Clinical application of computerized evaluation and re-education biofeedback prototype for sensorimotor control of the hand in stroke patients

Hsiu-Yun Hsu,Cheng-Feng Lin,Li-Chieh Kuo,Haw-Yen Chiu,Huan-Ting Kuo,Fong-Chin Su

doi:10.1186/1743-0003-9-26

Abstract

BackgroundHemianaesthesia patients usually exhibit awkward and inefficient finger movements of the affected hands. Conventionally, most interventions emphasize the improvement of motor deficits, but rarely address sensory capability and sensorimotor control following stroke. Thus it is critical for stroke patients with sensory problems to incorporate appropriate strategies for dealing with sensory impairment, into traditional hand function rehabilitation programs. In this study, we used a custom-designed computerized evaluation and re-education biofeedback (CERB) prototype to analyze hand grasp performances, and monitor the training effects on hand coordination for stroke patients with sensory disturbance and without motor deficiency.MethodsThe CERB prototype was constructed to detect momentary pinch force modulation for 14 sub-acute and chronic stroke patients with sensory deficiency and 14 healthy controls. The other ten chronic stroke patients (ranges of stroke period: 6–60 months) were recruited to investigate the effects of 4-weeks computerized biofeedback treatments on the hand control ability. The biofeedback procedures provide visual and auditory cues to the participants when the interactive force of hand-to-object exceeded the target latitude in a pinch-up-holding task to trigger optimal motor strategy. Follow-up measurements were conducted one month after training. The hand sensibility, grip forces and results of hand functional tests were recorded and analyzed.ResultsThe affected hands of the 14 predominant sensory stroke patients exhibited statistically significant elevation in the magnitude of peak pinch force (p = 0.033) in pinching and lifting-up tasks, and poor results for hand function tests (p = 0.005) than sound hands did. In addition, the sound hands of patients were less efficient in force modulation (p = 0.009) than the hands of healthy subjects were. Training with the biofeedback system produced significant improvements in grip force modulation (p = 0.020) and better performances in the subtests of pin insertion (p = 0.019), and lifting of lightweight objects (p = 0.005).ConclusionsThe CERB prototype can provide momentary and interactive information for quantitative assessing and re-educating force modulation appropriately for stroke patients with sensory deficits. Furthermore, the patients could transfer the learned strategy to improve hand function.

Highlights

Stroke-related impairment often restricts patients from properly participating in the activities of daily living, and impedes social interactions
Previous reports describe that approximately 60–70% of stroke patients exhibit mild to severe hand dysfunction [2,3,4,5]; and up to 20% of stroke survivors were dependent in their basic daily living activities [6]
Motor dysfunction is generally considered as the main cause of hand function deficit; by contrast, less emphasis has been directed to the effects of sensory disturbances on functional performances even though approximately 50–85% stroke survivors with dysfunction of different sensory modalities have been reported [20]

Summary

Introduction

Stroke-related impairment often restricts patients from properly participating in the activities of daily living, and impedes social interactions. Previous reports describe that approximately 60–70% of stroke patients exhibit mild to severe hand dysfunction [2,3,4,5]; and up to 20% of stroke survivors were dependent in their basic daily living activities [6] Such negative impacts on function are a strong motivation for researchers to investigate hand movement dynamics [7] and to develop effective therapeutic interventions for stroke patients [8]. Stroke patient hand dysfunction has been assessed by both quantitative and qualitative tests, such as the Brunnstrom recovery stages [9], maximum grip strength, the Fugl-Meyer assessment [10], and real-life Motor Activity Log questionnaires [11] Use of these traditional and common evaluation methods does not assess the delicate controls of the hand, such as spatio-temporal coordination of multi-segmented movements and precise force modulation. We used a custom-designed computerized evaluation and re-education biofeedback (CERB) prototype to analyze hand grasp performances, and monitor the training effects on hand coordination for stroke patients with sensory disturbance and without motor deficiency

Methods

Results

Conclusion