Posts Tagged UE

[Abstract] A soft supernumerary robotic finger and mobile arm support for grasping compensation and hemiparetic upper limb rehabilitation


In this paper, we present the combination of our soft supernumerary robotic finger i.e. Soft-SixthFinger with a commercially available zero gravity arm support, the SaeboMAS. The overall proposed system can provide the needed assistance during paretic upper limb rehabilitation involving both grasping and arm mobility to solve task-oriented activities. The Soft-SixthFinger is a wearable robotic supernumerary finger designed to be used as an active assistive device by post stroke patients to compensate the paretic hand grasp. The device works jointly with the paretic hand/arm to grasp an object similarly to the two parts of a robotic gripper. The SaeboMAS is a commercially available mobile arm support to neutralize gravity effects on the paretic arm specifically designed to facilitate and challenge the weakened shoulder muscles during functional tasks. The proposed system has been designed to be used during the rehabilitation phase when the arm is potentially able to recover its functionality, but the hand is still not able to perform a grasp due to the lack of an efficient thumb opposition. The overall system also act as a motivation tool for the patients to perform task-oriented rehabilitation activities.

With the aid of proposed system, the patient can closely simulate the desired motion with the non-functional arm for rehabilitation purposes, while performing a grasp with the help of the Soft-SixthFinger. As a pilot study we tested the proposed system with a chronic stroke patient to evaluate how the mobile arm support in conjunction with a robotic supernumerary finger can help in performing the tasks requiring the manipulation of grasped object through the paretic arm. In particular, we performed the Frenchay Arm Test (FAT) and Box and Block Test (BBT). The proposed system successfully enabled the patient to complete tasks which were previously impossible to perform.

Source: A soft supernumerary robotic finger and mobile arm support for grasping compensation and hemiparetic upper limb rehabilitation

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[Conference paper] Upper-Limb Kinematics During Feeding and Drinking – Abstract+References


Feeding and drinking are Activities of Daily Living which can be used to assess the motor control and functional ability of the upper limb. This paper presents the upper-limb kinematics during the execution of feeding and drinking activities, such analysis consisted in the measurement of angles of flexion for trunk and arm. Eight healthy subjects performed these activities in a simulated-environment while they were video recorded. Markers on anatomical landmarks were used to analyze the kinematics of the upper limb in the sagittal plane. Additionally an electro-hydraulic sensor was attached to each upper limb to assess the vertical position of the wrist relative to the shoulder. Results showed a difference on the angles of the elbow and trunk. The electro-hydraulic sensor showed to be an efficient way to record the vertical position of wrist.


Source: Upper-Limb Kinematics During Feeding and Drinking | SpringerLink

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[ARTICLE] Body-Machine Interfaces after Spinal Cord Injury: Rehabilitation and Brain Plasticity – Full Text HTML


The purpose of this study was to identify rehabilitative effects and changes in white matter microstructure in people with high-level spinal cord injury following bilateral upper-extremity motor skill training. Five subjects with high-level (C5–C6) spinal cord injury (SCI) performed five visuo-spatial motor training tasks over 12 sessions (2–3 sessions per week). Subjects controlled a two-dimensional cursor with bilateral simultaneous movements of the shoulders using a non-invasive inertial measurement unit-based body-machine interface. Subjects’ upper-body ability was evaluated before the start, in the middle and a day after the completion of training. MR imaging data were acquired before the start and within two days of the completion of training. Subjects learned to use upper-body movements that survived the injury to control the body-machine interface and improved their performance with practice. Motor training increased Manual Muscle Test scores and the isometric force of subjects’ shoulders and upper arms. Moreover, motor training increased fractional anisotropy (FA) values in the cingulum of the left hemisphere by 6.02% on average, indicating localized white matter microstructure changes induced by activity-dependent modulation of axon diameter, myelin thickness or axon number. This body-machine interface may serve as a platform to develop a new generation of assistive-rehabilitative devices that promote the use of, and that re-strengthen, the motor and sensory functions that survived the injury.

