Clinicians Support the Use of Novel Dual-Purpose Robotic Hand Orthosis for Post-Stroke Rehab

 But will this device cure spasticity of the hand? From an earlier post this seems to be it, but does not correspond to the picture below.

Can it get the hand fully recovered while still in the hospital?

Clinicians Support the Use of Novel Dual-Purpose Robotic Hand Orthosis for Post-Stroke Rehab

A majority of clinicians who work with stroke patients (64.9%) said they would use a novel robotic arm orthosis for both rehabilitation and assistance in performing daily activities. Most thought the prototype could be used at every stage of stroke rehabilitation.

Only 20% of participants had used robotic devices in the clinic, despite the large number of robotics available for use post-stroke.

• Involving clinicians in the development of devices may facilitate their adoption in clinical practice.

A new study in Disability and Rehabilitationexplores clinician perspectives about an experimental robotic arm orthosis developed by NewYork-Presbyterian physicians for stroke patients with upper limb weakness. Occupational and physical therapists in the study recognized both a rehabilitative and assistive role for the novel device, called MyHand, and provided input into its on-going development.

Below, Joel Stein, MD, chair of the Department of Rehabilitation and Regenerative Medicine at NewYork-Presbyterian and Columbia and senior author of the study, shares his insights from the study and on the role of robotics in rehabilitation and home settings.

Designing a Device to Address Upper Limb Weakness

Most stroke survivors with upper limb weakness have more difficulty opening their hand than closing it. We envisioned a robotic device that would allow them to use their preserved ability to bend the fingers but assists them with opening them. This could help people to pick up objects and manipulate them better. For example, they might be able to prepare a meal or pick up a bite of food and bring it to their mouth. 

Our device uses sensors to pick up electrical signals from the muscles in the forearm to elicit movement. Recently, we have been using machine learning and artificial intelligence to anticipate what the user intends to do in real time and equip the device to assist them with that action.

The Role of Clinicians in Device Design

As a clinician involved in research and technology, I have been approached in the past by engineering teams saying, “We built this impressive new device Do you think you could find a good use for it? Would this help your patients?” That is disappointing on the clinician side because the engineers missed the opportunity to hear from us earlier on in the design phase. As a result, a lot of these devices are technologically impressive but not that appealing clinically.

With this device, clinicians were involved from the beginning of the design process. We then expanded our understanding of clinician perspective by surveying a large national group of occupational and physical therapists to gather their perceptions of the MyHand prototype to guide future development. We wanted to understand their perceptions about the prototype, how they would use it with patients during treatment, and their opinions about the cost and other factors.

Study Results

The majority of the survey participants (64.9%) reported that they would have patients use the device for both rehabilitation and daily assistance performing household tasks, compared to those who would use it only for rehabilitation (28.6%) or assistance (6.6%). The respondents thought that the device could be used in outpatient (85.1%), acute rehabilitation (61.7%), and subacute rehabilitation (57.8% ) settings, and most perceived it useful in all stages of stroke. More than one-third of participants (37.5%) thought the device could be used in home settings.

One of our key findings was that less than 20% of the participating therapists have used robotic devices with patients. That's startling given that robotics started entering into the commercial realm for rehabilitation medicine in the late 1990s. Some of the challenges to adoption include device design and financial barriers.

MyHand device and EMG armband

Next Steps

In addition to clinicians’ views on the device, we have collected data on patients’ perspective about the prototype, which we are still analyzing. We’re also working on a number of technological improvements to enhance the function of the device.

One of the issues that has been a huge barrier in this field is that patients develop spasticity and that can worsen when they try and move the arm. We are partnering with colleagues at other institutions to try and find ways to address this so that people are not fighting the device.

When we do testing, our graduate students and engineering graduate students are present. The interaction between engineers and clinicians with patients in the room—the ability to troubleshoot in real time and get feedback from the patient—is priceless.

— Dr. Joel Stein

What sets us apart are our academic partnerships between NewYork-Presbyterian and Columbia, NewYork-Presbyterian and Weill Cornell Medicine, and Cornell University. When we perform testing, our medicine graduate students and engineering graduate students are present. The interaction between engineers and clinicians with patients in the room—the ability to troubleshoot in real time and get feedback from the patient—is priceless.

• Intro
• Designing a Device
• Role of Clinicians
• Study Results
• Next Steps

Learn More

Winterbottom L, Chen A, Mendonca R, Nilsen DM, Ciocarlie M, Stein J. Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis. Disability and Rehabilitation. 2024 Jul 8:1-10. doi: 10.1080/09638288.2024.2375056.

Sudbury(Ontario) med-tech company taking stroke rehabilitation device to commercial production

 I don't get it and by not pointing to any research on the product, you'll just have to ask your competent? doctor EXACTLY HOW IT WORKS AND ITS EFFICACY! Can it get the hand fully recovered while still in the hospital? NO? Then what will?

Sudbury med-tech company taking stroke rehabilitation device to commercial production

IRegained teams up with top U.S. distributor to sell MyHand rehab device to hospitals, clinics south of the border

Lindsay Kelly | Northern Ontario Business Jul 19, 2024 12:08 PM

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1 / 3 Eric Dumais (pointing), IRegained's clinical research lead, guides David Leblanc on the use of MyHand, while Vineet Johnson, IRegained's president and CEO, looks on.Lindsay Kelly/Northern Ontario Business

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00:07:05

Years of hustle have finally paid off for Sudbury's IRegained.

