Posts Tagged UE

[Abstract] Quantification method of motor function recovery of fingers by using the device for home rehabilitation – IEEE Conference Publication


After leaving hospital, patients can carry out rehabilitation by using rehabilitation devices. However, they cannot evaluate the recovery by themselves. For this problem, a device which can both carry out the rehabilitation and evaluation of the degree of recovery is required. This paper proposes the method that quantifies the recovery of the paralysis of fingers to evaluate a patient automatically. A finger movement is measured by a pressure sensor on the rehabilitation device we have developed. A measured data is used as a time-series signal, and the recovery of the paralysis is quantified by calculating the dissimilarity between a healthy subject’s signal and the patient’s signal. The results of those dissimilarities are integrated over all finger to be used as a quantitative scale of recovery. From the experiment conducted with hemiplegia patients and healthy subjects, we could trace the process of the recovery by the proposed method.

Source: Quantification method of motor function recovery of fingers by using the device for home rehabilitation – IEEE Conference Publication


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[Abstract] The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive training that is needed to trigger neuroplasticity following a stroke. However, the lack of fully adaptive assist-as-needed control of the robotic devices and an inadequate immersive virtual environment that can promote active participation during training are obstacles hindering the achievement of better training results with fewer training sessions required. This study thus focuses on these research gaps by combining these 2 key components into a rehabilitation system, with special attention on the rehabilitation of fine hand motion skills. The effectiveness of the proposed system is tested by conducting clinical trials on a chronic stroke patient and verified through clinical evaluation methods by measuring the key kinematic features such as active range of motion (ROM), finger strength, and velocity. By comparing the pretraining and post-training results, the study demonstrates that the proposed method can further enhance the effectiveness of fine hand motion rehabilitation training by improving finger ROM, strength, and coordination.

Source: The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

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[WEB SITE] 30+ Hand Therapy Exercises after Stroke – Flint Rehab

Hand therapy exercises after stroke will help you regain your fine motor skills and finally get your hand back.

However, hand movement can be one of the most stubborn and difficult functions to recover, so it’s important to experiment with all your options until you find the one that works best for you.

And just to be clear, this isn’t a normal list labeled 1, 2, 3, 4, etc. Rather, it’s a collection of every hand exercise that we’ve ever shared on the blog… ever.

Ready to dive into our ultimate list of hand therapy exercises for stroke recovery? Let’s go!

2 Hand Stretching Exercises

These stretching exercises can be practiced passively or actively. For those with paralyzed hands, you can practice these stretching exercises passively by using your unaffected hand to help you complete the exercises.

This will help prevent muscle stiffening and encourage movement in your affected hand.

For those who do have some movement in their hand, you can practice these stretching exercises actively (meaning no assistance from your unaffected hand) as a good warm up activity.

Wrist Extension and Flexion

hand therapy exercises after stroke wrist flexion extension

With your forearm on a table, let your hand hang off the side of the table with your palm down. Then, move your hand up and down, bending at your wrist. When you’re done, repeat with your palm facing up.

Thumb Extension and Flexion

hand therapy exercises thumb extension flexion

Start with your palm open, as if you were signaling the number 5. Then, practice moving your thumb over to your pinky side, as if you were signaling the number 4. Continue to move your thumb back and forth between these 2 positions.

6 Easy Hand Therapy Exercises

For those with some hand movement, try these simple tasks that involve common household items.

  • Stacking coins
  • Pinching clothespins
  • Playing board games like chess or checkers
  • Putting together a puzzle
  • Playing the piano
  • Playing a virtual piano app

These exercises can get boring fast though, so if you’re looking for some effective, musical fun, we recommend our MusicGlove hand therapy device.

2 Rotation and Shift Hand Exercises

Once you’ve mastered the complex hand manipulation exercise, you’ll be ready to work on performing rotation and shift exercises.

Take a pen, and try rotating it around your middle finger, using your thumb, index, and ring finger to help you manipulate the pen. Think about twirling the pen around your fingers.

Then, practice a shifting movement by holding the pen in a writing position (in between your thumb, index, and middle finger) and shifting the pen forward until you’re holding the end of the pen.

Then, shift the pen back until you’re holding the tip once again. Think about inching your fingers along the pen.