1. Introduction

Despite progress in the field of assistive technologies for people who suffered an injury to the spinal cord, most of the current devices to control computers and wheelchairs are set in place to require as little physical effort from the user as possible, and little attention has been paid to maintaining and strengthening the neural and muscular resources that survived the injury [1,2,3,4]. Spinal cord injury (SCI) leads to motor impairment, weakness, muscular and cortical atrophy and altered reflexes, and these have been shown to progress further with lack of exercise [5,6,7,8,9,10]. Even in individuals with injuries to the cervical spinal cord, some motor and sensory capacities may remain available in the upper body. Several studies have shown that using their remaining functions and keeping an active body is critical for people with SCI in order to avoid the collateral effects of paralysis and to potentially recover some of the lost mobility [5,6,7,11]. Therefore, it is crucial to develop the next generation of assistive-rehabilitative devices that promote learning through upper-body coordination.
Acquisition, retention and refinement of motor skills all rely on the capability of the nervous system to create new patterns of neural activation for accomplishing new tasks and for recovering lost motor functions [12]. Recent advances in neural imaging have allowed learning studies on juggling [13], balance [14] and body-machine interfaces (BMIs) by our group [15], to demonstrate motor skill learning-induced structural changes of cortical and subcortical areas in both gray matter and white matter by using diffusion tensor imaging (DTI). DTI non-invasively measures the direction and rate of water diffusion within tissue. White matter integrity is commonly measured by fractional anisotropy (FA), a normalized measure of the variance of the diffusion ellipsoid at each voxel [16]. FA values for white matter tissue have been shown to be affected by physiological parameters, such as axon diameter, axon number and myelin thickness [17].
Loss of somatosensory afference leads to functional cortical reorganization [18,19,20]. SCI has been shown to lead to spinal cord atrophy, cortical atrophy of primary and sensory cortex [8], descending motor tracts [9] and cortical reorganization of the sensorimotor system [8,10], and the degree of cortical reorganization is associated with the level of disability. Although the goal of most SCI treatments is to re-establish neural connections in order to restore motor function, it is unclear whether the anatomical and functional changes that follow injury can be reversed.
In this study, we investigated the rehabilitative effects and learning-induced changes in the brain white matter microstructure of people with high-level SCI after they practiced coordinated upper-body movements to control a computer cursor through a novel body-machine interface. Subjects learned to use the remaining ability of their shoulders and upper arms to perform movements that controlled a computer cursor to complete different related tasks. Complementary to [15], the purpose of this study was to identify changes in motor function and white matter by comparing clinical scores and FA values pre- and post-bilateral upper-body motor skill training in people with a high-level spinal cord injury. We started from the assumption that motor learning is likely to be associated with different brain reorganization in unimpaired subjects compared to subjects with tetraplegia, in consideration also of the greater need for the reorganization of motor functions in the latter group.

Continue —> Brain Sciences | Free Full-Text | Body-Machine Interfaces after Spinal Cord Injury: Rehabilitation and Brain Plasticity | HTML

Figure 5. Regions showing lower fractional anisotropy (FA) in spinal cord injury (SCI) subjects compared to controls. (A) Brain regions associated with motor function used to perform tract-based spatial statistics (TBSS) and ROI analyses; (B) TBSS results. Regions showing significantly higher (red-yellow) and lower (blue-light blue) FA values in SCI versus control subjects overlaid over the standard Montreal Neurological Institute (MNI)152 T1-weighted anatomical scan (p < 0.05, uncorrected). The location of each slice in Montreal Neurological Institute space is shown at the lower left section. a-s-pCR, anterior, superior and posterior corona radiata; CG, cingulum; g-bCC, genu and body of corpus callosum; a-pIC, anterior and posterior limbs of internal capsule.

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[WEB SITE] The Rehabilitation Gaming System

slideshow 1RGS is a highly innovative Virtual Reality (VR) tool for the rehabilitation of deficits that occur after brain lesions and has been successfully used for the rehabilitation of the upper extremities after stroke.
The RGS is based on the neurobiological considerations that plasticity of the brain remains  throughout life and therefore can be utilized to achieve functional reorganization of the brain areas affected by stroke. This can be realized by means of activation of secondary motor areas such as the so called mirror neurons system.

RGS deploys a deficit oriented training approach. Specifically, while training with RGS the patient is playing individualized games where movement execution is combined with the observation of correlated actions performed by a virtual body. The system optimizes the user’s training by analyzing the qualitative and quantitative aspects of the user’s performance. This warranties a detailed assessment of the deficits of the patient and their recovery dynamics.

Key articles and Recent publications

also see

Source: The Rehabilitation Gaming System | Rehabilitation Gaming System

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[ARTICLE] Eclectic/mixed model method for upper extremity functional recovery in stroke rehabilitation: A pilot study


Background: Eclectic treatment method is a flexible approach that uses techniques drawn from various schools of thought involving several treatment methods and allows the therapist to adapt to each client’s individual needs. Wider application for eclectic approach is however limited in stroke rehabilitation. Aim: The objective is to find out whether eclectic approach improves upper extremity (UE) functional recovery in acute stroke rehabilitation. Methodology: Twenty-five postacute unilateral supratentorial stroke subjects recruited from tertiary care hospitals recovered with Stage 2–5 in Brunnstorm stage of UE motor recovery (BRS-UE) underwent 45 min of eclectic approach for UE every day involving seven different treatment methods (5 min for each method) for 6 days consecutively. The outcome was UE subscale of the Fugl-Meyer Motor test (UE-FM), UE subscale of the Stroke Rehabilitation Assessment of Movement (UE-STREAM), Wolf Motor Function test (WMFT-FAS), and Stroke Impact Scale-16 (SIS-16) was collected at the end of the sixth session. Results: All the participants showed significant improvement in all the outcome measures. The Stage 2 and 3 subjects showed UE-STREAM (P = 0.007) WMFT-FAS (P < 0.001), SIS (P = 0.023) respectively and for Stage 4 and 5 the subjects have shown UE FM (P < 0.001), WMFT-FAS (P < 0.001), SIS (P = 0.004) with large magnitude of treatment effect for all stages of BRS-UE. Conclusion: Our study findings are in favor of integrating eclectic approach than single intervention/approach in clinical practice to improve the UE functional recovery for motor rehabilitation when the stroke occurs.


