[Abstract] Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

Abstract:

Introduction: This case study describes the application of a commercially available, custom myoelectric elbow–wrist–hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user’s electromyographic signal. Experience with the MEWHO and associated outcomes are reported.

Materials and Methods: The participant completed 21 outpatient occupational therapy sessions that incorporated the use of a custom MEWHO without grasp capability into traditional occupational therapy interventions. He then upgraded to an advanced version of that MEWHO that incorporated grasp capability and completed an additional 14 sessions. Range of motion, strength, spasticity (Modified Ashworth Scale [MAS]), the Box and Blocks test, the Fugl–Meyer assessment and observation of functional tasks were used to track progress. The participant also completed a home log and a manufacturers’ survey to track usage and user satisfaction over a 6-month period.

Results: Active left upper extremity range of motion and strength increased significantly (both with and without the MEWHO) and tone decreased, demonstrating both a training and an assistive effect. The participant also demonstrated an improved ability to incorporate his affected extremity (with the MEWHO) into a wide variety of bilateral, gross motor activities of daily living such as carrying a laundry basket, lifting heavy objects (e.g. a chair), using a tape measure, meal preparation, and opening doors.

Conclusion: Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices.

Source: EBSCOhost | 123998452 | Case Report on the Use of a Custom Myoelectric Elbow–Wrist–Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

[Abstract] Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke

Abstract

Objective

Determine the immediate impact of a portable, myoelectric elbow-wrist-hand orthosis (MEWHO) on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors.

Design

Observational cohort study Setting: Outpatient rehabilitation clinic

Participants

18 participants exhibiting chronic, moderate, stable, post-stroke, UE hemiparesis.

Interventions

Subjects were administered a battery of measures testing UE impairment as well as UE function. They then donned a fabricated MEWHO and were again tested on the same battery of measures while wearing the device.

Main Outcome Measures

The primary outcome measure was the UE section of the Fugl-Meyer Impairment Scale (FM). Subjects were also administered a battery of functional tasks and the Box and Blocks test (BB).

Results

Subjects exhibited significantly reduced UE impairment while wearing the MEWHO (FM: t {17} = 8.56, p < .0001), and increased quality in performing all functional tasks while wearing the MEWHO, with three subtasks showing significant increases (Feeding {grasp}: Z=2.251, p=.024; Feeding {elbow}: Z=2.966, p=.003; Drinking {grasp}: Z= 3.187, p=.001). Additionally, subjects showed significant decreases in time taken to grasp a cup (Z=1.286, p=.016) and increased gross manual dexterity while wearing a MEWHO (BB: Z =3.42, p < .001).

Conclusion

Results suggest that UE impairment, as measured by the FM, is significantly reduced when donning a MEWHO and these changes exceeded the FM’s clinically important difference threshold. Further, utilization of a MEWHO significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects’ ability to perform multi-joint functional movements and attain consistent functional changes.

Source: Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke – Archives of Physical Medicine and Rehabilitation