1 Advanced Hand Exercise

For this complex hand exercise, gather 10 small objects (like uncooked beans) and practice picking them up with your fingers. But instead of immediately setting them down, try holding all of the objects in your palm (of the same hand) while you continue to pick the rest up.

You’ll be working on pinching movements with your index finger and thumb while the rest of your fingers work to keep the objects in your palm.

Then, once all the objects are in your hand, practice putting them down one by one. You’ll use your thumb to move each object from your palm down to your index finger and thumb, and then place the object back down onto the table.

This requires a great deal of coordination and control, so if you can’t get it at first, remember that it’s a difficult task and you’ll get better with practice.

8 Hand Therapy Ball Exercises

Hand therapy balls are the cheapest tools you can use to regain hand movement after stroke. (Aside from stacking pennies…)

Try using a soft one if you’re still developing strength, and use something more firm if you’re focused more on regaining coordination. Hand therapy balls usually come in different thicknesses so that you can keep yourself consistently challenged.


  1. Power Grip – Squeeze the hand therapy ball with your fingers and thumb. Focus on pressing the pads and tips of your fingers into the ball.
  2. Pinch – Pinch the ball with fingers and thumb extended. Press your fingers down into the top of the ball and your thumb upward on the bottom of the ball.
  3. Thumb Extension – Roll the ball up and down your palm by flexing (making your thumb bent) and extending (making your thumb straight). This will move the ball up and down your hand in a somewhat straight motion.
  4. Table Roll – Roll the ball from the tip of your fingers to your palm.
  5. Finger Flexion – Hold the ball in your palm and press your fingers into the ball. This is different from the power grip above because you’re focusing on an inward movement instead of a global gripping movement. Imagine that you’re pressing your fingers stright into your palm.
  6. Thumb Roll – Use your thumb to roll the ball in a circular motion on your palm.
  7. Finger Squeeze – Squeeze the ball between two fingers – any two fingers you please.
  8. Thumb Opposition – Roll the ball side to side on your palm using your thumb.

You can read more details about these hand therapy ball exercises here.

8 Hand Therapy Putty Exercises

If you’re looking for something more creative than therapy balls, then therapy putty is just the thing you need.
hand therapy putty exercises

  1. Finger Scissors – Squeeze the putty between your fingers
  2. Fingertip Pinch – Pinch the putty using your thumb and fingertips
  3. Power Grip – Squeeze all your fingers into the putty
  4. Flat Pinch – Pinch the putty down into your thumb with straightened fingers
  5. Finger Spread – Wrap the putty around two fingers and spread your fingers apart
  6. Finger Extension – Wrap the putty around a hooked finger and then straighten your finger using the putty as resistance
  7. Finger Spread – Wrap the putty around your hand and then spread your fingers out to stretch the putty
  8. Full Grip – Squeeze down on the putty, pressing your fingers into your palm

You can find further explanation of these therapy putty exercises here.

And if you’re in need of some high quality putty, check out our 4-pack that comes in a variety of resistances.

9 Tabletop Hand Exercises

And now it’s time to meet Barbara!

Hand and finger exercises for stroke patients

Barb is our favorite physical therapist and – lucky you – she’s the one who guides all our hand therapy exercise videos on FlintFit.

We took 9 exercises straight out of FlintFit and put them in this article with tabletop hand exercises. The exercises are:

  1. Palm up and down
  2. Wrist bend movement
  3. Wrist side movement
  4. Rolling movement
  5. Wrist curl
  6. Grip and release
  7. Pen spin
  8. Coin drop
  9. Finger curl

Click here to get all 9 exercises with pictures.

MusicGlove – Hand Therapy with a Beat

Hand therapy is our specialty (if you couldn’t tell) and we changed the game by making it fun, too.

If you enjoy music and gaming, then you will love MusicGlove.

The device fits over your hand like a glove, and then you are encouraged to make various therapeutic pinching movements in sync with a musical game.

It’s a lot of fun, and it’s clinically proven to improve hand function in just 2 weeks.

If you want to take your hand therapy to the next level, then see if MusicGlove is a good fit for you.

