mirror therapy can be used for people with no movement of the hand or smaller movements of the hand and shoulder, but not functional movement of the hand.
If you have functional movement of your hand, meaning individual finger movement and wrist movement, you have surpassed the benefit that mirror therapy can provide.
It can be used early after stroke, as well as in the chronic stages of stroke.
What it is:
Virtual reality uses a computer interface to simulate a real life objects and events. It’s become an increasingly more prevalent rehabilitation technique to provide motivation and engagement in therapy.
There are two types:
- Immersive: goggles are placed over the eyes and the patient is visually in a different environment than their actual physical one
- Non-immersive: sensors are placed on the body and track the movement of the body and the movements are shown on a screen
Why it works:
Virtual reality works best when paired with traditional therapy. It’s theorized to provide more motivation and engagement for the intensity of therapeutic exercise needed for neuroplasticity. It’s been shown to beneficial in high doses, meaning more than 20 hours.
Another possible factor of why virtual reality works are the same mechanisms that make mirror therapy effective (tapping into the mirror neurons) could be similar.
Virtual reality also creates a biofeedback loop: your brain sends a signal to the muscle, the brain receives a signal back in the form of visual or auditory input. Basically, you get rewarded for your effort.
Who it’s for:
Virtual reality can be used with people who have mild to severe impairments, and from early after stroke to years out.
When deciding what’s right for you, it’s important to look at the adjustability of the device to meet you where you’re at and also to increase in difficulty as you improve.
If you have minimal movements, you’ll want a virtual reality tool specifically for stroke rehabilitation. If you have more movement, it’s possible to use gaming systems not specifically designed for rehab, but make sure you have the support to optimize it for rehab.
High Dose Repetitive Task Practice
What it is:
Repetitive Task Practice is when you practice a task or a part of a task over and over. Task-specific training is a type of repetitive task practice, and refers to the task we complete that is relevant to our daily life.
“Reach to grasp, transport and release” is a type of task-specific training because it is one of the common motor requirements for many functional daily tasks.
The keys for repetitive task practice:
- Task must be meaningful
- Participant must be an active problem-solver
- Real life objects are used
- Difficulty level is not too high and not too low
- Repetition is key
Why it works:
Repetitive Task Practice is based on motor learning theory. Our brains are driven by function. We’re able to achieve neuroplasticity with development of skills, as our brain processes the demands of the task, which have motor and cognitive components.
It’s often used with other treatments, such as virtual reality, to increase the 15 hour dosage that has been shown to be beneficial.
Who it’s for:
Task-specific practice is generally used and is studied in people who have some functional ability of their hand. It’s been shown to be beneficial throughout the rehabilitation process.
Even though the research has been focused on “functional ability” of the hand by practicing reach, grasp, transport, release; there’s potential for recovery by using the same principles of task-specific practice: real life objects, functional tasks, and problem-solving even without the ability to grasp.
Functionally, we can use our affected upper extremity as a stabilizer, an assist, or for manipulation. There are lots of ways to get that side involved to prevent “learned non-use” and to improve your problem-solving skills.
There are two key factors to any hand recovery method: support and meaning.
Neofect aims to support and inspire you to live your best life with virtual reality tools that can be used as part of a constraint-induced movement therapy program or with repetitive task practice.
Our comprehensive recovery and wellness app: Neofect Connect and our YouTube Channel: Find What Works are based on the principles of repetitive task practice and aim to give you the tools to live your best life.
Now the only question is, what are you waiting for?
Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010820. DOI: 10.1002/14651858.CD010820.pub2.
The dexterity of hands and fingers is related to the strength of control by cortico‐motoneuronal connections which exclusively exist in primates. The cortical command is associated with a task‐specific, rapid proprioceptive adaptation of forces applied by hands and fingers to an object. This neural control differs between “power grip” movements (e.g., reach and grasp of a cup) where hand and fingers act as a unity and “precision grip” movements (e.g., picking up a raspberry) where fingers move independently from the hand.
In motor tasks requiring hands and fingers of both sides a “neural coupling” (reflected in bilateral reflex responses to unilateral stimulations) coordinates power grip movements (e.g., opening a bottle). In contrast, during bilateral precision movements, such as playing piano, the fingers of both hands move independently, due to a direct cortico‐motoneuronal control, while the hands are coupled (e.g., to maintain the rhythm between the two sides).
While most studies on prehension concern unilateral hand movements, many activities of daily life are tackled by bilateral power grips where a neural coupling serves for an automatic movement performance. In primates this mode of motor control is supplemented by a system that enables the uni‐ or bilateral performance of skilled individual finger movements.
[Abstract + References] sEMG-biofeedback armband for hand motor rehabilitation in stroke patients: a preliminary pilot longitudinal study – IEEE Conference Publication