An Instrumented Glove-Controlled Portable Hand-Exoskeleton for Bilateral Hand Rehabilitation

Effective bilateral hand training is desired in rehabilitation programs to restore hand function for people with unilateral hemiplegia, so that they can perform daily activities independently. However, owing to limited human resources, the hand function training available in current clinical settings is significantly less than the adequate amount needed to drive optimal neural reorganization. In this study, we designed a lightweight and portable hand exoskeleton with a hand-sensing glove for bilateral hand training and home-based rehabilitation. The hand-sensing glove measures the hand movement of the less-affected hand using a flex sensor. Thereafter, the affected hand is driven by the hand exoskeleton using the measured hand movements. Compared with the existing hand exoskeletons, our hand exoskeleton improves the flexible mechanism for the back of the hand for better wearing experience and the thumb mechanism to make the pinch gesture possible. We designed a virtual reality game to increase the willingness of repeated movement practice for rehabilitation. Our system not only facilitates bilateral hand training but also assists in activities of daily living. This system could be beneficial for patients with hemiplegia for starting correct and sufficient hand function training in the early stages to optimize their recovery.

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Hand Rehabilitation Programs Used for Second to Fifth Metacarpal Fractures: A Systematic Literature Review Protocol

10.21203/rs.3.rs-16433/v1 ◽

2020 ◽

Author(s):

Monique Marie Keller ◽

Roline Y Barnes ◽

Corlia Brandt

Keyword(s):

Quality Of Life ◽

Meta Analysis ◽

Hand Function ◽

Health Related Quality ◽

Hand Rehabilitation ◽

Metacarpal Fractures ◽

Rehabilitation Programs ◽

Related Quality ◽

Health Related

Abstract BackgroundMetacarpal fractures have an incidence rate of 13.6 per 100000, affects males more than females and accounts for 33% of all hand fractures. No evidence-based rehabilitation program exists for second to fifth metacarpal fractures potentially causing poor health related quality of life, decrease hand function and disability.MethodsExperimental study designs, quasi-experimental, cohort studies and case control studies for the last ten years from January 2008 to September 2018 with English as a language restriction will be included. Sources investigating hand rehabilitation, immobilization, splinting and home programs after surgical and conservative management for second to fifth metacarpal fractures, will be included. MEDLINE, Academic Search Ultimate, CINAHL, CAB Abstracts, Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information, MasterFILE Premier, Google Scholar and other grey literature will be searched. Two independent reviewers will independently conduct the study selection, methodology quality assessment and extraction of data. Findings will be pooled, meta-analysis performed, Summary of Findings provided according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis if deemed appropriate.DiscussionIt is imperative to implement effective rehabilitation to prevent poor health related quality of life, decrease hand function and disability. In this systematic literature review, we will determine the existing evidence on hand rehabilitation programs used after post-surgical and conservative management for 20 to 59-year-old humans who sustained a single or multiple second to fifth metacarpal fracture.

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Pneumatic Hand Rehabilitation Device

Volume 2: Biomedical and Biotechnology Engineering; Nanoengineering for Medicine and Biology ◽

10.1115/imece2011-62966 ◽

2011 ◽

Cited By ~ 1

Author(s):

Robert P. Gagliard ◽

Robert Fregeolle ◽

Khalid M. Sharaf ◽

Mansour Zenouzi ◽

Douglas E. Dow

Keyword(s):

Physical Therapy ◽

Hand Function ◽

Insurance Coverage ◽

Air Pressure ◽

Hand Rehabilitation ◽

Hand Therapy ◽

Widespread Application ◽

Home Based ◽

Home Based Therapy ◽

Alternative Designs

A prototype of a pneumatic device for rehabilitation of the hand was designed, built and tested. Progressive impairment of hand function may result from a prolonged condition of hemiparesis, such as resulting from stroke. Reduced daily use of the affected limb, spasticity and contracture contribute to progressive impairment. Physical therapy attenuates the impairment in many patients, but regular sessions of physical therapy are difficult to maintain due to the associated costs, limited insurance coverage, and necessity of being at the clinic for each session. Systems or devices suitable for home-based therapy sessions would widen the accessibility of physical therapy to more patients. However, reported therapeutic systems appear to be expensive, heavy and complicated, thus limiting their suitability for widespread application in home settings. Recent reports of pneumatic based hand therapy systems suggest a platform for hand rehabilitation that would be simpler, lighter, less expensive, and have a lower risk of safety concerns. The design utilized in this project has the affected hand encased in a glove apparatus that has an embedded air bladder positioned ventral to each of the five digits on the palmer side of the hand, such that the bladder acts to assist extension of each finger and thumb as internal air pressure increases. Several alternative designs of glove-bladder combinations were designed, fabricated and tested. An electro-pneumatic regulator (SMC Corp. of America, Noblesville, IN) controlled the pressure of air to the bladders from an air compressor. The pneumatic regulator was controlled by a custom designed and assembled microcontroller (Arduino, open source) based control system. The microcontroller controlled solenoids that functioned as valves for the passage of air to the bladders from the pneumatic regulator, one solenoid for each of the 5 bladders in a glove. Tests were done to compare alternative glove-bladder designs. For a bladder corresponding to one digit, the relations between air pressure and the resulting torque were explored using a system of weights. Moreover, for constant pressure levels, the relations between angle of a digit and torque were explored. The pneumatic hand rehabilitation system developed in this project shows promise toward development of pneumatic hand therapy systems that would be suitable for home-based therapy.