Source: 30+ Hand Therapy Exercises after Stroke – Flint Rehab

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[VIDEO] Pablo Product Film – YouTube


Δημοσιεύτηκε στις 18 Ιουλ 2017

The PABLO is the latest in a long row of clinically tried and tested robotic- and computer-assisted therapy devices for arms and hands. The new design and the specially developed tyroS software make the PABLO more flexible and offer an expanded spectrum of therapy options.


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[ARTICLE] A novel generation of wearable supernumerary robotic fingers to compensate the missing grasping abilities in hemiparetic upper limb – Full Text PDF


This contribution will focus on the design, analysis, fabrication, experimental characterization and evaluation of a family of prototypes of robotic extra fingers that can be used as grasp compensatory devices for hemiparetic upper limb.

The devices are the results of experimental sessions with chronic stroke patients and consultations with clinical experts. All the devices share a common principle of work which consists in opposing to the paretic hand/wrist so to restrain the motion of an object.

Robotic supernumerary fingers can be used by chronic stroke patients to compensate for grasping in several Activities of Daily Living (ADL) with a particular focus on bimanual tasks.

The devices are designed to be extremely portable and wearable. They can be wrapped as bracelets when not being used, to further reduce the encumbrance. The motion of the robotic devices can be controlled using an Electromyography (EMG) based interface embedded in a cap. The interface allows the user to control the device motion by contracting the frontalis muscle. The performance characteristics of the devices have been measured through experimental set up and the shape adaptability has been confirmed by grasping various objects with different shapes. We tested the devices through qualitative experiments based on ADL involving a group of chronic stroke patients in collaboration with by the Rehabilitation Center of the Azienda Ospedaliera Universitaria Senese.

The prototypes successfully enabled the patients to complete various bi-manual tasks. Results show that the proposed robotic devices improve the autonomy of patients in ADL and allow them to complete tasks which were previously impossible to perform.

Full Text PDF

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[ARTICLE] Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke – Full Text

Several approaches to rehabilitation of the hand following a stroke have emerged over the last two decades. These treatments, including repetitive task practice, robotically assisted rehabilitation and virtual rehabilitation activities, produce improvements in hand function, but have yet to reinstate function to pre-stroke levels— which likely depends on developing the therapies to impact cortical reorganization in a manner that favors or supports recovery. Understanding cortical reorganization that underlies the above interventions is therefore critical to inform how such therapies can be utilized and improved, and is the focus of the current investigation. Specifically, we compare neural reorganization elicited in stroke patients participating in two interventions: a hybrid of robot-assisted virtual reality rehabilitation training (RAVR), and a program of repetitive task practice training (RTP).
Ten chronic stroke subjects participated in eight, three-hour sessions of RAVR therapy. Another group of 9 stroke subjects participated in eight sessions of matched RTP therapy. Functional Magnetic Resonance Imagining (fMRI) data were acquired during paretic hand movement, before and after training. We compared the difference between groups and sessions (before and after training) in terms of BOLD intensity, laterality index of activation in sensorimotor areas, and the effective connectivity between ipsilesional motor cortex (iMC), contralesional motor cortex (cMC), ipsilesional primary somatosensory cortex (iS1), ventral premotor area (iPMv), and supplementary motor area (iSMA). Last, we analyzed the relationship between changes in fMRI data and functional improvement measured by the Jebsen Taylor Hand Function Test (JTHFT), in an attempt to identify how neurophysiological changes are related to motor improvement.
Subjects in both groups demonstrated motor recovery after training, but fMRI data revealed RAVR-specific changes in neural reorganization patterns. First, BOLD signal in multiple regions of interest was reduced and re-lateralized to the ipsilesional side. Second, these changes correlated with improvement in JTHFT scores. Our findings suggest that RAVR training may lead to different neurophysiological changes when compared to traditional therapy. This effect may be attributed to the influence that augmented visual and haptic feedback during RAVR training exerts over higher-order somatosensory and visuomotor areas.


Recovery of hand function is challenging after stroke. Empirical data suggest that treatment can be beneficial if it includes many repetitions of challenging and meaningful tasks (13). Several approaches to delivering high volume, intense, and salient rehabilitation activities have emerged over the last two decades. These treatments, which include repetitive task practice (RTP), robotically assisted rehabilitation, and virtual rehabilitation activities, produce improvements in hand function that exceed the standard of care in the US (45).

