http://www.jneuroengrehab.com/content/11/1/171/abstract
Journal of NeuroEngineering and Rehabilitation 2014, 11:171
doi:10.1186/1743-0003-11-171
Published: 26 December 2014
Published: 26 December 2014
Abstract (provisional)
Background
Dexterous manipulation of the hand, one of the features of human motor control, is
often compromised after stroke, to the detriment of basic functions. Despite the importance
of independent movement of the digits to activities of daily living, relatively few
studies have assessed the impact of specifically targeting individuated movements
of the digits on hand rehabilitation. The purpose of this study was to investigate
the impact of such finger individuation training, by means of a novel mechatronic-virtual
reality system, on fine motor control after stroke.
Methods
An actuated virtual keypad (AVK) system was developed in which the impaired hand controls
a virtual hand playing a set of keys. Creation of individuated digit movements is
assisted by a pneumatically actuated glove, the PneuGlove. A study examining efficacy
of the AVK system was subsequently performed. Participants had chronic, moderate hand
impairment resulting from a single stroke incurred at least 6 months prior. Each subject
underwent 18 hour-long sessions of extensive therapy (3x per week for 6 weeks) targeted
at finger individuation. Subjects were randomly divided into two groups: the first
group (Keypad: N = 7) utilized the AVK system while the other group (OT: N = 7) received
a similarly intensive dose of occupational therapy; both groups worked directly with
a licensed occupational therapist. Outcome measures such as the Jebsen-Taylor Hand
Function Test (JTHFT), Action research Arm Test (ARAT), Fugl-Meyer Upper Extremity
Motor Assessment/Hand subcomponent (FMUE/FMH), grip and pinch strengths were collected
at baseline, post-treatment and one-month post-treatment.
Results
While both groups exhibited some signs of change after the training sessions, only
the Keypad group displayed statistically significant improvement both for measures
of impairment (FMH: p = 0.048) and measures of task performance (JTHFT: p = 0.021).
Additionally, the finger individuation index - a measure of finger independence -
improved only for the Keypad group after training (p = 0.05) in the subset (Keypad:
N = 4; OT: N = 5) of these participants for which it was measured.
Conclusions
Actively assisted individuation therapy comprised of non task-specific modalities,
such as can be achieved with virtual platforms like the AVK described here, may prove
to be valuable clinical tools for increasing the effectiveness and efficiency of therapy
following stroke.
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