[Abstract] Robot-assisted mirroring exercise as a physical therapy for hemiparesis rehabilitation

Abstract:

The paper suggests a therapeutic device for hemiparesis that combines robot-assisted rehabilitation and mirror therapy. The robot, which consists of a motor, a position sensor, and a torque sensor, is provided not only to the paralyzed wrist, but also to the unaffected wrist to induce a symmetric movement between the joints. As a user rotates his healthy wrist to the direction of either flexion or extension, the motor on the damaged side rotates and reflects the motion of the normal side to the symmetric angular position. To verify performance of the device, five stroke patients joined a clinical experiment to practice a 10-minute mirroring exercise. Subjects on Brunnstrom stage 3 had shown relatively high repulsive torques due to severe spasticity toward their neutral wrist positions with a maximum magnitude of 0.300kgfm, which was reduced to 0.161kgfm after the exercise. Subjects on stage 5 practiced active bilateral exercises using both wrists with a small repulsive torque of 0.052kgfm only at the extreme extensional angle. The range of motion of affected wrist increased as a result of decrease in spasticity. The therapeutic device not only guided a voluntary exercise to loose spasticity and increase ROM of affected wrist, but also helped distinguish patients with different Brunnstrom stages according to the size of repulsive torque and phase difference between the torque and the wrist position.

Source: Robot-assisted mirroring exercise as a physical therapy for hemiparesis rehabilitation – IEEE Conference Publication

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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

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

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.

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!

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

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

Abstract

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

[Abstract] A pilot study on the optimal speeds for passive wrist movements by a rehabilitation robot of stroke patients: A functional NIRS study

Abstract:

The optimal conditions inducing proper brain activation during performance of rehabilitation robots should be examined to enhance the efficiency of robot rehabilitation based on the concept of brain plasticity. In this study, we attempted to investigate differences in cortical activation according to the speeds of passive wrist movements performed by a rehabilitation robot for stroke patients. 9 stroke patients with right hemiparesis participated in this study. Passive movements of the affected wrist were performed by the rehabilitation robot at three different speeds: 0.25 Hz; slow, 0.5Hz; moderate and 0.75 Hz; fast. We used functional near-infrared spectroscopy to measure the brain activity during the passive movements performed by a robot. Group-average activation map and the relative changes in oxy-hemoglobin (ΔOxyHb) in two regions of interest: the primary sensory-motor cortex (SM1); premotor area (PMA) and region of all channels were measured. In the result of group-averaged activation map, the contralateral SM1, PMA and somatosensory association cortex (SAC) showed the greatest significant activation according to the movements at 0.75 Hz, while there is no significantly activated area at 0.5 Hz. Regarding ΔOxyHb, no significant diiference was observed among three speeds regardless of region. In conclusion, the contralateral SM1, PMA and SAC showed the greatest activation by a fast speed (0.75 Hz) rather than slow (0.25 Hz) and moderate (0. 5 Hz) speed. Our results suggest an optimal speed for execution of the wrist rehabilitation robot. Therefore, we believe that our findings might point to several promising applications for future research regarding useful and empirically-based robot rehabilitation therapy.

Published in: Rehabilitation Robotics (ICORR), 2017 International Conference on

Source: A pilot study on the optimal speeds for passive wrist movements by a rehabilitation robot of stroke patients: A functional NIRS study – IEEE Xplore Document

[Abstract] Virtual reality and non-invasive brain stimulation in stroke: How effective is their combination for upper limb motor improvement?

Abstract:

