Posts Tagged upper limb
[ARTICLE] Comparing Home Upper Extremity Activity with Clinical Evaluations of Arm Function in Chronic Stroke – Full Text PDF
[Abstract] Artificial intelligence-based interactive virtual reality-assisted gaming system for hand rehabilitation
[Abstract] Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication
Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.
Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.
Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject’s upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
Robotic neurorehabilitation has the potential to improve the quality and intensity of rehabilitation treatments in order to promote motor-cognitive recovery following a central nervous system disease.
Controversial results in literature maybe generated by confusion in the use of robots related to many technological and clinical features, and emphasized by excessive optimism or scepticism about this technology.
Budgets spent for robots in rehabilitation are expected to grow dramatically in the next future, but there is the need of evidence-based proofs to balance the business push.
There is need of further researches in motor-cognitive technological rehabilitation in order to better understand the gain that robotic therapy could add to conventional therapy in relation to the patient’s cognitive reserve.
There is a need for clinical consensus conferences that might give clinical indication to end users.
via Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication: Expert Review of Medical Devices: Vol 0, No 0
[ARTICLE] Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke – Full Text
The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable.
Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1–4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove.
The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were ‘more or less satisfied’ with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands.
The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.
Fifteen million individuals worldwide experience a stroke each year with 50,000 of these cases occurring in Canada . Approximately two-thirds of these individuals will experience neurological deficit  and half will never fully recover the hand function required to perform activities of daily living independently . Stroke survivors with severe hand impairment have difficulty producing hand motion and grip force and their increased muscle tone, spasticity and contractures keep their hand clenched in a fist. These stroke survivors have the potential to attain functional improvements years after their stroke by constantly incorporating the affected hand into activities of daily living (ADLs) and additional goal-directed tasks during their therapy exercises and daily routines [4,5,6].
There are many barriers to incorporating the affected hand into exercises and daily routines including time, discomfort, safety risks and mental and physical effort. Personalized, high-intensity, coaching and motion assistance is required to overcome these barriers but is often inaccessible to stroke survivors. The time and resource commitments are too substantial for many clinics to supply at a sufficient intensity and additional rehabilitation technologies and services can be inaccessible due to high cost, location and availability [7, 8]. As a result, stroke survivors often do not regain the hand range of motion (ROM), strength and coordination required to perform ADLs independently. Affordable and accessible rehabilitation technologies and services that enable stroke survivors with severe hand impairment to incorporate their affected hand into ADLs are needed to maximize neuromuscular recovery and daily independence.
Design targets for wearable hand robots
A main goal for wearable hand robots is to provide the hand function assistance and rehabilitation required to enable people after stroke to perform ADLs independently. Able-bodied individuals move their fingers through a ROM of 164o during activities of daily living, as calculated by summing the differences between the extension and flexion joint angles of the distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints . The thumb moves through a ROM of 40o, as calculated by summing the differences between the extension and flexion joint angles of the thumb’s interphalangeal (IP) and MCP joints . Grip forces averaging 67 N are exerted  and a combination of hand postures are used (i.e. a tripod pinch was used during 38% of the activities of daily living evaluated, extended hand (13%), cylindrical grasp (12%), lumbrical grasp (10%), lateral pinch (9%)) .
Capabilities of wearable hand robots
Wearable hand robots have manipulated able-bodied participants’ relaxed hands to provide 129o of index finger ROM, 83 N of grip strength as measured using a hand dynamometer, and 7 hand postures in Rose et al. . However, when these robots are evaluated with impaired hands the assistive capabilities have been much lower. For studies by Cappello et al. and Soekadar et al. with six and nine persons with impaired hands following a spinal cord injury, wearable hand robots have increased grip strength to 4 N  and ADL performance to 5.5 out of 7 on the Toronto Rehabilitation Institute – Hand Function Test by assisting pinch and palmar grasp postures [12, 13]. For a study by Yurkewich et al. with five persons with severely impaired hands following stroke (no voluntary index finger extension), a previous version of the HERO Grip Glove named the HERO Glove increased ROM to 79o and improved water bottle and block grasping performance . Refer to  for a supplementary table detailing recently developed wearable hand robots, their capabilities and their evaluation results. Hand robots need to be improved to generate strong extension and grip forces that overcome muscle tone and securely stabilize various object geometries, such as a water bottle and a fork. These robots should also be easy to put on clenched hands, comfortable during multiple hours of use, lightweight so as not to affect the motion of weak arms and affordable so they are accessible to people with limited income even though these considerations create design tradeoffs that sacrifice assistive capabilities [14, 15].