The med-tech startup, whose MyHand device helps stroke patients regain hand function, is moving to commercial production, having secured a major distributor, Performance Health, to market, sell and disseminate its product in the U.S.

It's been a long time coming, said Vineet Johnson, a co-founder and the company's president and CEO, for whom MyHand has been a passion project.

“A startup is, basically, you give up everything that you're doing and you have to put your heart and soul into this,” he said in an interview with Northern Ontario Business.

Receiving approval from the U.S. Food and Drug Administration (FDA) in January 2023 gave IRegained the OK it needed to move to the next step of commercialization.

Performance Health is one of the top distributors of medical rehabilitation equipment in the U.S., catering to a roughly 40 per cent share of the market, Johnson said, with a focus on getting devices like his into hospitals and medical clinics across the country.

He expects MyHand will sell for about US$30,000 to US$50,000.

To date, IRegained has secured a number of deals with a variety of Canadian and U.S. hospitals and clinics to use MyHand, but the device has not been widely available.

Landing a "big fish” like Performance Health to take the company to the next level is invaluable, Johnson added.

“For a startup, we don’t have to do sales; we don't have to do marketing — they deal with it,” he said.

“Even if their cut is bigger, the volume of devices they're going to sell is much higher, and your margins go up. So, an investor coming in will come in and go, ‘I like this because this is a business that can sustain itself.’”

Assembly of the device, which has, until now, taken place at IRegained's office and lab space at NORCAT on Maley Drive, will move to a Mississauga manufacturing facility that meets the licensing requirements of Health Canada and the FDA.

As production ramps up, Johnson is hopeful of opening a second facility in Sudbury where he'll add to the existing 15-person complement of staff that's currently comprised of local graduates of Laurentian University and Cambrian College.

They'll need people to look after stocking and shipping product, filling purchase orders, and customer service, “but who, how much and when is hard to predict,” he said.

First, he has to get MyHand to the people who need it most.

A little larger than a desktop printer — on wheels — the device prompts users to do repeated activities, stimulating neuropathways in the brain, and eventually helping stroke patients relearn basic hand function.

The device as it looks today — sleek, sophisticated and portable — has evolved since its early days as a basic box.

It can be wheeled to any spot in a hospital, plugged in, and be ready for a patient to sit and begin treatment. There's even a built-in storage compartment for spare parts so that operators don't have to go hunting for them should a replacement be needed.

“Clinicians have a very busy timeline, and during their timelines, they don't want to sit around spending multiple hours or a lot of time setting things up,” Johnson said.

“The design of the device had everything thought through, and that's why you see what you see."

A lot of the feedback on the device came from stroke patients themselves. Johnson's team has recruited locals to try out the device, with twofold benefit: he gets input on how to make it better, while users get the impact of the treatment.

Inspired by his frustration at the lack of rehabilitation options for patients who have experienced stroke, the first inkling of Johnson's idea surfaced in the early 2000s after graduating high school and embarking on a career in physiotherapy.

He went on to complete a master's degree in neuroscience on stroke recovery, and moved on to a PhD on developing robotic devices for stroke patients. Along the way, Johnson has collaborated with other co-founders, although only one remains involved with the company.

By 2016, IRegained was registered as a company, at least on paper, and the following year, Johnson decided to work on the company's business plan while heading off on a backpacking adventure.

Returning to Canada, he went all in on IRegained, taking two years off to focus solely on developing the company. But they were lean times, said Johnson, who worked evenings as a driver for Uber and Amazon after failing to secure a professional position in his field.

"You would think, if you have four degrees, somebody would give you a job," he said. “It was hard; I couldn't meet my bills."

One time, a kind stranger covered his $2 purchase after all his credit cards were declined at the cash.

As a founder, "you should be willing to do that,” he laughed. “Not many people are idiotic enough to do that.”

But his belief in his work propelled him to carry on.

One in four people above the age of 65 will experience stroke, Johnson said, sometimes even when they don't have lifestyle indicators like a poor diet, being a smoker, or lacking proper sleep.

He marvelled at the idea that, in 2024, you can order food from a smartphone and have it delivered directly to you, but patients who live with the effects of a stroke are left with few viable options for rehabilitation.

And those who lose their range of motion must sometimes rely on other people for basic needs, like dressing in the morning.

For formerly robust, active people who have lived their lives independently, it can be a "disgusting, humiliating, almost dehumanizing" experience, Johnson said.

“Your dignity is lost, and that is all we have in life."

Securing Performance Health is the first stage toward commercial production. Johnson said IRegained is still on the lookout for investors to keep building the company, and eventually, he's looking at expanding MyHand's reach to Southeast Asia, an area of the globe that's home to 3.5 billion people.

But first he has to solidify IRegained's North American reach.

That he's got to this point at all, he said, is thanks to a collection of local funding partners — both public and private — that have supported his efforts along the way.

A celebratory gathering held at NORCAT on July 19 was done, in part, to pay thanks to those parties. Johnson believes the collaborative approach they've taken to helping launch IRegained and other local startups is uniquely Sudburian.

“The fact that all of these people collaborated together to make it happen is phenomenal,” he said. “You won't see that in many parts of the world.”