[BLOG POST] 5 Smartphone Games That Encourage Wrist Rehabilitation

By Kristin Valdes, OTD, OT, CHT

Tired of using dumbbells for rehabilitation following distal radius fractures? Looking for new interventions to increase client engagement? Look no further than your patient’s smartphone! Incorporate it into exercise routines to help your patients regain wrist balance and to provide proprioceptive input.

Evidence Supports Proprioceptive Activities

Emerging evidence supports the use of proprioceptive activities for distal radius fracture rehabilitation.¹ A cross-sectional study involving females treated operatively and non-operatively for a distal radius fracture found that participants had significantly less joint position sense in comparison to study controls.² The proprioceptive limitations correlated highly with functional impairment on the Patient Rated Wrist Evaluation.³

By addressing proprioceptive deficits while encouraging functional wrist range of motion, smartphone applications complement a traditional hand therapy program for individuals requiring skilled therapy following a distal radius fracture.

Some games to consider:

• Chopper Lite – Action packed side-scrolling helicopter game where a tilt of the screen flies the chopper.
• Labyrinth – Classic labyrinth game in which you must guide a ball through a labyrinth by moving your device.
• Tilt Maze Lite – Maze game where a tilt of your device helps a marble through a maze toward the exit. Use different mazes to test wrist balance and timing. The game stores the player’s best time for each maze so patients can track their performance as their wrist heals.
• Water Slide Extreme – Unique water slide game featuring tight corners and huge loops that you must navigate by twisting or leaning your device.
• Snail Mail – Kart-style racing game in which the player controls a racing snail on a mission to collect packages and deliver them to the farthest reaches of the universe while dodging obstacles such as laser towers, slugs, asteroids, and salt.

The clinician should consider using smartphones as an intervention following distal radius fractures. Skilled hand therapists can assist with appropriate postural mechanics and provide guidelines for the amount of time a patient should devote to gaming.

Rehabilitation at Your Fingertips

Certain smartphone applications can be used to address client-specific deficits, decrease functional concerns, and achieve client-centered goals. Incorporating smartphone gaming in hand therapy may provide motivation and convenience to your clients.

 

Below, Kristin Valdes discusses wrist proprioception using smartphone apps in a short video from her course, Rehabilitation Following Wrist Fracture.

Watch First Chapter FREE

 

About Kristin Valdes, OTD, OT, CHT

Kristin Valdes, OTD, OT, CHT, is the owner and director of Hand Works Therapy in Sarasota, Florida. She is an associate professor at Gannon University and has been in private practice for over twenty years, specializing in the treatment and rehabilitation of the upper extremity. Her clinical expertise includes treatment of the hand, wrist, elbow, shoulder, splinting, and arthritis. Dr. Valdes has published articles in the Journal of Hand Therapy, Hand, Journal of Manipulative and Physiological Therapeutics, and the Journal of Physical Therapy Science. She serves as a member of the Board of the American Society of Hand Therapists and American Association of Hand Surgery.Dr. Valdes has published chapters on hand, elbow, and shoulder fractures and dislocations in Advanced Concepts of Hand Pathology and Surgery. She is an assistant editor of the Journal of Hand Therapy. Dr. Valdes received her OTD degree with a specialization in hand rehabilitation from Rocky Mountain University of Health Care Professions in Provo, Utah. Dr Valdes is member of the Guatemala Healing Hands Medical Mission.

 

References

1. Algar, L., & Valdes, K. (2014). Using smartphone applications as hand therapy interventions. Journal of Hand Therapy, 27(3), 254–257. doi:10.1016/j.jht.2013.12.009
2. Karagiannopoulos, C., Sitler, M., Michlovitz, S., & Tierney, R. (2014a). A Descriptive Study on Wrist and Hand Sensori-Motor Impairment and Function Following Distal Radius Fracture Intervention. Journal of Hand Therapy, 27(3), e2–e3. doi:10.1016/j.jht.2013.08.006
3. Karangiannopoulos, et al. (2014)

via 5 Smartphone Games That Encourage Wrist Rehabilitation | MedBridge Blog

[Abstract] Robotic Exoskeleton for Wrist and Fingers Joint in Post-Stroke Neuro-Rehabilitation for Low-Resource Settings

Abstract

Robots have the potential to help provide exercise therapy in a repeatable and reproducible manner for stroke survivors. To facilitate rehabilitation of the wrist and fingers joint, an electromechanical exoskeleton was developed that simultaneously moves the wrist and metacarpophalangeal joints.

The device was designed for the ease of manufacturing and maintenance, with specific considerations for countries with limited resources. Active participation of the user is ensured by the implementation of electromyographic control and visual feedback of performance. Muscle activity requirements, movement parameters, range of motion, and speed of the device can all be customized to meet the needs of the user.