Although a strong case has been made that virtual reality (VR) and robotics can be useful technologies for delivering challenging, meaningful, and mass practice, outcome studies investigating the true benefits of VR/robotics as compared to dose-matched RTP remain mixed (67). For example, we have shown significant group-level improvement in hand and arm function of chronic stroke survivors in response to RTP and robot-assisted VR (RAVR) training to be similar for both groups (8), a finding that agrees with group-level effects in other clinical studies (910). However, whether the underlying neural patterns of reorganization that are induced by the different training regimes are also similar remains unknown. This becomes important to understand because it may inform researchers and clinicians whether RAVR versus RTP may preferentially facilitate distinct neural patterns of reorganization. If so, then perhaps the therapy choice can be tailored more appropriately to individuals to elicit optimal benefits.

The goal of this study was to compare the effect of RAVR- and RTP-based interventions on neural pattern reorganization. Because neural reorganization likely reflects complex processes that include the formation of new connections and/or re-weighting of existing connections, the patterns that emerge are unlikely to be reliably captured using one proxy of activation. For example, while numerous studies have shown training-induced changes in the extent of brain activity, the results of those studies conflict in terms of whether the changes reflect an increase or a decrease in brain activity (1115). Second, there seems to be a relationship between the pattern of reorganization (increase or decrease in ipsilesional somatosensory activation) and intactness of the hand knob area of M1 and its descending motor fibers (16), and a dependence on whether the lesion is cortical or subcortical (17). Connectivity measures may be a complementary way to understand neural reorganization patterns underlying stroke recovery (18) by providing additional information about dynamic network-level changes above and beyond what can be inferred from extent and laterality of activation (1920).

In this study, we therefore characterize the pattern of neural reorganization using multiple measures that included the magnitude of change in brain activation, the extent of activation, the re-lateralization of brain activation in a set of homologous interhemispheric regions of interest, and interactions between multiple regions of interest based on measures of functional and effective connectivity. To our knowledge, this is the first study to characterize brain reorganization at the ROI and network interaction level with multiple functional magnetic resonance imaging (fMRI) measures before and after RAVR and RTP training. In order to delineate the relevance of brain reorganization after training, we also correlated the brain activation outcomes with clinical outcome measures.

We hypothesized that both treatments might have similar effects on the magnitude and laterality of activation in a given region of interest. However, because RAVR training provides a training environment that is enriched and augmented with visual and haptic feedback, we expected that the functional and effective connectivity between motor/premotor cortices and visuomotor areas like the superior parietal lobule may show stronger effects in the RAVR group, as compared to the RTP-based training group (2125). We propose that identifying the neurophysiologic correlates of behavioral motor function improvement might allow strategic refinement of existing training approaches and the development of individually tailored interventions. […]


Continue —>  Frontiers | Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke | Neurology

Figure 1(A,B) The robotic arm, a data glove and force-reflecting hand system used in the robot-assisted virtual reality therapy. (C) Virtual reality feedback during the fMRI movement task. For each hand, one arrow points to the starting position of the hand (open) and another arrow defines the magnitude of finger flexion during the task.

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[Abstract] Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice 


Background and Purpose

Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions.


Design: This is a retrospective analysis of randomized trial data. Participants: 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands. Procedure: PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories.


PTs and OTs spent on average 4–7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on “moving around using transportation,” “self care,” and “household tasks” categories.


Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm-oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries.

Source: Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice – Jong – 2017 – Physiotherapy Research International – Wiley Online Library

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[Abstract] Occupational therapy for the upper limb after stroke: implementing evidence-based constraint induced movement therapy into practice. – Doctoral thesis


Constraint induced movement therapy (CIMT), an intervention to increase upper limb (UL) function post-stroke, is not used routinely by therapists in the United Kingdom; reasons for this are unknown. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework to analyse CIMT research and context, a series of related studies explored implementation of CIMT into practice.

