Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label grasping. Show all posts
Showing posts with label grasping. Show all posts

Wednesday, December 10, 2025

AI-Powered Bionic Hand Restores Natural, Intuitive Grasping Ability

 Will our fucking failures of stroke associations figure out a way to implement this for stroke survivors? It will never occur; they have constantly proven they are complete failures at anything to do with stroke recovery!

AI-Powered Bionic Hand Restores Natural, Intuitive Grasping Ability

Summary: A new study shows that integrating artificial intelligence with advanced proximity and pressure sensors allows a commercial bionic hand to grasp objects in a natural, intuitive way—reducing cognitive effort for amputees. By training an artificial neural network on grasping postures, each finger could independently “see” objects and automatically move into the correct position, improving grip security and precision.

Participants performed everyday tasks such as lifting cups and picking up small items with far less mental strain and without extensive training. The shared-control system balanced human intent with machine assistance, enabling effortless, lifelike use of a prosthetic hand.

Key Facts

  • Natural Control: AI-enabled fingers used proximity and pressure sensors to form stable, intuitive grasps.
  • Reduced Cognitive Load: Participants performed tasks with less mental effort and greater precision.
  • Shared Autonomy: The system blended user control with AI assistance to avoid conflict and enhance dexterity.

Source: University of Utah

Whether you’re reaching for a mug, a pencil or someone’s hand, you don’t need to consciously instruct each of your fingers on where they need to go to get a proper grip.

The loss of that intrinsic ability is one of the many challenges people with prosthetic arms and hands face. Even with the most advanced robotic prostheses, these everyday activities come with an added cognitive burden as users purposefully open and close their fingers around a target.

In addition to improved performance on standardized tasks, they also attempted multiple everyday activities that required fine motor control. Credit: Neuroscience News

Researchers at the University of Utah are now using artificial intelligence to solve this problem. By integrating proximity and pressure sensors into a commercial bionic hand, and then training an artificial neural network on grasping postures, the researchers developed an autonomous approach that is more like the natural, intuitive way we grip objects. When working in tandem with the artificial intelligence, study participants demonstrated greater grip security, greater grip precision and less mental effort.

Critically, the participants were able to perform numerous everyday tasks, such as picking up small objects and raising a cup, using different gripping styles, all without extensive training or practice.

The study was led by engineering professor Jacob A. George and Marshall Trout, a postdoctoral researcher in the Utah NeuroRobotics Lab, and appears Tuesday in the journal Nature Communications.

“As lifelike as bionic arms are becoming, controlling them is still not easy or intuitive,” Trout said. “Nearly half of all users will abandon their prosthesis, often citing their poor controls and cognitive burden.”

One problem is that most commercial bionic arms and hands have no way of replicating the sense of touch that normally gives us intuitive, reflexive ways of grasping objects. Dexterity is not simply a matter of sensory feedback, however. We also have subconscious models in our brains that simulate and anticipate hand-object interactions; a “smart” hand would also need to learn these automatic responses over time.

The Utah researchers addressed the first problem by outfitting an artificial hand, manufactured by TASKA Prosthetics, with custom fingertips. In addition to detecting pressure, these fingertips were equipped with optical proximity sensors designed to replicate the finest sense of touch. The fingers could detect an effectively weightless cotton ball being dropped on them, for example.

For the second problem, they trained an artificial neural network model on the proximity data so that the fingers would naturally move to the exact distance necessary to form a perfect grasp of the object. Because each finger has its own sensor and can “see” in front of it, each digit works in parallel to form a perfect, stable grasp across any object.

But one problem still remained. What if the user didn’t intend to grasp the object in that exact manner? What if, for example, they wanted to open their hand to drop the object? To address this final piece of the puzzle, the researchers created a bioinspired approach that involves sharing control between the user and the AI agent. The success of the approach relied on finding the right balance between human and machine control.

“What we don’t want is the user fighting the machine for control. In contrast, here the machine improved the precision of the user while also making the tasks easier,” Trout said. “In essence, the machine augmented their natural control so that they could complete tasks without having to think about them.”