Twelve stroke survivors, ranging from the subacute to chronic phases of recovery (mean 10.6 months post-stroke) participated in a pilot study with the device. Participants completed 20 sessions, each lasting 45 minutes. Overall, subjects exhibited statistically significant changes (p < 0.05) in clinical outcome measures following the treatment, with the Fugl-Meyer Stroke Assessment score for the upper extremity increasing from 36 to 50 and the Barthel Index increasing from 74 to 89. Active range of wrist motion increased by 190 while spasticity decreased from 1.75 to 1.29 on the Modified Ashworth Scale.

Thus, this device shows promise for improving rehabilitation outcomes, especially for patients in countries with limited resources.

via Robotic Exoskeleton for Wrist and Fingers Joint in Post-Stroke Neuro-Rehabilitation for Low-Resource Settings – IEEE Journals & Magazine

[Abstract] DESIGN AND DEVELOPMENT OF A NEW APPROACH TO WRIST REHABILITATION

Abstract

Wrist injuries are a very common type of pathology that can compromise most daily
tasks. Conventional therapy is dependent on the availability of physiotherapists as well as devices
designed for this purpose. Conventional devices do not accompany the patient throughout their
rehabilitation process, requiring their constant replacement. Vibratory therapies emerged in recent
years and have demonstrated several benefits in this area. However, there are few vibratory
devices designed for wrist rehabilitation. In this paper, we propose two different portable and
active models for wrist rehabilitation based on vibratory therapy for wrist rehabilitation. The first
model has a cylindrical shape and the second model has a dumbbell shape. The results obtained
showed that vibratory therapy can assist the wrist rehabilitation because it promoted
improvements in joint amplitude gain in all wrist movements. Furthermore, the second device
demonstrated higher joint gains than the first device. In addition, the results obtained from the
measurement of accelerations demonstrate that the natural frequencies of both devices are
adequate for wrist and forearm rehabilitation as well as the mode of vibration. There are
differences between what the simulations predicted and what was obtained in practice in terms of
natural frequency values.

Full Text PDF

[Abstract] Fuzzy sliding mode control of a wearable rehabilitation robot for wrist and finger

Abstract

Purpose

The purpose of this paper is to introduce a new design for a finger and wrist rehabilitation robot. Furthermore, a fuzzy sliding mode controller has been designed to control the system.

Design/methodology/approach

Following an introduction regarding the hand rehabilitation, this paper discusses the conceptual and detailed design of a novel wrist and finger rehabilitation robot. The robot provides the possibility of rehabilitating each phalanx individually which is very important in the finger rehabilitation process. Moreover, due to the model uncertainties, disturbances and chattering in the system, a fuzzy sliding mode controller design method is proposed for the robot.

Findings

With the novel design for moving the DOFs of the system, the rehabilitation for the wrist and all phalanges of fingers is done with only two actuators which are combined in one device. These features make the system a good choice for home rehabilitation. To control the robot, a fuzzy sliding mode controller has been designed for the system. The fuzzy controller does not affect the coefficient of the sliding mode controller and uses the overall error of the system to make a control signal. Thus, the dependence of the controller to the model decreases and the system is more robust. The stability of the system is proved by the Lyapunov theorem.

Originality/value

The paper provides a novel design of a hand rehabilitation robot and a controller which is used to compensate the effects of the uncertain parameters and chattering phenomenon.

via Fuzzy sliding mode control of a wearable rehabilitation robot for wrist and finger | Emerald Insight

[Abstract + References] Improving Motivation in Wrist Rehabilitation Therapies – Conference paper

Abstract

Rehabilitation encompasses a wide variety of activities aimed at reducing the impact of injuries and disabilities by applying different exercises. Frequently, such exercises are carried out at home as a repetition of the same movements or tasks to achieve both motor learning and the necessary cortical changes. Although this increases the patients’ available time for rehabilitation, it may also have some unpleasant side effects. That occurs because carrying out repetitive exercises in a more isolated environment may result in a boring activity that leads patients to give up their rehabilitation. Therefore, patients’ motivation should be considered an essential feature while designing rehabilitation exercises. In this paper, we present how we have faced this need by exploiting novel technology to guide patients in their rehabilitation process. It includes a game crafted to make recovery funny and useful, at the same time. The game and the use we made of the specific hardware follow the recommendations and good practices provided by medical experts.

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via Improving Motivation in Wrist Rehabilitation Therapies | SpringerLink

[Abstract + References] An Exoskeleton Design Robotic Assisted Rehabilitation: Wrist & Forearm – Conference paper

Abstract

Robotic systems are being used in physiotherapy for medical purposes. Providing physical training (therapy) is one of the main applications of fields of rehabilitation robotics. Upper-extremity rehabilitation involves shoulder, elbow, wrist and fingers’ actions that stimulate patients’ independence and quality of life. An exoskeleton for human wrist and forearm rehabilitation is designed and manufactured. It has three degrees of freedom which must be fitted to real human wrist and forearm. Anatomical motion range of human limbs is taken into account during design. A six DOF Denso robot is adapted. An exoskeleton driven by a serial robot has not been come across in the literature. It is feasible to apply torques to specific joints of the wrist by this way. Studies are still continuing in the subject.

