Wearable Hand-Rehabilitation System with Soft Gloves for Patient with Face Paralysis and Disability

Artificially intelligent advances such as tech gloves allow handicapped wearers to handle daily matters as normal. A wearable hand-rehabilitation system, i.e., a robotic arm, is engineered with controlled programming to control a disabled hand with features such as movement of fingers and holding items. A life-threatening disease (stroke) is caused when brain cells start to die, causing around 50–70% of patients to face paralysis and disability. People may face after-effects such as reduced use of the hand and limb or a paralyzed hand. Many methods have been introduced to overcome these issues, including therapies, but they are not so reliable when overcoming disability issues. To overcome these issues, we proposed a smart robotic hand that encounters hand disability issues. The smart robotic hand will aid the hands of disabled people by replacing their disabled hand with the smart robotic hand and by controlling the movement of the robot with the movement of the other hand. This can also be helpful for environments where it is not feasible for humans to work, such as in nuclear reactors and in bomb disposal squads. Some people have disabilities of the hand, so this smart robotic hand can also be used in that scenario. The robotic hand is mainly controlled through a flex sensor. By using Arduino, flex sensor outputs are mapped accordingly to the servo motors. The robot is controlled by a wired arrangement.

The application of image processing for Human-Computer Interface (HCI) using the Eye

The field of Human-Computer Interaction (HCI) has been developing tremendously since the past decade. The existence of smartphones or modern computers is already a norm in society these days which utilizes touch, voice and typing as a means for input. To further increase the variety of interaction, human eyes are set to be a good candidate for another form of HCI. The amount of information which the human eyes contain are extremely useful, hence, various methods and algorithm for eye gaze tracking are implemented in multiple sectors. However, some eye-tracking method requires infrared rays to be projected into the eye of the user which could potentially cause enzyme denaturation when the eye is subjected to those rays under extreme exposure. Therefore, to avoid potential harm from the eye-tracking method that utilizes infrared rays, this paper proposes an image-based eye tracking system using the Viola-Jones algorithm and Circular Hough Transform (CHT) algorithm. The proposed method uses visible light instead of infrared rays to control the mouse pointer using the eye gaze of the user. This research aims to implement the proposed algorithm for people with hand disability to interact with computers using their eye gaze.

Multiple Sclerosis and MyChart Messaging: A Retrospective Review Evaluating Its Use

Background: Understanding patterns of MyChart (Epic Systems Corp) messaging has the potential to alter clinical practice. However, because most research evaluating its use has been conducted in limited contexts, utilization patterns in patients with multiple sclerosis (MS) remain unclear. We characterized factors associated with high rates of MyChart messaging in patients with MS. Methods: We performed a retrospective cross-sectional analysis of adult patients in an academic outpatient clinic’s database (N = 439). Inclusion criteria were one or more clinic visits and MS diagnosis. We extracted demographic and disease-specific characteristics and MyChart messaging information. Results: MyChart users in the database totaled 74% (n = 324). MyChart users were more often younger, had shorter duration since diagnosis, had lower Patient-Determined Disease Steps scores, and were more likely to be using high-efficacy disease-modifying therapies than nonusers. Messaging rates were positively correlated with total number of unique medications (R = 0.17, P = .003) and negatively correlated with age (R = –0.11, P = .018). Conclusions: Although research has implicated arm-hand disability and impaired vision as barriers to patient portal use, these findings suggest the relationship between MS-specific disease burden and MyChart utilization is also a function of underlying medical complexity in capacities beyond physical disability. These data may serve as groundwork for investigation into other disease-specific settings and for quality improvement research to mitigate these high rates in at-risk patients, optimizing provider time investment, clinic productivity, and patient safety and preventing health care provider burnout.

Evaluation of WNT Signaling Pathway Gene Variants WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 in Patients with Dupuytren’s Contracture