Methods and Findings
Systematic review: nineteen CIMT randomised controlled trials found evidence of effectiveness in sub-acute stroke, but could not determine the most effective evidence-based protocols. Further review of qualitative data found paucity of evidence relating to acceptability and feasibility of CIMT.
Focus group: perceptions of the feasibility, including facilitators and barriers, of implementing CIMT into practice were explored in a group of eight therapists. Thematic analysis identified five themes: personal characteristics; setting and support; ethical considerations; education and training; and practicalities, which need to be addressed prior to implementation of CIMT.

Mixed-methods, pilot study (three single cases): pre- and post-CIMT (participant preferred protocol) interviews explored perceptions and experiences of CIMT, with pre- and post-CIMT measurement of participation and UL function. Findings indicated: (i) provision of evidence-based CIMT protocols was feasible, although barriers persisted; (ii) piloted data collection and analysis methods facilitated exploration of stroke survivors’ perceptions and experiences, and recorded participation and UL function.

Findings traversed PARIHS elements (evidence, context, facilitation), and should be considered prior to further CIMT implementation. Future studies of CIMT should explore: effects of CIMT protocol variations; characteristics of stroke survivors most likely to benefit from CIMT; interactions between CIMT and participation.

Source: Keele Research Repository – Keele University

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[VIDEO] gloreha Sinfonia – YouTube

Fits like a Glove

Doctors, phisiotherapists and caregivers have a mutual key goal: enhancing Patient Quality of Life. Professional experience and robotic technology are the ideal means to a successful rehabilitation.
Gloreha is a robotic glove which permits customizable, task-oriented, and adjustable therapies. An involving and motivating therapy is given by the sum of upper limb motor recovery, proprioceptive stimulation and interaction with real objects.
Gloreha Sinfonia is a device for upper limb rehabilitation that supports patients during all the phases of recovery.

A comfortable and lightweight glove
The key feature of Gloreha Sinfonia is a rehabilitation glove which supports fingers joint motion, while detecting voluntary active motion.
Patients are totally involved during motor exercises, thanks to multisensory stimulation and 3D animation on the screen.
According to necessity, motion can be triggered by the robotic glove (passive mobilization), or by the patients themselves (active games). The device will support patients’ effort, intervening only when necessary (active-assisted mobilization).

Task-oriented functional exercises for rehabilitation
The aim of every rehabilitation program is the recovery of the Activities of Daily Living (ADL). Gloreha Sinfonia helps patients perform grasping, reaching, picking exercises, and interacting with real objects.
Gloreha Sinfonia is an ideal workstation designed to recover functional movements. It also provides a wide variety of motivational and challenging exercises with different difficulty levels.

Weight compensation
Gloreha Sinfonia includes two dynamic supports. Their function is to relieve upper limb weight, fostering the completion of functional exercises:
Patients’ arms can completely move and float freely.

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[Abstract] The effect of bilateral arm training on motor areas excitability in chronic stroke patients



Physical therapy exercises that do not enhance motor areas neuroplasticity lead to motor impairment especially at the upper extremity (UE) in the chronic stroke patients. The aim of this study was to assess the effect of using bilateral arm training on motor areas excitability (neuroplasticity) in the chronic stroke patients.


Thirty male chronic stroke patients with moderate impairment of UE were assigned into two equal groups. The changes of motor areas excitability (neuroplasticity) were assessed before and after arm training by spectral analysis of mapping electroencephalogram (EEG). Delta, theta, alpha, beta 1 and beta 2 waves were recorded. The equation which was used to detect the neural plasticity and the changing at motor areas excitability was dividing the fast wave/slow waves or detecting the ratio of mean frequency of (beta 2 + beta 1 + alpha/theta + delta).


Patients in group 1 (G1) received unilateral arm training and patients in group 2 (G2) received bilateral arm training. The Results: Showed significant increase in the excitability (neuroplasticity) at (F4 + F8) and (C4) motor areas in G2 comparing to G1 (p!9 .006) and (p!9 .036 ) respectively.


Bimanual training leads to activation of extensive networks in both hemispheres.


It was concluded that bilateral arm training is a recommended method to enhance the motor areas excitability (neuroplasticity) in the chronic stroke patients.


Post stroke physical therapy can make use of bimanual training for better rehabilitation.

Source: S185 The effect of bilateral arm training on motor areas excitability in chronic stroke patients – Clinical Neurophysiology

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