Improving Residual Hand Function in Chronic, Complete SCI with BCI-Enabled Functional Task Practice

A large prescriptive data set of wrist, metacarpal arch fingers and thumb movements has been collected using twenty-four 4mm hemispherical passive reflective markers placed on the wrist, hand and fingers. Movements of each participant were captured by a set of 6-camera infrared motion analysis system (QUALISYS) sampling at 60Hz while undertaking a clinical hand function assessment, the Southampton Hand Assessment Procedure (SHAP). Without Muscle Contraction and With Muscle Contraction versions of objects are assessed and were tested, characteristics of individual movement strategies presented and initial results have shown interesting variations that correspond with physiological and functional approaches to movement. With the whole designed system, patient can improved hand function with the result of vigorous physical activity through the SHAP procedures, from the supervision of researcher can determine the functionality of one patient’s hand and wrist which will benefit subjects with a dramatic effect on one’s daily life as we know exercise is related to better health. Using advanced software such as Visual 3D and Qualisys Tracking Manager, researcher can monitor patient’s recovery progress, with suitable angle of calculation of one’s fingers, acceptable force and velocity of one’s produced depending on age and size of hand of subjects.

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Cortical vs. afferent stimulation as an adjunct to functional task practice training: a randomized, comparative pilot study in people with cervical spinal cord injury

Clinical Rehabilitation ◽

10.1177/0269215514556087 ◽

2014 ◽

Vol 29 (8) ◽

pp. 771-782 ◽

Cited By ~ 18

Author(s):

Joyce Gomes-Osman ◽

Edelle C Field-Fote

Keyword(s):

Direct Current ◽

Nerve Stimulation ◽

Transcranial Direct Current Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Short Term ◽

Electrical Nerve Stimulation ◽

Direct Current Stimulation ◽

Cohen’S D ◽

Task Practice ◽

Functional Task

Objective: To assess single-session effects of three different types of stimuli known to increase cortical excitability when combined with functional task practice. Design: Randomized cross-over trial. Participants: A total of 24 participants with chronic cervical spinal cord injury. Interventions: One 30-minute session of each, applied concurrently with functional task practice: transcranial direct current stimulation, vibration, and transcutaneous electrical nerve stimulation. Measurements: Nine-hole Peg Test, pinch force, visuomotor tracking, and cortical excitability were collected at pretest, posttest and late posttest (30 minutes after). Early effects (posttest minus pretest) and short-term persistence (late posttest minus pretest) were assessed using a general linear mixed model. Magnitude of effect size was assessed using the Cohen’s d. Results: Transcutaneous electrical nerve stimulation was associated with moderate, significant early effects and short-term persistence on Nine-hole Peg Test performance (1.8 ±1.8, p = 0.003, d = 0.59; 2.0 ±2.5, p < 0.001, Cohen’s d = 0.65, respectively). Transcranial direct current stimulation (1.8 ±2.5, p = 0.003, Cohen’s d = 0.52) was also associated with significant short-term persistence of moderate size on Nine-hole Peg Test performance (1.8 ±2.5, p = 0.003, Cohen’s d = 0.52) and visuomotor tracking performance ( p = 0.05, d = 0.51). Early effects on corticomotor excitability were significant for transcutaneous electrical nerve stimulation ( p = 0.003), approached significance for transcranial direct current stimulation ( p = 0.07), and only vibration was associated with significant short-term persistence ( p = 0.006). Conclusions: Meaningful improvements in aspects of hand-related function that persisted at least 30 minutes after intervention were observed with transcutaneous electrical nerve stimulation and transcranial direct current stimulation, when combined with functional task practice.

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Priming the Ipsilesional Motor Cortex with Excitatory rTMS to Augment Functional Task Practice Post-Stroke

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2016.08.288 ◽

2016 ◽

Vol 97 (10) ◽

pp. e93

Author(s):

Dorian Rose ◽

Carolynn Patten ◽

Alexandra Taylor ◽

William Triggs

Keyword(s):

Motor Cortex ◽

Post Stroke ◽

Task Practice ◽

Functional Task

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Clinical Trial of HEXORR II for Robotic Hand Movement Therapy After Stroke

10.21203/rs.3.rs-74894/v1 ◽

2020 ◽

Author(s):

Ji Chen ◽

Iian Black ◽

Diane Nichols ◽

Tianyao Chen ◽

Melissa Sandison ◽

...

Keyword(s):

Clinical Trial ◽

Motion Capture ◽

Hand Function ◽

Hand Movement ◽

Chronic Stroke ◽

High Dose ◽

Robotic Hand ◽

Robotic Therapy ◽

Task Practice ◽

Upper Extremity Impairment

Abstract BackgroundImpaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. MethodsFifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6 month followup. ResultsFourteen individuals completed the protocol. Fugl-Meyer scores improved significantly over the 3 time points, indicating reductions in upper extremity impairment. Flexor hypertonia (Ashworth) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability when the arm was supported by gravity. However, extension ability did not improve significantly during a reach and grasp task, and there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. ConclusionsFuture work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks. Trial registration: CLINICALTRIALS.GOV, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987

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Combined Use of Repetitive Task Practice and an Assistive Robotic Device in a Patient With Subacute Stroke

Physical Therapy ◽

10.2522/ptj.20050149 ◽

2006 ◽

Vol 86 (10) ◽

pp. 1378-1386 ◽

Cited By ~ 25

Author(s):

Ellen M Frick ◽

Jay L Alberts

Keyword(s):

Upper Extremity ◽

Hand Function ◽

Robotic Therapy ◽

Extremity Function ◽

Subacute Stroke ◽

Combined Use ◽

Before And After ◽

Task Practice ◽

Upper Extremity Function ◽

Combined Intervention

Abstract Background and Purpose. This case report describes a training program comprising repetitive task practice (RTP) and robotic therapy for a patient with subacute stroke and resultant impaired upper-extremity function. Case Description. A 63-year-old man with right-sided hemiplegia resulting from a hemorrhagic stroke received a combined intervention of RTP and robotic therapy for 4 hours per day for 3 weeks. Clinical and kinetic evaluations were performed before and after intervention. Outcomes. Following the combined intervention, clinical improvements in hand function were observed, maximum grip force decreased slightly, and interlimb coupling decreased. Discussion. An intervention of RTP with robotic therapy may be an effective method to improve upper-extremity function following stroke. Furthermore, the case suggests that improvements in strength are not necessary for improved dexterous function, provided that a minimal level of strength is present.

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Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke

Frontiers in Rehabilitation Sciences ◽

10.3389/fresc.2021.728753 ◽

2021 ◽

Vol 2 ◽

Author(s):

Ji Chen ◽

Iian Black ◽

Diane Nichols ◽

Tianyao Chen ◽

Melissa Sandison ◽

...

Keyword(s):

Motion Capture ◽

Hand Function ◽

Hand Movement ◽

Chronic Stroke ◽

High Dose ◽

Robotic Hand ◽

Robotic Therapy ◽

Before And After ◽

Task Practice ◽

Upper Extremity Impairment

Impaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. Fifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6-month followup. Fourteen individuals completed the protocol. Fugl-Meyer scores improved significantly at the 6 month time point compared to baseline, indicating reductions in upper extremity impairment. Flexor hypertonia (Modified Ashworth Scale) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability after the intervention that continued to improve during the followup period. However, there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. Future work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks.Trial Registration:ClinicalTrials.gov, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987.

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