Abstract
In previous work, we developed an exoskeleton, Hand Spring Operated Movement Enhancer (HandSOME II), that allows movement at 15 hand degrees of freedom (DOF). Eleven separate elastic elements can be added to customize the extension assistance for individuals with impaired hand function. In this pilot study of twelve individuals with stroke, we measured the immediate improvements in range of motion (ROM) and upper extremity function when wearing the device. Index finger ROM was significantly improved at the PIP (p=.01) and DIP joints (p=.026), and the max extension was significantly increased at the MCP (p<.001), PIP (p=.013) and DIP joints (p=.016). The thumb CMC abduction max (p=.017) and CMC flexion/extension ROM also increased (p=.04). In a grip and release task involving various objects, six subjects were unable to complete the tasks without assistance. Across these 6 subjects, 13 of 42 tasks were completed without assistance, while 36 of 42 tasks were completed when wearing HandSOME II. Despite the extension assistance provided by the device, flexion grip force was not statistically decreased. HandSOME II can potentially increase the effectiveness of repetitive task practice in patients with moderate-severe hand impairment by allowing completion of grasp and release tasks that are impossible to complete unassisted.
Highlights
THERE are approximately 800,000 new stroke cases every year in the US [1]
For the biomechanical evaluation of the HandSOME II device, we focused on kinematics of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of the index finger; flexion/extension and range of motion (ROM)
Our results demonstrate that chronic stroke patients can improve function of the affected hand immediately by donning the HandSOME II device
Summary
THERE are approximately 800,000 new stroke cases every year in the US [1]. Fifty percent of affected individuals over the age of 64 show hemiparesis at six months and 26% of them are fully dependent on others for activities of daily living (ADL) [2]. Rehabilitation in the upper extremity targets reaching and grasping movements, but in order to use the upper limb for ADL, a high degree of motor control is needed. Motor recovery of the paretic hand is a critical component for functional recovery in the upper limb [5]. By applying extension force to the fingers, exoskeletons can assist the effectiveness of task-related repetitive practice by enabling completion of their movements, increasing the effectiveness of task practice in the upper extremities [8]. A recent meta-analysis found that robotic devices provide larger gains in arm function, strength and ADL ability in comparison to other interventions [9]. Most devices are not wearable for use during ADL, which limits transfer of gains to real world everyday use of the upper extremity [10]
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