Upper limb (UL) hemiparesis is frequently a disabling consequence of stroke. The ability to improve UL functioning is associated with motor relearning and experience dependent neuroplasticity. Interventions such as non-invasive brain stimulation (NIBS) and task-practice in virtual environments (VEs) can influence motor relearning as well as adaptive plasticity. However, the effectiveness of a combination of NIBS and task-practice in VEs on UL motor improvement has not been systematically examined. The objective of this review was to examine the evidence regarding the effectiveness of combining NIBS with task-practice in VEs on UL motor impairment and activity levels. A systematic review of the published literature was conducted using standard methodology. Study quality was assessed using the PEDro scale and Down’s and Black checklist. Four studies examining the effects of a combination of NIBS (involving transcranial direct current stimulation; tDCS and repetitive transcranial magnetic stimulation; rTMS) were retrieved. Of these, three studies were randomized controlled trials (RCTs) and one was a cross-sectional study. There was 1a level evidence that the combination of NIBS and task-practice in a VE was beneficial in the sub-acute stage. A combination of training in a VE with rTMS as well as tDCS was beneficial for motor improvements in the UL in sub-acute stage of stroke (1b level). The combination was not found to be superior compared to task practice in VEs alone in the chronic stage (1b level). The results suggest that people with stroke may be capable of improving levels of motor impairment and activity in the sub-acute stage if their rehabilitation program involves a combination on NIBS and VE training. Emergent questions regarding the use of more sensitive outcomes, different types of stimulation parameters, locations and training environments still need to be addressed.

Published in: Virtual Rehabilitation (ICVR), 2017 International Conference on

Source: Virtual reality and non-invasive brain stimulation in stroke: How effective is their combination for upper limb motor improvement? – IEEE Xplore Document

[Abstract] The eWrist — A wearable wrist exoskeleton with sEMG-based force control for stroke rehabilitation.

Abstract:

Chronic wrist impairment is frequent following stroke and negatively impacts everyday life. Rehabilitation of the dysfunctional limb is possible but requires extensive training and motivation. Wearable training devices might offer new opportunities for rehabilitation. However, few devices are available to train wrist extension even though this movement is highly relevant for many upper limb activities of daily living. As a proof of concept, we developed the eWrist, a wearable one degree-of-freedom powered exoskeleton which supports wrist extension training. Conceptually one might think of an electric bike which provides mechanical support only when the rider moves the pedals, i.e. it enhances motor activity but does not replace it. Stroke patients may not have the ability to produce overt movements, but they might still be able to produce weak muscle activation that can be measured via surface electromyography (sEMG). By combining force and sEMG-based control in an assist-as-needed support strategy, we aim at providing a training device which enhances activity of the wrist extensor muscles in the context of daily life activities, thereby, driving cortical reorganization and recovery. Preliminary results show that the integration of sEMG signals in the control strategy allow for adjustable assistance with respect to a proxy measurement of corticomotor drive.

Published in: Rehabilitation Robotics (ICORR), 2017 International Conference on

Source: The eWrist — A wearable wrist exoskeleton with sEMG-based force control for stroke rehabilitation – IEEE Xplore Document

[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.

[BLOG POST] Home After a Stroke: Good and Bad News About Hand Recovery

I do not have a high level of hand recovery so I look for studies that do not cherry-pick high functioning stroke survivors to test the efficacy of rehab.  Many studies with positive results start with stroke survivors who already have beginning finger and thumb movement.  To decide how excited to get I look at the outcome measures as well as the statistical differences before and after treatment.  Looking at test scores is a good way to decide if research results apply to someone like you.

Franck and his associates studied stroke survivors with no spontaneous hand recovery (1).
Group 1 was taught to keep the affected arm/hand in an “optimal condition” and what to do when discomfort occurred.  Before rehab, the highest score on the Fugl-Meyer test was a 9 out of 66 which can be achieved with arm movements like reaching.  After 6 weeks of rehab for 4.5 hours per week, the highest Fugl-Meyer score was a 20 which can be achieved with NO hand or wrist movement.  After rehab, object manipulation on the Action Research Arm Test (ARAT) improved from 0 to 1 out of 57 for the highest functioning subject.  This is the bad news.

Before rehab Group 2 had ARAT scores for object manipulation ranging from 1 to 9 out of 57(1). They were given “high-intensity” therapy to use their hand during functional tasks.  Before rehab, the highest Fugl-Meyer score was a 25 out of 66. After 6 weeks of rehab for 6.0 hours per week, the highest Fugl-Meyer score was a 54. This dramatic improvement can be achieved only with hand and wrist movements.  After rehab, the highest ARAT score improved from 9 to 42 out of 57.
This dramatic improvement can only be achieved by gaining the ability to pick up objects like a ball.
This is good news because a client’s life can changed when he or she can manipulate objects.