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Fig. 1. Wrist and forearm motions [17]

via An Exoskeleton Design Robotic Assisted Rehabilitation: Wrist &amp; Forearm | SpringerLink

 

[Abstract] User Experience Evaluation of an Interactive Virtual Reality-Based System for Upper Limb Rehabilitation – IEEE Conference Publication

Abstract

This article evaluates the usability of an interactive virtual reality system for the recovery of hand and wrist mobility by means of the LeapMotion device and the Unity3D graphics engine. Through the programmed interfaces, the proposed VR system allows the patient to correctly complete established medical protocols via exercise routines with audio and video feedback. The usability evaluation of the VR system was carried out using the VRUSE model in an experiment. This model was utilized to design a survey consisting of 10 items, where each item represents a model factor. The survey was applied in the experiment in which 30 patients participated. The obtained results showed that the VRUSE factors of the proposed VR system for rehabilitation are significantly related to its overall use, with factor correlation values lower than 0,005. Patients participating in the experiment consider that the interactive virtual reality-based system for upper limb rehabilitation is usable. Additionally, it was proved that the rehabilitation environments programmed in the Unity 3D graphics engine allows patients to comply precisely with the established medical protocols, driving them to a progressive movement recovery of the affected limb.

 

via User Experience Evaluation of an Interactive Virtual Reality-Based System for Upper Limb Rehabilitation – IEEE Conference Publication

[Conference paper] Wrist Rehabilitation Equipment Based on the Fin-Ray® Effect – Abstract + References

Abstract

A swift post-traumatic recovery of upper limbs can be achieved best by means of dedicated rehabilitation equipment. A speedy recovery process ensures the early reintegration of patients into society. The rehabilitation equipment proposed in this paper is conceived for the simultaneous passive mobilization of the radiocarpal, metacarpophalangeal and interphalangeal joints. The paper presents and discusses the construction and actuation system of the equipment. The elements of novelty put forward by this equipment refer to the Fin-Ray® effect underlying the design of the hand support and to its operation by means of a pneumatic muscle – an actuator with inherently compliant behavior. The discussion includes the occurring of hysteresis, and concludes that it does not affect the efficiency of the rehabilitation exercises..

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via Wrist Rehabilitation Equipment Based on the Fin-Ray® Effect | SpringerLink

[Abstract] Pre-therapeutic Device for Post-stroke Hemiplegic Patients’ Wrist and Finger Rehabilitation

Abstract

Background/Objectives

This paper suggests a pre-therapeutic device for post-stroke hemiplegic patients’ wrist and finger rehabilitation both to decrease and analyze their muscle tones before the main physical or occupational therapy.

Method/Statistical Analysis

We designed a robot which consists of a BLDC motor, a torque sensor, linear motion guides and bearings. Mechanical structure of the robot induces flexion and extension of wrist and finger (MCP) joints simultaneously with the single motor. The frames of the robot were 3D printed. During the flexion/extension exercise, angular position and repulsive torque of the joints are measured and displayed in real time.

Findings

A prototype was 3D printed to conduct preliminary experiment on normal subject. From the neutral joint position (midway between extension and flexion), the robot rotated 120 degrees to extension direction and 30 degrees to flexion direction. First, the subject used the machine with the usual wrist and finger characteristics without any tones. Second, the same subject intentionally gave strength to the joints in order to imitate affected upper limb of a hemiplegic patient. During extension exercise, maximum repulsive torque of the normal hand was 2 Nm whereas that of the firm hand was almost 5 Nm. The result revealed that the device was capable enough to not only rotate rigid wrist and fingers with the novel robotic structure, but also present quantitative data such as the repulsive torque according to the joint orientation as an index of joint spasticity level.

Improvements/Applications

We are planning to improve the system by applying torque control and arranging experiments at hospitals to obtain patients’ data and feedbacks to meet actual needs in the field.

via Indian Journals

[Abstract] Attention-controlled assistive wrist rehabilitation using a low-cost EEG Sensor

Abstract

It is essential to make sure patients be actively involved in motor training using robot-assisted rehabilitation to achieve better rehabilitation outcomes. This paper introduces an attention-controlled wrist rehabilitation method using a low-cost EEG sensor. Active rehabilitation training is realized using a threshold of the attention level measured by the low-cost EEG sensor as a switch for a flexible wrist exoskeleton assisting wrist ?exion/extension and radial/ulnar deviation. We present a prototype implementation of this active training method and provide a preliminary evaluation. The feasibility of the attention-based control was proven with the overall actuation success rate of 95%. The experimental results also proved that the visual guidance was helpful for the users to concentrate on the wrist rehabilitation training; two types of visual guidance, namely looking at the hand motion shown on a video and looking at the user’s own hand, had no significant performance difference; a general threshold of a certain group of users can be utilized in the wrist robot control rather than a customized threshold to simplify the procedure.

via Attention-controlled assistive wrist rehabilitation using a low-cost EEG Sensor – IEEE Journals & Magazine