SaeboGlove therapy for upper limb disability and severe hand impairment after stroke (SUSHI): Study protocol for a randomised controlled trial

Background Impaired active digital extension is common after stroke, hindering functional rehabilitation, and predicting poor recovery. The SaeboGlove assists digital extension and may improve outcome after stroke. We recently performed a single group, open, pilot trial of the SaeboGlove early after stroke which demonstrated satisfactory safety, feasibility and acceptability. An adequately powered randomised clinical trial is now needed to assess the clinical effectiveness of the SaeboGlove. Methods SUSHI is a pragmatic, multicentre, parallel-group, randomised controlled trial with blinded outcome assessment, and embedded process and economic evaluations. Adults, 7–60 days post-stroke, with upper limb disability and severe hand impairment, including reduced active digital extension, will be recruited from NHS inpatient stroke services in Scotland. Participants will be randomised on a 1:1 basis to receive 6 weeks of self-directed, repetitive, functional-based practice involving a SaeboGlove plus usual care, or usual care only. The primary outcome is upper limb function measured by the Action Research Arm Test (ARAT) at 6 weeks. Secondary outcomes will be measured at 6 and 14 weeks. A process evaluation will be performed via interviews with ‘intervention’ participants, and their carers and clinical therapists. A within-trial cost-effectiveness analysis will be performed. 110 participants are required to detect a difference between groups of 9 in the ARAT with 90% power at a 5% significance level allowing for 11% attrition. Discussion SUSHI will determine if SaeboGlove self-directed, repetitive, functional-based practice improves upper limb function after stroke, whether it is acceptable to stroke survivors and whether it is cost-effective.

Intracortical motor conduction is associated with hand dexterity in progressive multiple sclerosis

Background: Hand dexterity dysfunction is a key feature of disability in people with progressive multiple sclerosis (PMS). It underlies corticospinal tract (CST) and cerebellar integrity, as well as disruption of cortical networks, which are hardly assessed by standard techniques. Transcranial magnetic stimulation is a promising tool for evaluating the integrity of intracortical motor pathways. Objective: To investigate neurophysiological correlates of motor hand impairment in PMS. Methods: Antero-posterior (AP) stimulation of the primary motor cortex activates the CST indirectly through polysynaptic pathways, while a direct CST activation occurs with latero-medial (LM) directed current. Thirty PMS and 15 healthy controls underwent dominant hand motor evoked potentials (MEP) using AP and LM-directed stimulation, and a clinical assessment of dexterity (nine-hole peg test) and strength (MRC scale, grip and pinch). Results: PMS with AP-LM latency difference 2.5 standard deviation above the mean of controls (33%) showed worse dexterity but no difference in upper limb strength. Accordingly, AP-LM latency shortening predicted dexterity (R2 = 0.538, p < 0.001), but not strength impairment. On the contrary, absolute MEP latencies only correlated with strength (grip: R2 = 0.381, p = 0.014; MRC: R2 = 0.184, p = 0.041). Conclusion: AP-LM latency shortening may be used to assess the integrity polysynaptic intracortical networks implicated in dexterity impairment.

Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke

Background. Stroke is one of the most common causes of physical disability worldwide. The majority of survivors experience impairment of movement, often with lasting deficits affecting hand dexterity. To date, conventional rehabilitation primarily focuses on training compensatory maneuvers emphasizing goal completion rather than targeting reduction of motor impairment. Objective. We aim to determine whether finger dexterity impairment can be reduced in chronic stroke when training on a task focused on moving fingers against abnormal synergies without allowing for compensatory maneuvers. Methods. We recruited 18 chronic stroke patients with significant hand motor impairment. First, participants underwent baseline assessments of hand function, impairment, and finger individuation. Then, participants trained for 5 consecutive days, 3 to 4 h/d, on a multifinger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies. To test generalization, we assessed performance in trained and nontrained chords and clinical measures in both the paretic and the nonparetic hands. To evaluate retention, we repeated the assessments 1 day, 1 week, and 6 months post-training. Results. Our results showed that finger impairment assessed by the individuation task was reduced after training. The reduction of impairment was accompanied by improvements in clinical hand function, including precision pinch. Notably, the effects were maintained for 6 months following training. Conclusion. Our findings provide preliminary evidence that chronic stroke patient can reduce hand impairment when training against abnormal flexor synergies, a change that was associated with meaningful clinical benefits.