A number of sensor types (i.e. button [12, 14, 16], electromyography [17, 18], motion [10, 14], force , voice , vision [21, 22] and electroencephalography  have been selected to control robot assistance based on varied motivations such as robust operation or motivating neuromuscular activation. However, other than button control, these control strategies are still in an experimental stage that requires experts to manually tune each user’s orthosis .
A single study evaluating two stroke survivors’ satisfaction with a wearable hand robot was completed by Yap et al.  to understand their needs and preferences in wearable hand robot design. More rigorous studies would further inform designers on how to adapt their wearable hand robots to maximize the intended users’ satisfaction and arm and hand use.
This article presents the portable Hand Extension Robot Orthosis (HERO) Grip Glove, including its novel design features and the evaluation of its assistive capabilities and usability with 11 stroke survivors with severe hand impairments. The HERO Grip Glove, shown in Fig. 1, assists five-finger extension, thumb abduction and tripod pinch grasping using particular cable materials and routing patterns and only two linear actuators. A fold-over wrist brace is used to mount the electronic components, support the wrist, and ease donning. The robot is controlled by hand motion or a button. The robot is open source for broad access, untethered and lightweight for unencumbered use throughout daily routines, and soft to conform to hands and objects of varying geometries. The HERO Grip Glove increases range of motion and ADL performance with large and small objects and increases grip strength for those without grip strength. The participants’ quantitative and qualitative feedback from their user satisfaction questionnaires provides guidance for assistive technology developers and motivation for deploying the HERO Grip Glove to stroke survivors for use throughout their daily routines.
Continue —-> Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text
[Abstract] Optimization of Upper Extremity Rehabilitation by Combining Telerehabilitation With an Exergame in People With Chronic Stroke: A Mixed-Method Study Protocol
Background: Exergames have the potential to provide an accessible, remote approach for post stroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed and lack of motivation to pursue exercise program, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant completion and adherence. Currently, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation.
Objective: 1) To determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life and motivation, in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program) 2) To examine the feasibility of using the technology with stroke participants at home 3) To identify the obstacles and facilitators for its use by stroke participants and therapists and understand the shared decision-making process.
Methods: A mixed-methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct video conferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 stroke participants, randomly assigned to a control group (n=26, 2 months on-paper home exercise program: the graded repetitive arm supplementary program with no supervision) and an experimental group (n=26, 2 months home program using the technology). A blinded trained evaluator will be responsible for the face to face administration of the outcome measures. The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE in 28 everyday tasks), Stroke Impact Scale-16 (impact on quality of life) and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process (recruitment and retention rates), resources (exercise adherence, time spent with therapist,), management (technical problems)and scientific (safety, simple size) outcomes. Qualitative data will be collected by interviews with both participants and therapists.
Results: We expect to: A) Collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke B) collect feasibility data with users at home (adherence, safety, technical difficulties, etc.) and C) identify the obstacles and facilitators for the technology use and understand the shared decision-making process.
Conclusions: This paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation.
D Kairy et al. Contemp Clin Trials 47, 49-53. PMID 26655433. – Randomized Controlled TrialFindings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of car …
Mult Scler 22 (12), NP9-NP11. PMID 26041800.See Nilsagard et al.25Qualitative research approach. Interviewed (15-45 mins) within two weeks after the end of the intervention period. Interview covered refl …
Comparison of Kinect2Scratch Game-Based Training and Therapist-Based Training for the Improvement of Upper Extremity Functions of Patients With Chronic Stroke: A Randomized Controlled Single-Blinded TrialJW Hung et al. Eur J Phys Rehabil Med 55 (5), 542-550. PMID 30781936. – Randomized Controlled TrialKinect2Scratch game training was feasible, with effects similar to those of therapist-based training on UE function of patients with chronic stroke.
KE Laver et al. Cochrane Database Syst Rev 1 (1), CD010255. PMID 32002991. – ReviewWhile there is now an increasing number of RCTs testing the efficacy of telerehabilitation, it is hard to draw conclusions about the effects as interventions and comparat …
KE Laver et al. Cochrane Database Syst Rev 2013 (12), CD010255. PMID 24338496. – ReviewWe found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials tha …
[Dissertation] Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis
In the stroke rehabilitation literature, control interventions are often referred to as standard care or conventional rehabilitation. Concerningly, the majority of stroke rehabilitation trials lack an empirically based rationale for how control interventions are comparable to standard care rehabilitation. Inadequate descriptions of, and rationales for, control interventions across stroke rehabilitation trials are significant barriers to the advancement of evidence-based practice. Without a true understanding of `standard care’ in real-world practice, there is no way to know if the control intervention is truly comparable. There is an urgent need to characterize `standard care’ rehabilitation to inform control intervention development and improve interpretability of clinical trial results. The purpose of this study was to investigate current practices of occupational therapy practitioners in outpatient rehabilitation settings to address upper extremity hemiparesis in adult stroke survivors.
