Abstract
BackgroundLoss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation. Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual’s capability to perform essential activities of daily living (ADL).ObjectiveThis pilot study investigated the therapeutic effect of a self-administered home-based hand rehabilitation programme for people with cervical SCI using the soft extra muscle (SEM) Glove by Bioservo Technologies AB.MethodsFifteen participants with chronic cervical motor incomplete (AIS C and D) SCI were recruited and provided with the glove device to use at home to complete a set task and perform their usual ADL for a minimum of 4 h a day for 12 weeks. Assessment was made at Week 0 (Initial), 6, 12 and 18 (6-week follow-up). The primary outcome measure was the Toronto Rehabilitation Institute hand function test (TRI-HFT), with secondary outcome measures including pinch dynamometry and the modified Ashworth scale.ResultsThe TRI-HFT demonstrated improvement in hand function at Week 6 of the therapy including improvement in object manipulation (58.3 ±3.2 to 66.9 ±1.8, p ≈ 0.01), and palmar grasp assessed as the length of the wooden bar that can be held using a pronated palmar grip (29.1 ±6.0 cm to 45.8 ±6.8 cm, p <0.01). A significant improvement in pinch strength, with reduced thumb muscle hypertonia was also detected. Improvements in function were present during the Week 12 assessment and also during the follow-up.ConclusionsSelf-administered rehabilitation using the SEM Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home. Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to improve long-term neuromuscular activity. Future studies should characterise the neuromuscular mechanism of action and the minimal rehabilitation programme necessary with the assistive device to improve ADL tasks following chronic cervical SCI.Trial registration numberTrial registration: ISRCTN, ISRCTN98677526, Registered 01/June/2017 - Retrospectively registered, http://www.isrctn.com/ISRCTN98677526
Highlights
High level spinal cord injury (SCI) often involves impairment of both upper and lower limb function, with the deficit in hand function perceived by affected individuals as a high priority problem [1, 2]
Self-administered rehabilitation using the soft extra muscle (SEM) Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home
Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to (Continued on page)
Summary
High level spinal cord injury (SCI) often involves impairment of both upper and lower limb function, with the deficit in hand function perceived by affected individuals as a high priority problem [1, 2]. Despite the intensive hand rehabilitation therapy or compensatory strategies provided by the spinal cord injury centre during the sub-acute rehabilitation phase, significant impaired function often continues to be present during chronic SCI. This presents a challenge in how an effective self-administered home-based therapy programme could be provided. Loss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual’s capability to perform essential activities of daily living (ADL)
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