Effectiveness of mixed reality-based rehabilitation on hands and fingers by individual finger-movement tracking in patients with stroke

 Actually being able to individually move fingers doesn't work when you have spasticity. So this research leaves survivors behind. They obviously were testing on high functioning survivors.

Effectiveness of mixed reality-based rehabilitation on hands and fingers by individual finger-movement tracking in patients with stroke

• Yeajin Ham,
• Dong-Seok Yang,
• Younggeun Choi &
• Joon-Ho Shin 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 140 (2024) Cite this article

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Abstract

Background

Mixed reality (MR) is helpful in hand training for patients with stroke, allowing them to fully submerge in a virtual space while interacting with real objects. The recognition of individual finger movements is required for MR rehabilitation. This study aimed to assess the effectiveness of updated MR-board 2, adding finger training for patients with stroke.

Methods

Twenty-one participants with hemiplegic stroke (10 with left hemiplegia and 11 with right hemiplegia; nine female patients; 56.7 ± 14.2 years of age; and onset of stroke 32.7 ± 34.8 months) participated in this study. MR-board 2 comprised a board plate, a depth camera, plastic-shaped objects, a monitor, a palm-worn camera, and seven gamified training programs. All participants performed 20 self-training sessions involving 30-min training using MR-board 2. The outcome measurements for upper extremity function were the Fugl–Meyer assessment (FMA) upper extremity score, repeated number of finger flexion and extension (Repeat-FE), the thumb opposition test (TOT), Box and Block Test score (BBT), Wolf Motor Function Test score (WMFT), and Stroke Impact Scale (SIS). One-way repeated measures analysis of variance and the post hoc test were applied for the measurements. MR-board 2 recorded the fingers’ active range of motion (AROM) and Dunnett’s test was used for pairwise comparisons.

Results

Except for the FMA-proximal score (p = 0.617) and TOT (p = 0.005), other FMA scores, BBT score, Repeat-FE, WMFT score, and SIS stroke recovery improved significantly (p < 0.001) during MR-board 2 training and were maintained until follow-up. All AROM values of the finger joints changed significantly during training (p < 0.001).

Conclusions

MR-board 2 self-training, which includes natural interactions between humans and computers using a tangible user interface and real-time tracking of the fingers, improved upper limb function across impairment, activity, and participation. MR-board 2 could be used as a self-training tool for patients with stroke, improving their quality of life.

Trial registration number: This study was registered with the Clinical Research Information Service (CRIS: KCT0004167).

Background

Stroke is a prevalent, severe, and incapacitating worldwide health issue, and a key component of stroke care is rehabilitation [1]. Continuous and sufficient rehabilitation is required to elicit functional improvement [2]. Several augmented and virtual reality applications have been implemented to enhance rehabilitation [3]. Mixed reality (MR), which blends virtual reality and physical things, allows participants to fully submerge themselves into a virtual space by interacting with real objects, thereby maintaining their sense of reality. Previous studies have demonstrated the feasibility of MR-based rehabilitation (MRR) specifically for upper limb rehabilitation among participants with stroke [4, 5]. The real physical objects of MRR play the role of tangible user interfaces, enabling more engagement, active participation, and effective learning [6, 7]. MRR could be useful for hand rehabilitation because the physical interfaces provide a haptic sense to the contacting hand, which is a gate for the interaction of the body with objects [8].

Finger individuation can be impaired even by small or lacunar lesions resulting from a stroke [9]. This impaired individuation affects a range of activities, such as typing, grasping, and transporting of objects [10]. Reduced finger strength and impaired finger individuation are two motor deficits affecting hand function following stroke [11]. The potential benefits of the MRR can be achieved through complex hand movement that require individual finger movements. Colomer et al. presented an MRR program that included finger tapping, pincer grasping, and mass grasping [5]. However, recognizing individual finger movements is challenging in previously introduced MR systems because they are only sensed using a depth-perception camera, not collecting kinematic data [5, 8]. Capturing the entire finger movement is particularly difficult for stroke participants because they commonly experience spasticity, dystonia, or deformities, which impede adequate movement perception from the camera [12, 13]. Various types of sensors, including wearable and flexible sensors and inertial measurement unit (IMU) sensors, have been used for fingers [14,15,16]. However, sensing using an IMU sensor is affected by attachment location, and wearable-type sensors are difficult to wear by participants with stroke.

To address these issues, we updated the MRR system (MR-board 2) by adding a palm camera (TapSix) and specific training programs for fingers [17]. We originally developed an MR board for hand rehabilitation and demonstrated the feasibility of the MR board as a self-training tool for the upper extremity in patients with stroke [8]. The MR board provided interventions regarding gross hand movements only and did not include individual finger training (FT). The newly developed MR-board 2 can provide finger-relevant training, allowing for more hierarchical training according to the participants’ capabilities and goals. When participants could not train their fingers at the initial stage, they received gross hand training, such as grasping, releasing, and object manipulation. If they regain finger function, they can move on to individual FT.

Therefore, we hypothesized that MR-board 2 could benefit upper-limb self-rehabilitation, especially for hand rehabilitation, including FT and capturing entire finger movements. This study aimed to apply MR-board 2 to participants with stroke as a tool for self-rehabilitation and explore its effectiveness across every domain (impairment, limitation, and restriction) of the International Classification of Functioning, Disability, and Health (ICF) [18]. We also recorded and analyzed each joint involved in the entire finger movement during FT.

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