In Chapter 2, a cross-sectional e-mail survey was sent to OT practitioners across the United States to determine current practice patterns of therapists working in outpatient stroke rehabilitation nationwide. The results of this study (n=269) revealed that stretching, bilateral upper extremity training, strength training, weightbearing, manual therapy and task-oriented training were used by more than 85% of OT practitioners in our sample. Poor patient compliance (84%), medical complexity (64%), and spasticity (63%) were the most commonly reported barriers to patients meeting their OT goals in outpatient rehabilitation.
Chapters 3 and 4 present the results of a video-based observational study of outpatient OT sessions at an academic medical center. The Rehabilitation Treatment Specification System (RTSS) was used to analyze 30 OT treatment sessions. The average total session time was 52 ± 4.7 minutes with 36.2 ± 7.4 minutes of active time and 15.8 ± 7.1 minutes of inactive time per session. Interventions in the RTSS categories of `Skills and Habits’ (e.g., task-oriented activities) and `Organ Function’ (e.g., stretching, weightbearing) were used in the majority of OT sessions with `Skills and Habits’ activities accounting for 59% of active time and `Organ Function’ activities accounting for 35% of active time. After removing outliers, an average of 150.2 ± 85.2 UE repetitions occurred per session. Functional electrical stimulation (FES) was commonly used as an adjuvant to task-oriented activities and knowledge of performance was provided often during treatment.
Taken together, these results suggest that task-oriented training is commonly used by OT practitioners to address UE hemiparesis and musculoskeletal interventions are often used to mitigate spasticity in preparation for task-oriented activities. Future research will include video observation and analysis of OT practice sessions across multiple practice settings, as well as analyzing our remaining survey data across multiple practice settings (e.g., inpatient rehabilitation, skilled nursing facilities) to describe similarities and differences with the current findings.
[ARTICLE] Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial – Full Text
Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales.
Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM).
R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen’s d = − 0.81, p = 0.019), elbow extension (Cohen’s d = − 0.71, p = 0.038), and trunk movement (Cohen’s d = − 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen’s d = − 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen’s d = 1.16, p = 0.019).
Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings.
Stroke is a primary cause of long-term disability worldwide  with nearly 1.1 million persons in Europe suffering a stroke each year . Importantly, this number is expected to increase to more than 1.5 million cases per year in 2025, mainly due to an aging population .
Approximately 70–85% of persons post-stroke present with impairment of an upper limb [4, 5] that persists even after 3–6 months from stroke , leading to a significant reduction of independence and quality of life . Consequently, improving upper limb functionality is a core element of stroke rehabilitation to reduce disability and increase the capacity to perform the activities of daily living (ADLs) . Different rehabilitative approaches have been proposed [9, 10], including constraint induced movement therapy , functional electrical stimulation [12, 13], virtual reality [14, 15] and robot therapy [16, 17]. Regarding the latter approach, two recent reviews [16, 17] indicated that robot-based rehabilitation is effective in improving ADLs, arm function and muscle strength in persons post-stroke. Previous studies suggested that the advantage of robotic devices, when compared with other physiotherapy approaches, may be the capability of these systems to provide rehabilitation paradigms enabling a strict application of some motor learning principles [18,19,20] indispensible to promote neural plasticity and reorganization [21,22,23]. In particular these principles include (1) the provision of highly intensive training involving a large number of goal-directed movements (e.g. center-out reaching of peripheral targets aimed at improving the coordination between shoulder and elbow) [21, 24], (2) the promotion of active participation by the person, also when severely impaired , and (3) the provision of real-time sensory feedback (visual and haptic) and quantitative summary feedback that can be used by the participant to correct his/her movement [14, 26]. Importantly, as previously discussed [27, 28], further investigation is needed to evaluate if the application of these motor learning principles can enhance the transfer of the rehabilitation effects also to non-trained tasks and contexts typical of ADLs.
