Your doctor should immediately acquire these tools. You need an objective assessment of your hand and wrist disabilities in order to determine what rehab protocols are to be used. Your doctor will immediately say there are no protocols available. True, and what has your doctor done to establish any stroke protocols?
Their reasons for doing nothing.
Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job?
A suite of automated tools to quantify hand and wrist motor function after cervical spinal cord injury
The
Correction to this article has been published in Journal of NeuroEngineering and Rehabilitation 2020 17:3
Abstract
Background
Cervical spinal cord injury (cSCI) often causes chronic upper extremity disability. Reliable measurement of arm function is critical for development of therapies to improve recovery after cSCI. In this study, we report a suite of automated rehabilitative tools to allow simple, quantitative assessment of hand and wrist motor function.Methods
We measured range of motion and force production using these devices in cSCI participants with a range of upper limb disability and in neurologically intact participants at two time points separated by approximately 4 months. Additionally, we determined whether measures collected with the rehabilitative tools correlated with standard upper limb assessments, including the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the Jebsen Hand Function Test (JHFT).Results
We find that the rehabilitative devices are useful to provide assessment of upper limb function in physical units over time in SCI participants and are well-correlated with standard assessments.Conclusions
These results indicate that these tools represent a reliable system for longitudinal evaluation of upper extremity function after cSCI and may provide a framework to assess the efficacy of strategies aimed at improving recovery of upper limb function.Introduction
Spinal cord injury is a common cause of disability, affecting more than 300,000 people in the US [1].
The majority of injuries occur at the cervical level, which often
impairs function of upper extremities and can lead to chronic disability
[2,3,4].
Accurate and sensitive measurement of upper limb function is a critical
part of the development and assessment of new therapies to improve
recovery after SCI.
The most common method of arm assessment after cSCI involves subjective ordinal scoring of motor function by a skilled examiner [5,6,7]. While this approach yields rapid and reliable results, ordinal assessment may not always be sensitive to small improvements that can be functionally meaningful [8, 9]. Objective measurement may provide improved measurement sensitivity, and as sensor technologies have become smaller and more accessible, numerous tools have been developed for assessing arm function after cSCI [10]. Dynamometers and myometers are widely used to measure isometric force of isolated arm functions in continuous physical units [11, 12]. Other assessment tools measure position and force during execution of simulated functional tasks [13, 14]. These systems indeed provide greater precision or a more direct characterization of functional ability than traditional measures, but the continued reliance upon ordinal assessment indicates an unmet clinical need for the development of measurement technologies.
To increase their utility and implementation, measurement systems should be simple to use, facilitate standardized administration, report sensitive, quantitative metrics, and provide reliable longitudinal testing [15]. We designed a suite of modular rehabilitative devices for objective assessment of various isolated hand and wrist motor functions to address these needs. In addition to the measurement modules, a table-mounted armrest with simple, interchangeable tasks facilitates standardized administration across a wide range of arm impairments [11]. The system records measurements in continuous physical units, providing unambiguous results across many aspects of function. Furthermore, the devices enable collection of multiple trials to increase sensitivity and reliability of measurements.
In this study, we tested whether these tools could quantify motor impairments in individuals with cSCI, determined measurement detection limits, and examined retest reliability by assessing the same participants 4 months later. We also established concurrent validity by correlating performance on the rehabilitative devices with two common metrics of upper limb function after cSCI, the Graded Refined Assessment of Strength, Sensibility, and Prehension (GRASSP) exam and the Jebsen Hand Function Test (JHFT) [5]. Our results demonstrate that the system provides reliable measurements over time and that performance correlates with established outcome measures. The results indicate that the novel system can deliver simple and reliable longitudinal evaluation of upper extremity function after cSCI and may provide a framework to assess the efficacy of strategies aimed at improving recovery of upper limb function.
The most common method of arm assessment after cSCI involves subjective ordinal scoring of motor function by a skilled examiner [5,6,7]. While this approach yields rapid and reliable results, ordinal assessment may not always be sensitive to small improvements that can be functionally meaningful [8, 9]. Objective measurement may provide improved measurement sensitivity, and as sensor technologies have become smaller and more accessible, numerous tools have been developed for assessing arm function after cSCI [10]. Dynamometers and myometers are widely used to measure isometric force of isolated arm functions in continuous physical units [11, 12]. Other assessment tools measure position and force during execution of simulated functional tasks [13, 14]. These systems indeed provide greater precision or a more direct characterization of functional ability than traditional measures, but the continued reliance upon ordinal assessment indicates an unmet clinical need for the development of measurement technologies.
To increase their utility and implementation, measurement systems should be simple to use, facilitate standardized administration, report sensitive, quantitative metrics, and provide reliable longitudinal testing [15]. We designed a suite of modular rehabilitative devices for objective assessment of various isolated hand and wrist motor functions to address these needs. In addition to the measurement modules, a table-mounted armrest with simple, interchangeable tasks facilitates standardized administration across a wide range of arm impairments [11]. The system records measurements in continuous physical units, providing unambiguous results across many aspects of function. Furthermore, the devices enable collection of multiple trials to increase sensitivity and reliability of measurements.
In this study, we tested whether these tools could quantify motor impairments in individuals with cSCI, determined measurement detection limits, and examined retest reliability by assessing the same participants 4 months later. We also established concurrent validity by correlating performance on the rehabilitative devices with two common metrics of upper limb function after cSCI, the Graded Refined Assessment of Strength, Sensibility, and Prehension (GRASSP) exam and the Jebsen Hand Function Test (JHFT) [5]. Our results demonstrate that the system provides reliable measurements over time and that performance correlates with established outcome measures. The results indicate that the novel system can deliver simple and reliable longitudinal evaluation of upper extremity function after cSCI and may provide a framework to assess the efficacy of strategies aimed at improving recovery of upper limb function.
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