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Abstract WP205: Home-Based Virtual Reality Therapy for Hand Recovery After Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp205 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adam MacLellan ◽

Catherine Legault ◽

Alay Parikh ◽

Leonel Lugo ◽

Stephanie Kemp ◽

...

Keyword(s):

Virtual Reality ◽

Upper Extremity ◽

Large Scale ◽

Controlled Trial ◽

Hand Function ◽

Chronic Stroke ◽

Stroke Survivors ◽

Hand Rehabilitation ◽

Stroke Patients ◽

Home Based

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.

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Understanding Gaps between Daily-Living and Clinical Settings in Chronic Disease Management (Preprint)

10.2196/preprints.17590 ◽

2020 ◽

Author(s):

Mustafa Ozkaynak ◽

Rupa Valdez ◽

Katia Hannah ◽

Gina Woodhouse ◽

Patrick Klem

Keyword(s):

Health System ◽

Daily Living ◽

Information Technologies ◽

Patient Adherence ◽

Physical Workload ◽

Collaborative Management ◽

Clinical Settings ◽

Health Information Technologies ◽

Home Based ◽

Health Related

BACKGROUND Management of chronic conditions entails numerous activities in both clinical and daily-living settings. Of course, activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily-living environments. OBJECTIVE The purpose of this study was to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an exemplar. We conceptualized gaps as latent phenomena (i.e., a break in continuity). METHODS Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain-based health system were recruited. Data was collected by primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data was analyzed qualitatively based on a theory-driven approach and framework method of analysis. RESULTS The causes of gaps included clinician recommendations not fitting into patient’s daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised patient adherence. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. CONCLUSIONS Understanding gaps, their consequences, and mitigating strategies, can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health system and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily-living settings (i.e., limited number and types of routines that are tracked).

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Development of the Home based Virtual Rehabilitation System (HoVRS) to Remotely Deliver an Intense and Customized Upper Extremity Training

10.21203/rs.3.rs-64042/v1 ◽

2020 ◽

Author(s):

Qinyin Qiu ◽

Amanda Cronce ◽

Jigna Patel ◽

Gerard G Fluet ◽

Ashley Mont ◽

...

Keyword(s):

Hand Function ◽

Chronic Stroke ◽

Hand Rehabilitation ◽

Kinematic Data ◽

Virtual Rehabilitation ◽

Home Based ◽

Rehabilitation System ◽

Kinematic Measures ◽

And Training ◽

Training Protocol

Abstract Background: After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. Methods: In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least 15 minutes every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. Results: All patients completed the study without any adverse events. Subjects on average spent 13.5 hours using the system. Clinical and kinematic data were collected pre and post study. The whole group improved on the Fugl-Meyer (FM) assessment and on six kinematic measurements. In addition, a combination of these kinematic measures was able to predict a substantial portion of subjects’ FM scores. Conclusion: The outcomes of this pilot study warrant further investigation of the system’s ability to promote recovery of hand function in subacute and chronic stroke.

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Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study

Journal of Medical Internet Research ◽

10.2196/17590 ◽

2021 ◽

Vol 23 (2) ◽

pp. e17590

Author(s):

Mustafa Ozkaynak ◽

Rupa Valdez ◽

Katia Hannah ◽

Gina Woodhouse ◽

Patrick Klem

Keyword(s):

Daily Living ◽

Information Technologies ◽

Mitigation Strategies ◽

Physical Workload ◽

Collaborative Management ◽

Clinical Settings ◽

Health Information Technologies ◽

Home Based ◽

Clinician Education ◽

Health Related

Background Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments. Objective The aim of this study is to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity). Methods Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis. Results The causes of gaps included clinician recommendations not fitting into patients’ daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. Conclusions Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.