Globally, stroke is the third major cause of mortality and a major health issue in low- and middle-income countries like India.[1]Eighty percent of stroke survivors experience motor impairments (hemiparesis) typically affecting movement of the face, arm, trunk, and leg of one side of the body often persistent and disabling them. These residual impairments limit their functional independence and predisposing them to restrict their participation in community and social roles.[2],[3]

Upper limb hemiparesis is one of the primary impairments following the stroke. It is often reported to be incomplete in functional recovery and to restore the motor skills. The studies on recovery of voluntary arm movements have also shown that 5–20% of stroke survivors achieved complete functional recovery and 30–60% of paretic arm can never have complete recovery during the first 6 months after the stroke.[4],[5] Common upper extremity (UE) impairments after the stroke include paresis, loss of fractionated movement, abnormal muscle tone and/or changes in somatosensation, shoulder pain, and subluxation which prevents the functional use of the arm, bimanual tasks and also for fine motor skills.[6],[7] Post stroke, persistent arm motor impairment (a period of 1 year or above) can be associated with anxiety and poorer perception of health-related quality of life and subjective well-being.[8],[9]

One of the primary aims of the stroke rehabilitation is to improve the arm functions and to regain the gross and fine motor skills. Currently, the existing rehabilitation protocols that are designed to improve UE functions include the various treatment methods/interventions such as Roods, Brunnstorm, proprioceptive neuromuscular facilitation, neuro-developmental therapy techniques, repetitive/task-specific training, strength training, sensorimotor interventions, constraint-induced movement therapy, virtual reality, spasticity treatment, electromyographic/biofeedback, transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, functional electric stimulation, motor imagery, mirror therapy, and bilateral arm training.[10] However, recent systematic reviews have concluded that there is insufficient evidence observed for any intervention or approach that can currently be used in routine practice to improve the paretic upper limb functions.[11]

An eclectic therapy is a therapeutic approach that incorporates a variety of therapeutic principles and philosophies to create the ideal treatment program to meet the specific needs of the patient or client. The intervention of an eclectic approach is based on the stable principles of the classic traditional methods but is open to refining and can be used in conjunction with the elements of other various new methods, thus providing a framework for designing an optimal neurorehabilitation protocol.[12],[13] The studies have shown that the eclectic approach is suitable for a diverse and complex set of patients.[14],[15],[16] However, wider application of eclectic approach in stroke rehabilitation is limited in literature.

Continue —> Eclectic/mixed model method for upper extremity functional recovery in stroke rehabilitation: A pilot study Kumar K V, Joshua AM, Kedambadi R, Mithra P P – J Nat Sc Biol Med

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[Research Poster] Upper Limb Virtual Reality Training Provides Increased Activity Compared With Conventional Training for Severely Affected Subacute Patients After Stroke

To compare amount of activity of virtual reality (VR) and conventional task-oriented training (CT).

Source: Upper Limb Virtual Reality Training Provides Increased Activity Compared With Conventional Training for Severely Affected Subacute Patients After Stroke – Archives of Physical Medicine and Rehabilitation

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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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[Abstract+References] Movement Kinematics of the Ipsilesional Upper Extremity in Persons With Moderate or Mild Stroke

Background. An increasing number of studies have indicated that the ipsilesional arm may be impaired after stroke. There is, however, a lack of knowledge whether ipsilesional deficits influence movement performance during purposeful daily tasks.

Objective. The aim of this study was to investigate whether, and to what extent, movement impairments are present while performing an ipsilesional upper extremity task during the first 3 months after stroke.

Methods. Movement kinematics describing movement time, smoothness, velocity, strategy, and pattern were captured during a standardized drinking task in 40 persons with first-ever stroke and 20 controls. Kinematics were measured early and at 3 months poststroke, and sensorimotor impairment was assessed with Fugl-Meyer Assessment in stroke.

Results. Half of the ipsilesional kinematics showed significant deficits early after stroke compared to controls, and the stroke severity had a significant impact on the kinematics. Movements of the ipsilesional arm were slower, less smooth, demonstrated prolonged relative time in deceleration, and increased arm abduction during drinking. Kinematics improved over time and reached a level comparable with controls at 3 months, except for angular velocity of the elbow and deceleration time in reaching for those with more severe motor impairment.

Conclusions. This study demonstrates that movements of the ipsilesional arm, during a purposeful daily task, are impaired after stroke. These deficits are more prominent early after stroke and when the motor impairment is more severe. In clinical studies and praxis, the use of less-affected arm as a reference may underestimate the level of impairment and extent of recovery.

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Source: Movement Kinematics of the Ipsilesional Upper Extremity in Persons With Moderate or Mild Stroke – Jan 20, 2017

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


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.


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


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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