The effects of motor rehabilitation on upper limb function are commonly assessed with clinical scales  that are mainly focused on task accomplishment, but do not give quantitative, objective and sensitive information on underlying changes in neuromotor control strategies involving inter-joint coordination and/or compensatory movements [30,31,32,33]. As discussed by Levin et al. , the main goal of motor rehabilitation is to lead the person to accomplish a task. However, also the assessment of how the task is performed is of paramount importance to evaluate whether the person has regain the ability to execute the task with a more physiological upper limb motor pattern (recovery), or he/she has developed compensatory strategies, such as abnormal trunk rotations (compensation) [30, 31, 34,35,36,37]. Instrumented motion analysis may provide this information and complement clinical assessment [31,32,33, 38, 39].
Instrumented analysis is usually performed using quantitative robot-based indexes describing a number of trained and non-trained tasks [28, 40,41,42,43,44]. As summarized in a review by Nordin et al. , the most common robot-based parameters describing upper limb movement and sensation include the amplitude of robot-generated forces [40, 41], temporal and speed metrics [40, 43, 44, 46, 47], response latency [46, 47], accuracy indexes [40, 43, 44, 46, 47], path length and range of motion [41, 42, 46, 47], and movement smoothness [40,41,42,43,44, 46, 47]. The test-retest reliability, the discriminant ability and the concurrent validity of these robot-based indexes have been analyzed in a large number of studies. Among these studies, those including the largest samples of persons post-stroke [41, 46,47,48,49] found good to excellent reliability [41, 48], good discriminant ability [41, 47], and moderate to high concurrent validity with clinical scales [41, 46, 47, 49]. The main advantage of the robot-based indexes is that they can be easily obtained during the course of the robotic training, thus providing indications about the gradual progression of the participants’ performance . By contrast, the main drawback is that these parameters mainly describe the trajectory of the end-effector during planar tasks executed within the robot workspace that is different from the typical daily living contexts.
This drawback may be partly overcome by using more sophisticated kinematic analysis techniques [32, 33, 38, 51,52,53,54,55,56,57] aimed at characterizing the execution of more ecological activities performed outside the robot workspace, including pointing tasks [34, 37] or reaching forward and touching real objects placed on a table, such as boxes [54, 55], cups , glasses [32, 33, 57], discs , cones  and desk bells [52, 53, 56]. Compared to the robot-based indexes, these analyses may provide a more detailed characterization of the different components of a task (e.g. upper limb and trunk movements), thus adding information about the way a task is performed before and after a rehabilitation treatment. This, in turn, may help in assessing the effects of such treatment in terms of neuromotor recovery and/or compensation [30, 34, 37, 50]. However, with the exception of Cirstea and Levin  who described trunk and arm motion during a 3D pointing tasks, all the above mentioned studies analyzed activities that mainly involved movements in the horizontal plane, with a minimal vertical component against gravity that is, however, a fundamental aspect of ADLs.
Following these considerations, this pilot study had two aims. The first aim was to assess the effects of planar robotic rehabilitation versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from instrumented kinematic analysis of upper limb and trunk during the execution of a non-trained task involving horizontal and vertical arm movements. The second aim was to compare the effects of the two rehabilitation approaches on arm function as measured by clinical scales. We hypothesized that robot therapy provides larger improvements in the coordination between shoulder and elbow joints and in upper limb impairment, since it enables a rigorous application of the motor learning principles described above, in particular administration of high intensity goal-directed training, promotion of active participation, and provision of feedback.
[Abstract] The post-stroke upper limb improvement effort survey (IMPETUS): a survey of individuals with chronic stroke
Background: There is a considerable literature on arm/hand dysfunction post stroke, but little information on the participants’ opinions about perceived and desired arm/hand strength, recovery, and function.
Objective: The objective of this study was to examine the perceptions of individuals with stroke about arm/hand function and training devices.
Methods: A 69-item survey was developed addressing: activity before and after stroke, involved arm/hand function, willingness to use a training device, and important device characteristics. The survey included items from the Hand Function and Strength Subscales of the Stroke Impact Scale (SIS). Face validity was established by physical therapists and individuals with stroke. The survey was administered via phone and online.
Results: 852 registry participants were recruited. Ninety-seven responded; 83 completed the survey. Subjects were 51 males, 31 females; mean age: 65 (25–95); meantime since stroke: 13 years (1–34; SD 6.678). There was a statistically significant difference between perceived and desired arm/hand strength, recovery, and function p<0.0001. Impairment factors, such as weakness and spasticity were greater barriers to recovery than socio-economic ones. Most participants (94%) were willing to use a device; functional gains during/following use were the most important characteristics.