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Hiring Practices of Exercise Physiologist in Cardiac Rehabilitation Programs among Mid-Atlantic States in the United States

Journal of Clinical Exercise Physiology ◽

10.31189/2165-6193-5.3.32 ◽

2016 ◽

Vol 5 (3) ◽

pp. 32-36 ◽

Cited By ~ 1

Author(s):

Allison Hope Bowersock ◽

William Alexander Breeding ◽

Carmel Alexander Sheppard

Keyword(s):

United States ◽

Patient Education ◽

Cardiac Rehabilitation ◽

Science Curriculum ◽

Exercise Physiology ◽

Clinical Skill ◽

The United States ◽

Hiring Practices ◽

Clinical Settings ◽

Rehabilitation Programs

Purpose: The purpose of this survey was to identify factors that may be influencing the appreciation of exercise physiology as a discipline as demonstrated by hiring practices in regional clinical settings. Methods: A telephone survey was administered to 33 cardiac rehabilitation programs in 5 states in the Mid-Atlantic region of the United States (Kentucky, North Carolina, Tennessee, Virginia, and West Virginia). Results: The distribution of nurses and exercise physiologists (EPs) employed by the 33 facilities varied by state, but overall there were 86 nurses and 55 EPs working among the surveyed facilities. Of the 33 surveyed facilities, 12 (36%) reported a preference for hiring nurses over EPs; only 4 (12%) reported a preference for hiring EPs over nurses. The remaining facilities (n = 17; 52%) reported no preference (n = 12; 36%) or that the decision depends on a variety of factors (n = 5; 15%). Several common themes were identified from respondents. These included that, compared to nurses, EPs have greater expertise in exercise prescription and better understanding of safe exercise progression for patients. However, nurses were believed to possess greater assessment and clinical skill with an emphasis on emergency response preparedness and greater general patient education skills. Conclusion: Academic programs that prepare students for careers as EPs employed in clinical settings may benefit from additional coursework and internship site selection that focus on clinical assessment skills, emergency preparedness, and patient education to reinforce their work in an exercise science curriculum.

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Telemedicine in Cancer Care

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_200141 ◽

2018 ◽

pp. 540-545 ◽

Cited By ~ 64

Author(s):

S. Joseph Sirintrapun ◽

Ana Maria Lopez

Keyword(s):

Health Care ◽

Access To Care ◽

Cancer Care ◽

Symptom Management ◽

Lifestyle Modification ◽

Clinical Settings ◽

Home Based ◽

Home Based Care ◽

Care Costs ◽

Improve Access

Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient’s electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.

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Using the Internet to assess activities of daily living and hand function in people with Parkinson's disease

Neurorehabilitation ◽

10.3233/nre-2008-23307 ◽

2008 ◽

Vol 23 (3) ◽

pp. 253-261 ◽

Cited By ~ 25

Author(s):

Tammy Hoffmann ◽

Trevor Russell ◽

Leah Thompson ◽

Amy Vincent ◽

Mark Nelson

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Activities Of Daily Living ◽

Daily Living ◽

Hand Function ◽

The Internet

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Maintaining Effects of Pulmonary Rehabilitation at Home in Chronic Obstructive Pulmonary Disease: A Systematic Literature Review

Home Health Care Management & Practice ◽

10.1177/1084822321990376 ◽

2021 ◽

pp. 108482232199037

Author(s):

Duarte Pinto ◽

Lissa Spencer ◽

Soraia Pereira ◽

Paulo Machado ◽

Paulino Sousa ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Literature Review ◽

Pulmonary Rehabilitation ◽

Rehabilitation Program ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Maintenance Strategies ◽

Rehabilitation Programs ◽

Home Based ◽

Pulmonary Rehabilitation Program

To systematize strategies that may support patients with Chronic Obstructive Pulmonary Disease to maintain the effects of pulmonary rehabilitation over time. This systematic literature review was conducted, and the evidence was electronically searched in the Web of Science, Scopus, and EBSCO databases. This review included randomized controlled clinical trials, published until September 2019, that addressed components of an unsupervised home-based pulmonary rehabilitation program, maintenance strategies following outpatient pulmonary rehabilitation programs, as well as data on outcomes for quality of life, exercise performance, and dyspnea. A final sample of 5 articles was obtained from a total of 1693 studies. Data for final synthesis were grouped into 2 categories: components of unsupervised home-based pulmonary rehabilitation programs and maintenance strategies. An unsupervised home-based pulmonary rehabilitation program should consist of an educational component, an endurance training component, and a strength training component. When patients are transferred to the home environment, it is important to include more functional exercises specifically adapted to the patient’s condition, goals, and needs.

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