The researchers also conducted studies with four participants whose amputations fall between the elbow and wrist. In addition to improved performance on standardized tasks, they also attempted multiple everyday activities that required fine motor control. Simple tasks, like drinking from a plastic cup, can be incredibly difficult for an amputee; squeeze too soft and you’ll drop it, but squeeze too hard and you’ll break it.

“By adding some artificial intelligence, we were able to offload this aspect of grasping to the prosthesis itself,” George said. “The end result is more intuitive and more dexterous control, which allows simple tasks to be simple again.”

George is the Solzbacher-Chen Endowed Professor in the John and Marcia Price College of Engineering’s Department of Electrical & Computer Engineering and the Spencer Fox Eccles School of Medicine’s Department of Physical Medicine and Rehabilitation.

This work is part of the Utah NeuroRobotics Lab’s larger vision to improve the quality of life for amputees.

“The study team is also exploring implanted neural interfaces that allow individuals to control prostheses with their mind and even get a sense of touch coming back from this,” George said. “Next steps, the team plans to blend these technologies, so that their enhanced sensors can improve tactile function and the intelligent prosthesis can blend seamlessly with thought-based control.”

The study was published online Dec.9 in Nature Communications under the title “Shared human-machine control of an intelligent bionic hand improves grasping and decreases cognitive burden for transradial amputees.”

Coauthors include NeuroRobotics Lab members Fredi Mino, Connor Olsen and Taylor Hansen, as well as Masaru Teramoto, research assistant professor in the School of Medicine’s Division of Physical Medicine & Rehabilitation, David Warren, research associate professor emeritus in the Department of Biomedical Engineering, and Jacob Segil of the University of Colorado Boulder.

Funding: Funding came from the National Institutes of Health and National Science Foundation.

Key Questions Answered:

Q: How does the AI improve grasping in a bionic hand?

A: The system uses fingertip proximity and pressure sensors plus a trained neural network to automatically position each finger for a stable, natural grasp.

Q: Does the user lose control of the prosthetic hand?

A: No. A shared-control framework blends human intent with machine assistance, preventing conflict and preserving user agency.

Q: Why is this important for amputees?

A: Current prostheses require high cognitive effort; the new AI-driven system restores intuitive, low-effort grasping similar to natural hand function.

Editorial Notes:

  • This article was edited by a Neuroscience News editor.
  • Journal paper reviewed in full.
  • Additional context added by our staff.

About this neurotech and robotics research news

Author: Evan Lerner
Source: University of Utah
Contact: Evan Lerner – University of Utah
Image: The image is credited to Neuroscience News

Wednesday, May 21, 2025

Hand function and type of grasp used by chronic stroke individuals in actual environment

 With NO cure for my spasticity, I NEVER use my affected hand!

Hand function and type of grasp used by chronic stroke individuals in actual environment

Amanda Magalhães Demartino, Letícia Cardoso Rodrigues, Raquel Pinheiro Gomes & Stella Maris Michaelsen To cite this article: Amanda Magalhães Demartino, Letícia Cardoso Rodrigues, Raquel Pinheiro Gomes & Stella Maris Michaelsen (2019): Hand function and type of grasp used by chronic stroke individuals in actual environment, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2019.1591037 To link to this article: https://doi.org/10.1080/10749357.2019.1591037
Amanda Magalhães Demartino a , Letícia Cardoso Rodrigues a , Raquel Pinheiro Gomes a and Stella Maris Michaelsen a a Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, Brazil 
ABSTRACT 

Background: 

Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. 

Objective: 

To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. Method: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. 

Results: 

Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. 

Conclusion: 

The paretic UL is predominantly employed for stabilization function using a whole- hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks. 

Friday, April 18, 2025

Hand function and type of grasp used by chronic stroke individuals in actual environment

 

 Actual use for me is zero. It takes my good right hand a fair amount of time to force open the fingers and thumb at the same time to even attempt to grasp something. And then to remove my hand I have to jerk it off.  This was useless research! Useful would be curing spasticity! GET THERE!

