Simulated Home Therapy Program for the Hand After Stroke
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 6/28/2017 |
| Start Date: | May 2011 |
| End Date: | December 2014 |
The purpose of this study is to investigate the benefits of incorporating an actuated,
EMG-controlled glove into occupational therapy of the hand.
EMG-controlled glove into occupational therapy of the hand.
Stroke survivors with chronic hemiparesis of the upper extremity undertook 18 one-hour
training sessions over a 6-week period. Participants received occupational therapy focusing
on grasp-and-release using a task-oriented protocol developed at the Rehabilitation
Institute of Chicago by Dr. Mary Ellen Stoykov. Over 90% of all repetitions performed during
each session were focused on functional activities, as opposed to active exercise. The
skills and strategies developed in therapy were then implemented into activities identified
as goals by the participant, such as donning socks. Difficulty of the task, activity, or
exercise was progressed for each participant to provide optimal challenge to enhance skill.
Subjects were assigned to one of two groups by casting lots. One group (VAEDA Glove)
performed all tasks while wearing a custom Voice And EMG-Driven Actuated glove, the VAEDA
Glove. The other group (No-Glove) performed the same types of tasks without use of the VAEDA
Glove. The VAEDA Glove is a portable active-assistance glove, designed to assist digit
extension in order to allow repeated practice of specified tasks. The glove contains cables
traversing the dorsal side of the digits in order to provide extension and resist flexion.
Forces are transmitted through the cables from a servomotor located remotely to the digits.
The servomotor controls torque or displacement in the cable. Along the digits, the cables
traverse through custom plastic blocks, which serve both to guide the cable and to prevent
joint hyperextension.
The VAEDA Glove can be controlled with up to 3 channels of electromyography (EMG). For this
study, electrodes were placed above flexor digitorum superficialis (FDS) and extensor
digitorum communis (EDC). The group using the J-Glove could receive assistance during hand
opening, but only if appropriate EMG activity was detected. The EDC EMG activity had to
reach a prescribed threshold before extension assistance would be provided. Similarly, FDS
EMG activity had to surpass a threshold level during hand closing before the user was
allowed to flex the digits. Feedback of muscle activity was available to the user through a
custom graphical user interface.
training sessions over a 6-week period. Participants received occupational therapy focusing
on grasp-and-release using a task-oriented protocol developed at the Rehabilitation
Institute of Chicago by Dr. Mary Ellen Stoykov. Over 90% of all repetitions performed during
each session were focused on functional activities, as opposed to active exercise. The
skills and strategies developed in therapy were then implemented into activities identified
as goals by the participant, such as donning socks. Difficulty of the task, activity, or
exercise was progressed for each participant to provide optimal challenge to enhance skill.
Subjects were assigned to one of two groups by casting lots. One group (VAEDA Glove)
performed all tasks while wearing a custom Voice And EMG-Driven Actuated glove, the VAEDA
Glove. The other group (No-Glove) performed the same types of tasks without use of the VAEDA
Glove. The VAEDA Glove is a portable active-assistance glove, designed to assist digit
extension in order to allow repeated practice of specified tasks. The glove contains cables
traversing the dorsal side of the digits in order to provide extension and resist flexion.
Forces are transmitted through the cables from a servomotor located remotely to the digits.
The servomotor controls torque or displacement in the cable. Along the digits, the cables
traverse through custom plastic blocks, which serve both to guide the cable and to prevent
joint hyperextension.
The VAEDA Glove can be controlled with up to 3 channels of electromyography (EMG). For this
study, electrodes were placed above flexor digitorum superficialis (FDS) and extensor
digitorum communis (EDC). The group using the J-Glove could receive assistance during hand
opening, but only if appropriate EMG activity was detected. The EDC EMG activity had to
reach a prescribed threshold before extension assistance would be provided. Similarly, FDS
EMG activity had to surpass a threshold level during hand closing before the user was
allowed to flex the digits. Feedback of muscle activity was available to the user through a
custom graphical user interface.
Inclusion Criteria:
- chronic upper extremity hemiparesis subsequent to stroke (minimum of 6 months
post-stroke)
- moderate hand impairment classified as Stage 4 on the Chedoke McMaster Stroke
Assessment
Exclusion Criteria:
- anti-spasticity medications/injections taken less than 6 month prior to enrollment
- contractures greater than 20 degrees
- inability to follow single-step commands
- significant upper extremity pain (self-reported pain of greater than 6 on a 10-point
scale)
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