A proposed soft pneumatic actuator control based on angle estimation from data-driven model

This article proposes a bending angle controller for soft pneumatic actuators, which could be implemented in soft robotic rehabilitation gloves to assist patients with hand impairment, such as stroke survivors. A data-driven model is used to estimate the angle as pneumatic pressure is applied to the actuator. Furthermore, a finite element model was used to manually optimize the dimensions of the actuator. An embedded flex sensor, which together with a custom testing rig, was used to gather input data for the data-driven model. This rig contains a pneumatic pressure control circuit as well as a camera for image acquisition. Collected data were fed into a linear regression model to predict the data-driven model. Experiments were carried out to validate model’s accuracy as well as modified proportional–integral–derivative controller angle controller performance. The latter controller is designed to mitigate the non-linear response of solenoid valves at different pressures of the actuator. The data-driven model along with the used controller allows more accurate estimation and quicker response.

Upper limb robotic neurorehabilitation after pediatric stroke

Introduction. Pediatric brain stroke is a rare condition, with the incidence of 1.2?13/100,000. The most common consequence is hemiparesis with unilateral hand impairment. There is level 4 evidence that robotics may improve the function of upper limbs. In this paper, we present the effect of combined robotic rehabilitation and kinesitherapy on the distal portion of the arm in the chronic phase of hemiparesis in childhood. Case outline. In a 7.5-year-old girl the treatment with robotic neurorehabilitation was administered in the chronic phase of post-stroke rehabilitation, 18 months after the stroke, involving individualized kinesitherapy for 30 minutes, and virtual reality-based rehabilitation using the robotic Smart Glove for 30 minutes. The rehabilitation protocol was administered for 12 weeks (five times a week). The results of therapeutic evaluation showed that the level 2 of Manual Ability Classification System remained unchanged until the end of treatment, while the grade assigned for the spasticity of flexors in the forearm and fingers was 2 at the treatment onset, 1+ after four weeks of therapy, and 1 after eight and 12 weeks of therapy. Qualitative improvement of arm function through the increase of the overall value of the Quality of Upper Extremity Skills Test was evidenced at each evaluation testing, being the greatest after the first four weeks of rehabilitation (4.83%). Conclusion. The result of our study suggests that combined robotic rehabilitation and kinesitherapy can improve the functional motor performance of the arm involved in the chronic recovery phase after a pediatric stroke.

Myoelectric untethered robotic glove enhances hand function and performance on daily living tasks after stroke

Introduction Wearable robots controlled using electromyography could motivate greater use of the affected upper extremity after stroke and enable bimanual activities of daily living to be completed independently. Methods We have developed a myoelectric untethered robotic glove (My-HERO) that provides five-finger extension and grip assistance. Results The myoelectric controller detected the grip and release intents of the 9 participants after stroke with 84.7% accuracy. While using My-HERO, all 9 participants performed better on the Fugl-Meyer Assessment-Hand (8.4 point increase, scale out of 14, p < 0.01) and the Chedoke Arm and Hand Activity Inventory (8.2 point increase, scale out of 91, p < 0.01). Established criteria for clinically meaningful important differences were surpassed for both the hand function and daily living task assessments. The majority of participants provided satisfaction and usability questionnaire scores above 70%. Seven participants desired to use My-HERO in the clinic and at home during their therapy and daily routines. Conclusions People with hand impairment after stroke value that myoelectric untethered robotic gloves enhance their motion and bimanual task performance and motivate them to use their muscles during engaging activities of daily living. They desire to use these gloves daily to enable greater independence and investigate the effects on neuromuscular recovery.

Flexion and Extension Capable Motor Tendon Actuated Exosuit Glove With Open Palm

Patients suffering from medical conditions resulting in hand impairment experience difficulty in performing simple daily tasks, like getting dressed or using a pencil, resulting in a poorer quality of life. Rehabilitation attempts to help such individuals regain a sense of control and normalcy. In this context, recent advances in robotics have manifested in multiple designs of hand exoskeletons and exosuit gloves for assistance and rehabilitation. These designs are typically actuated using pneumatic, shape memory alloys and motor-tendon actuators. The proposed Motor Tendon Actuated Exosuit Glove (MTAEG) with an open palm is a soft material glove capable of both flexion and extension of all four fingers of the human hand. Its minimally invasive design maintains an open palm to facilitate haptic and tactile interaction with the environment. The MTAEG achieves flexion-extension motion with joint angles of 45° at the metacarpal joint which is 57% of the desired motion; 90° at the proximal interphalangeal joint which is 100% of the desired motion; and 50° at the distal interphalangeal joint which is 96% of the desired motion. The paper discusses the challenges in achieving the desired motion without the ability to directly model human tendons, and the inability to actuate joints individually.