Limitations: Participants had greater arm impairment and were more chronic than other studies.
Conclusions: Participants desired more arm/hand strength, function, and recovery that they perceived they had achieved. Impairment – level factors posed more barriers to arm recovery than socioeconomic ones. Most participants were interested in using arm/hand training devices; the most important device characteristic is functional gain.
Background: Stroke is the leading cause of disability worldwide, with many stroke survivors having persistent upper limb functional impairment. Aside from therapist-directed rehabilitation, few efficacious recovery tools are available for use by stroke survivors in their own home. Game-based virtual reality systems have already shown promising results in therapist-supervised settings and may be suitable for home-based use.
Objective: We aimed to assess the feasibility of unsupervised home-based use of a virtual reality device for hand rehabilitation in stroke survivors.
Methodology: Twenty subacute/chronic stroke patients with upper extremity impairment were enrolled in this prospective single-arm study. Participants were instructed to use the Neofect Smart Glove 5 days per week for 8 weeks, in single sessions of 50 minutes or two 25-minute sessions daily. We measured (1) compliance to prescribed rehabilitation dose, (2) patient impression of the intervention, and (3) efficacy measures including the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT) and the Stroke Impact Scale (SIS).
Results: Seven subjects (35%) met target compliance of 40 days use, and 6 subjects (30%) used the device for 20-39 days; there were no age or gender differences in use. Subjective patient experience was favorable, with ninety percent of subjects reporting satisfaction with their overall experience, and 80% reporting perceived improvement in hand function (figure 1). There was a mean improvement of 26.6±48.8 seconds in the JTHFT (p=0.03) and 16.1±15.3 points in the domain of the SIS that assesses hand function (p<0.01). There was a trend towards improvement in the UE-FM (2.2±5.5 points, p=0.10).
Conclusions: A novel virtual reality gaming device is suitable for unsupervised use in stroke patients and may improve hand/arm function in subacute/chronic stroke patients. A large-scale randomized controlled trial is needed to confirm these results.
[Case Study] Robotic rehabilitation of the paralyzed upper limb for a stroke patient using the single-joint hybrid assistive limb: a case study assessed by accelerometer on the wrist – Full Text PDF
[Purpose] Recent studies have reported the effectiveness of robotic rehabilitation of paralyzed upper limbs in stroke patients. For example, the Single-Joint Hybrid Assistive Limb has been shown to improve upper limb impairments. However, limited data are available on the effectiveness of robotic rehabilitation of the upper limb with regards to daily living. In this case study, an accelerometer was adopted to examine whether rehabilitation using the Single-Joint Hybrid Assistive Limb improved upper limb activity during daily living in a stroke patient.
[Participant and Methods] The participant was a 69-year-old male diagnosed with stroke and left hemiparesis. The Single-Joint Hybrid Assistive Limb was applied to the participant’s elbow on the paralyzed side. The participant wore an accelerometer on each wrist to measure the activities of the upper limbs. Clinical tests of the paralyzed upper limb were also performed.
[Results] The activity of the paralytic limb was significantly higher after Single-Joint Hybrid Assistive Limb intervention than before the intervention. On the other hand, none of the results of the clinical tests changed beyond a clinically important difference.
[Conclusion] The Single-Joint Hybrid Assistive Limb could be useful for promoting active use of a paralyzed upper limb in daily living. In addition, an accelerometer could be especially useful for evaluating the effects of robotic rehabilitation.
Hemiparesis is a sequela that can substantially influence the lives of patients with stroke. For these patients, exercise therapy can improve not only the impairment but also the patients’ daily activities and quality of life1, 2). Recent studies have reported the effectiveness of robotic rehabilitation of paralyzed upper limbs in patients with stroke37). For example, Saita et al. demonstrated that the Single-Joint Hybrid Assistive Limb (HAL-SJ; HAL-FS01, CYBERDYNE, Inc., Tsukuba, Japan) improved upper limb impairment in stroke patients7) . However, these studies evaluated the upper limb function in a testing situation, such as by using Fugl-Meyer assessment or the Action Research Arm Test. Few data are available about the effectiveness of robotic rehabilitation for the upper limb for activities of daily living.
Recently, some studies reported that an accelerometer provides an effective method for assessing arm activity in daily living for patients with stroke8) . Thus, accelerometer may be useful for evaluating the effectiveness of robotic rehabilitation for daily activities. In this case study, accelerometer was used to examine whether robotic rehabilitation using the HAL-SJ improved upper limb activity in daily living in a patient with stroke.