Dupuytren’s contracture (DC) represents a chronic fibroproliferative pathology of the palmar aponeurosis, which leads to flexion contractures of finger joints and hand disability. In recent decades, the WNT signaling pathway has been revealed to play a significant role in the manifestation and pathogenesis of DC. Our study aimed to evaluate the associations between Dupuytren’s contracture and WNT-related single-nucleotide polymorphisms: Wnt Family Member 7B (WNT7B) rs6519955 (G/T), Secreted Frizzled Related Protein 4 (SFRP4) rs17171229 (C/T) and R-spondin 2 (RSPO2) rs611744 (A/G). We enrolled 216 patients (113 DC cases and 103 healthy controls), and DNA samples were extracted from the peripheral blood. Genotyping of WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 was performed using the Real-Time PCR System 7900HT from Applied Biosystems. WNT7B rs6519955 genotype TT carriers were found to possess a higher prevalence of DC (OR = 3.516; CI = 1.624–7.610; p = 0.001), whereas RSPO2 rs611744 genotype GG appears to reduce the likelihood of the manifestation of DC nearly twofold (OR = 0.484, CI = 0.258–0.908, p = 0.024). In conclusion, SNPs WNT7B rs6519955 and RSPO2 rs611744 are associated with the development of Dupuytren’s contracture: WNT7B rs6519955 TT genotype increases the chances by 3.5-fold, and RSPO2 rs611744 genotype GG appears to attenuate the likelihood of the manifestation of DC nearly twofold. Findings of genotype distributions among DC patients and control groups suggest that SFRP4 rs17171229 is not significantly associated with development of the disease.

Relation between Hand Bone Mineral Density, Degree of Joint Destruction, and Hand Function in Adults Rheumatoid Arthritis Patients

Background: Rheumatoid Arthritis [RA] is a chronic systemic disease that affects the functional capacity of the hand due to inflammatory arthritis and joint destruction. RA patients have difficulties with everyday life activities and daily living activities. The prevalence of osteoporosis is estimated to be about twice that of the general population. Dual-energy X-ray absorptiometry (DEXA) is the most precise tool for detecting loss in bone mineral density in RA. Aim of the study: This study aims to investigate the relation between generalized bone mineral density (BMD) and each of hand joint destruction and hand function in order to find out its possible role in assessment of rheumatoid hand disability. Patients and Methods: Fifty patients diagnosed as RA based on the 2010 ACR Rheumatoid Arthritis Classification Criteria were included in this study. All patients were subjected to the following scores: Duruöz Hand Index (DHI), Grip Ability Test (GAT), Grip strength test, and Pinch strength tests for assessing the function of the dominant hand of each patient. The participants were also subjected to plain x-ray evaluated by van der Heijde-modified total Sharp score (vdH-S) to assess the damage of the joints of the dominant hand, and Dual-energy X-ray absorptiometry (DEXA) to assess the Bone Mineral Density. Results: The current study showed that wrist BMD was correlated with grip strength, pinch strength, GAT, and van der Heijde modified sharp score of the dominant hand. Moreover, X-ray joint findings were significantly correlated with each of total grip ability test, grip strength, and pinch strength as the hand disability manifested more with joint damage. Conclusion: In conclusion, Osteoporosis, hand function, and joint damage in RA are correlated suggesting related pathophysiological mechanisms. The Severity of RA could be related to osteoporosis as well as joint destruction and hand disability.

POS0845 SCLERODERMIC HAND SENSOR: SMART TECHNOLOGY APPLIED TO RHEUMATOLOGY

Background:Systemic Sclerosis (SSc) is an autoimmune rheumatic disease characterized by excessive production and accumulation of collagen in the skin and internal organs and by injuries to small arteries.Impairment of the musculoskeletal system is one of the main causes of disability in SSc, indeed, about 90% of these patients have a loss of hand function. To date, the degree of skin involvement is evaluated through a semi-quantitative method called Rodnan Skin Score (RSS) or Modified-RSS (MRSS). However, MRSS is a method that has limitations related to the operator and his experience and does not provide information on joint mobility.Arduino® is an open source integrated online platform based on easy to use hardware and software. It is a system for creating interactive projects by inserting a special configuration code, using the Arduino® development environment. Through this platform it is possible to create electronic devices with specific purposes to lead the possibility of integrating different kits (eg types of sensors) in relation to the object of study.Objectives:We have therefore created an electronic instrument (Sclerodermic Hand Sensor - SHS) independent operator and easily reproducible in order to measure the degree of mobility (flexion) of the hand in patients with SSc (Fig.1). The aim was to evaluate whether the SHS was able to highlight significant differences between patients with SSc and healthy patients.Methods:We recruited 20 female patients with SSc according to ACR criteria with a mean age of 50.8 ± 15.5 years and 20 healthy (HC) patients with a mean age of 44.3 ± 10.8 years (Tab.1), in order to test the effectiveness and sensitivity of the SHS tool.Results:The results showed a significant difference between the two groups of patients (SSc vs HC) independent of the measurement method used as expected (Goniometer SSc / HC: Δ45.80 ° p: 0.003 SHS SSc / HC: Δ65.17 ° p: 0.002, Fig.1c), however the device created with Arduino® proved to be more sensitive than the goniometric measurement in detecting the degree of joint flexion (p: 0.002). The flexion sensor, indeed, unlike the goniometer, evaluates the simultaneous articular excursion of the entire finger (MCF, IFP and IFD) and not just one segment (Fig.1).Conclusion:This technology application, thanks to the creation of dedicated electronic devices, allows the physicians to be supported in clinical practice with independent operating tools.The tool we propose could be a valid support in accurately assessing the joint and indirectly skin involvement of sclerodactyly in this type of patient, especially in the context of a clinical trial to evaluate the efficacy of a treatment.Further studies are needed to compare with other methods to assess hand disability in SSc such as the use of HAMIS (Hand Mobility in Scleroderma) test.References:[1]Sandqvist G et al. J Rheumatol. 2016 Jul;43(7):1356-62.[2]https://www.arduino.cc.Table 1.SSc Patients CharacteristicsChararcteristicsSScPatients (n°, subset D=Diffuse; L=Limited)20 (9D/11L)Age, mean ± SD years50.8 ± 15.5Duration of Raynaud’s Phenomenon (mean ± SD years)12.8 ± 4.4Duration of SSc (mead ± SD years)8.4 ± 3.6MRSS (mean ± SD years)15.9 ± 5.3Disclosure of Interests:None declared