1. Franck J, Johannes R, Smeets E, Seelen H. Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation. PLOS One. 6/21/2017. doi.org/10.11371/journal.pone.0179453

Source: Home After a Stroke: Good and Bad News About Hand Recovery

[BLOG POST] Home After a Stroke: Reviewing Virtual Reality Rehab

Between September 2011 and May 2017 Dean published 173 posts about the use of virtual reality to provide rehab for stroke survivors.  The results for the hand are depressing.  For six years research focused on a subject’s ability to touch an object on the screen so the computer can move an object or make it disappear.  Enjoying these quick reactions is not enough to justify the cost of this expensive equipment.  It was a good place to start 6 years ago, but progress towards useful gains is disappointing.  Stroke survivors want to manipulate objects with their hand.

There is a glimmer of hope.  Gauthier (1) used video games that make stroke survivors do more than use their shoulder and elbow to reach forward and side to side.  These games require forearm and wrist motions.  This may not sound exciting but these motions orient our hand to the many different positions objects rest in. The photo shows the forearm is halfway between palm up and palm down so the hand can pick up a glass.  Cocking the wrist means the rim of the glass is not pointed at the ceiling but at the person’s mouth.

Unfortunately, Gauthier selected stroke survivors who already had a few degrees of active forearm and wrist movement.  How can subjects make the leap from just reaching to turning their hand palm up to catch a parachute on a video screen?  My OT gave me exercises that helped me regain forearm and wrist motions.  These small motions have made me more independent.  For example, I can turn my hand halfway between palm up and palm down to grab my cane so my sound hand can catch the door before the person in front of me lets it slam shut.  I picture stroke survivors practicing forearm and wrist motions and then immediately trying to turn their hand palm up so they can turn over a card on the computer screen. Fun + repetition is good.

1. Gauthier L, et al. Video game rehabilitation for outpatient stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis. BMC Neurology. 2017;17-109. doi:10.1186/s12883-017-0888-0.

Source: Home After a Stroke: Reviewing Virtual Reality Rehab

[WEB SITE] Robotic-Assisted Rehabilitation Therapy Designed to Aid Stroke Recovery

Pictured here is the experimental setup for the estimation of the 3 DOF human forearm and wrist impedance. (Photo courtesy of UNIST)

Scientists from Ulsan National Institute of Science and Technology (UNIST) have developed a new robotic tool to assess muscle overactivity and movement dysfunction in stroke survivors.

They suggest, in a study published recently in IEEE Transactions on Neural Systems and Rehabilitation Engineering, that their robotic-assisted rehabilitation therapy may help improve the stroke patients’ mobility.

The study was led by Professor Sang Hoon Kang of Mechanical, Aerospace and Nuclear Engineering at UNIST in collaboration with Professor Pyung-Hun Chang of DGIST and Dr Kyungbin Park of Samsung Electronics Co Ltd, according to a media release from UNIST.

In their study, Kang and the others on the team developed a rehabilitation robotic system that quantitatively measures the 3 degrees-of-freedom (DOF) impedance of human forearm and wrist in minutes.

Using their impedance estimation device, which they call the distal internal model based impedance control (dIMBIC)-based method, the team was able to accurately characterize the 3 DOF forearm and wrist impedance, including inertia, damping, and stiffness, for the first time, the release continues.

“The dIMBIC-based method can be used to assist in the quantitative and objective evaluation of neurological disorders, like stroke,” Kang says, in the release. “Findings from this study will open a new chapter in robot-assisted rehabilitation in the workplace accident rehabilitation hospitals, as well as in nursing homes and assisted living facilities.”

The research team expects that, in the long run, the proposed 3 DOF impedance estimation may promote wrist and forearm motor control studies and complement the diagnosis of the alteration in wrist and forearm resistance post-stroke by providing objective impedance values including cross-coupled terms, the release concludes.

[Source(s): Ulsan National Institute of Science and Technology (UNIST), Science Daily]

Source: Robotic-Assisted Rehabilitation Therapy Designed to Aid Stroke Recovery – Rehab Managment