Wearable vibrotactile stimulation for upper extremity rehabilitation in chronic stroke: clinical feasibility trial using the VTS Glove

Six years after this suggestion from this earlier research we finally get something. Totally fucking appalling timeline, it is as if stroke survivors mean nothing and stroke 'leaders' are doing nothing.

Remote vibrotactile noise improves light touch sensation in stroke survivors' fingertips via stochastic resonance February 2014 

The findings suggest that a wearable device applying vibrotactile noise at the wrist could enhance sensation and grip ability without interfering with object manipulation in everyday tasks.

The latest here:

Wearable vibrotactile stimulation for upper extremity rehabilitation in chronic stroke: clinical feasibility trial using the VTS Glove

Caitlyn E. Seim 1*,
 Steven L. Wolf  2,
and Thad E. Starner 3
*Correspondence: cseim@stanford.edu
1 Stanford University, Department of Mechanical Engineering, Stanford,
CA, USA

Abstract

Objective: 
Evaluate the feasibility and potential impacts on hand function using a wearable stimulation device
(the VTS Glove) which provides mechanical, vibratory input to the affected limb of chronic stroke survivors.
Methods: 
A double-blind, randomized, controlled feasibility study including sixteen chronic stroke survivors
(mean age: 54; 1-13 years post-stroke) with diminished movement and tactile perception in their affected hand. Participants were given a wearable device to take home and asked to wear it for three hours daily over eight weeks. The device intervention was either (1) the VTS Glove, which provided vibrotactile stimulation to the hand, or (2) an identical glove with vibration disabled. Participants were equally randomly assigned to each condition. Hand and arm function were measured weekly at home and in local physical therapy clinics.
Results:
Participants using the VTS Glove showed significantly improved Semmes-Weinstein monofilament
exam, reduction in Modified Ashworth measures in the fingers, and some increased voluntary finger flexion, elbow and shoulder range of motion.
Conclusions: 
Vibrotactile stimulation applied to the disabled limb may impact tactile perception, tone and
spasticity, and voluntary range of motion. Wearable devices allow extended application and study of
stimulation methods outside of a clinical setting.
Keywords:
stroke; stimulation; upper extremity; vibrotactile; spasticity
Background
Over 15 million people have a stroke each year, making it one of the leading causes of disability in the United States and worldwide [1, 2, 3]. Upper limb disability occurs in about 50% of cases [4, 5] and diminished tactile perception in about 35-55% [6, 7]. Current methods of therapy for upper limb dysfunction after stroke focus on activities which use the limb; however, these forms of rehabilitation are not accessible to survivors with very limited function. Somatosensory stimulation may be an effective and accessible modality for rehabilitation. Most fundamentally, somatosensory input is known to drive cortical organization and skill acquisition [8, 9, 10]. Somatosensory input has also been associated with sensorimotor recovery after CNS injury in animal [11, 12] as well
as human studies [13]. Afferent input is also integral to limb use. Tactile perception and proprioception are


Figure 1 The computerized glove that provides vibrotactile
stimulation for this study.
factors in motor performance and are thought to coactivate with motor cortical circuits [14, 15, 16].
Afferent electrical stimulation has been studied as a means for providing sensory input to the disabled
extremity of stroke survivors [17, 18, 19, 20, 21], and preliminary evidence shows changes in tactile perception, motor function and brain activity. Mechanical, vibratory stimulation can be applied without the placement, electrodes or gel of electrical stimulation. Afferent electrical stimulation most often targets cutaneous sensory receptors in the skin; while vibrotactile stimulation can activate both muscle afferent fibers and cutaneous sensory receptors without inducing movement. Vibrotactile stimulation has been coupled with other methods such as robotic manipulation or music practice exercises for rehabilitation [22, 23], and applied to the arm for in-situ dexterity improvement
[24]. Improved spasticity and significant neuromuscular changes have been found in laboratory studies of whole-body vibration (WBV) [25, 26, 27, 28] and focal muscle/tendon vibration [29, 30, 31, 32, 33, 34, 35].
Despite encouraging data, vibrotactile stimulation is not widely used outside the clinic because there
are no mobile devices that can deliver and study this form of mechanical stimulation for prolonged periods of time. Here we designed a lightweight, wireless, wearable device to apply vibrotactile stimulation to the hand. Wearable devices are closely coupled with the body, and thus allow stimulation for extended periods of time and in the background of daily life. The intervention is mobile and simple to apply without access to a clinic. Users simply wear the device, requiring little
exertion and time, which may facilitate adherence. The device was deployed in a controlled feasibility trial of chronic stroke survivors with upper limb sensorimotor deficits. If wearable stimulation proves to be effective it could directly impact healthcare delivery, because it
may provide a mobile, affordable rehabilitation option for patients who otherwise would not have access to high intensity stroke rehabilitation.