AB0844 HAND GRIP STRENGTH EVALUATION IN RHEUMATOLOGIC DISEASES

Background:Handgrip muscle strength test describes the strength of the hand muscles used to grasp or grip. Currently, hand grip evaluation is often used in clinical practice, as a marker of function and disability. In fact, it has already been applied as an outcome measure in arthritis rheumatoid clinical trials, to demonstrate the benefits of several treatments [1]. However, hand disability should also be considered in all other rheumatological diseases.Objectives:The main aim of this study is to assess the handgrip muscle strength test in a rheumatological cohort of patients as compared to a control group.Methods:This is a cross-sectional pilot study. We considered eligible 35 rheumatological consecutive female patients followed at our outpatients’ clinic of Internal Medicine (I Policlinico of Naples) and 35 healthy control females (HC). Both groups included only right-handed individuals. Rheumatological patients were distributed as follows: 5 rheumatoid arthritis (14,3%), 9 psoriatic arthritis (25,7%), 4 systemic lupus erythematosus (11,4%), 10 systemic sclerosis (28,6%), 4 fibromyalgia (11,4%), 3 juvenile idiopathic arthritis (8,6%). The course of disease was under optimal treatment in all patients.The type of hand grip used is the power grip, in which an object is held firmly by wrapping the fingers around it, pressing the object against the palm, and using the thumb to apply counter-pressure. We considered as either right or left hand valid measure the mean of three consecutive tests per arm. Between-groups differences were tested both by a uni- and multivariable analysis.Results:The two subgroups were homogeneously distributed for age (median age 42 yrs. [IQR 33-48] vs. 36 yrs. [IQR 30-52] in HC; p=0.902). At univariate analysis, hand grip strength was significantly lower in the rheumatological patients, both at right hand (right 19.5 kg [IQR 13.6-24.8] vs. 24.5 kg [IQR 20.8-29] in HC; p=0.004) and left hand (18.5 kg [IQR 13.9-22.5] vs. 23.7 kg [IQR 19-27.3] in HC; p=0.002), as compared to HC. This finding was further confirmed at multivariable analysis only as for the left hand (OR 0.919, 95%CI: 0.858-0.984; p=0.016).Conclusion:Rheumatological diseases are burdened by hand disability, mostly affecting daily activities performance [2,3]. Beyond an optimal disease control, our pilot study shows a decrease in left hand strength as compared to healthy controls. This might be due to a reduced use of the non-dominant hand, which may lead over time to a higher deficit of strength. As such, these patients should be prescribed to a left hand exercise to improve both mobility and strength and, consequently, hand function.References:[1]Eberhardt K, Sandqvist G, Geborek P (2008) Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis. Scand J Rheumatol 37(2):109–112.[2]Feced Olmos CM, Alvarez-Calderon O, Hervás Marín D, et al. Relationship between structural damage with loss of strength and functional disability in psoriatic arthritis patients. Clin Biomech (Bristol, Avon). 2019 Aug;68:169-174. doi: 10.1016/j.clinbiomech.2019.06.009.[3]Maddali-Bongi S, Del Rosso A, Mikhaylova S, et al. Impact of hand and face disabilities on global disability and quality of life in systemic sclerosis patients. Clin Exp Rheumatol. 2014 Nov-Dec;32(6 Suppl 86):S-15-20.Disclosure of Interests:None declared