Hand function and type of grasp used by chronic stroke individuals in actual environment

Amanda Magalhães Demartino, Letícia Cardoso Rodrigues, Raquel Pinheiro Gomes & Stella Maris Michaelsen To cite this article: Amanda Magalhães Demartino, Letícia Cardoso Rodrigues, Raquel Pinheiro Gomes & Stella Maris Michaelsen (2019): Hand function and type of grasp used by chronic stroke individuals in actual environment, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2019.1591037 To link to this article: https://doi.org/10.1080/10749357.2019.1591037
Amanda Magalhães Demartino a , Letícia Cardoso Rodrigues a , Raquel Pinheiro Gomes a and Stella Maris Michaelsen a a Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, Brazil 

ABSTRACT 


Background: 

Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. 

Objective

To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. Method: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. 

Results: 

Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more fre- quently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. 

Conclusion: 

The paretic UL is predominantly employed for stabilization function using a whole- hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks.

Wednesday, March 19, 2025

Hand function and type of grasp used by chronic stroke individuals in actual environment

 Actual use for me is zero. It takes my good right hand a fair amount of time to force open the fingers and thumb at the same time to even attempt to grasp something. And then to remove my hand I have to jerk it off.  This was useless research! Useful would be curing spasticity! GET THERE!

Hand function and type of grasp used by chronic stroke individuals in actual environment

Amanda Magalhães Demartino, Letícia Cardoso Rodrigues, Raquel Pinheiro Gomes & Stella Maris Michaelsen To cite this article: Amanda Magalhães Demartino, Letícia Cardoso Rodrigues, Raquel Pinheiro Gomes & Stella Maris Michaelsen (2019): Hand function and type of grasp used by chronic stroke individuals in actual environment, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2019.1591037 To link to this article: https://doi.org/10.1080/10749357.2019.1591037
Amanda Magalhães Demartino a , Letícia Cardoso Rodrigues a , Raquel Pinheiro Gomes a and Stella Maris Michaelsen a a Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, Brazil 

ABSTRACT 


Background: 

Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. 

Objective: 

To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. Method: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. 

Results: 

Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. 

Conclusion: 

The paretic UL is predominantly employed for stabilization function using a whole- hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks. 

Tuesday, March 11, 2025

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

I'm sure survivors with spasticity were not included in this testing.

 Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Olivier Lambercy 1,2* , Ludovic Dovat 1 , Hong Yun 3 , Seng Kwee Wee 3 , Christopher WK Kuah 3 , Karen SG Chua 3 , Roger Gassert 2 , Theodore E Milner 4 , Chee Leong Teo 1 and Etienne Burdet 5,1 Abstract 


Background: 

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/ supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function. 

Methods: 

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up. 

Results: 

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot. Conclusions: The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

Monday, March 10, 2025

Hand function and type of grasp used by chronic stroke individuals in actual environment

 

I have zero grasping ability and very distorted reaching, both problems as a result of spasticity.  You have to cure spasticity first before this helps most survivors. As is this research is useless for getting survivors recovered, which is the whole fucking point of stroke research! SURVIVOR RECOVERY! You're fired!

Hand function and type of grasp used by chronic stroke individuals in actual environment

 

ABSTRACT

Background: Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance.

Objective: To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment.

Method: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand.

Results: Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup.

Conclusion: The paretic UL is predominantly employed for stabilization function using a whole-hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks.

Additional information

Funding

We received study funding from FAPESC (Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina) 01/2014 - Programa Universal - nº 2015TR322. This study was not peer reviewed or invited.

Wednesday, December 18, 2024

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Did any of these subjects have spasticity? Without that information no one can tell whom this will work for? So, bad research.

 Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Olivier Lambercy 1,2* , Ludovic Dovat 1 , Hong Yun 3 , Seng Kwee Wee 3 , Christopher WK Kuah 3 , Karen SG Chua 3 , Roger Gassert 2 , Theodore E Milner 4 , Chee Leong Teo 1 and Etienne Burdet 5,1 

Abstract 


Background: 

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/ supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function. 

Methods: 

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up. 

Results: 

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot. 

Conclusions: 

The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy. 

Sunday, December 15, 2024

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

 Without telling us EXACTLY what the disabilities were, there is no way to determine whom this will work for! Doesn't anyone in stroke know how to run research that get survivors recovered?

15 years ago, this research came out: WHO approved this new one? They should be fired for incompetence in not knowing of previous research!

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

2009, 2009 IEEE International Conference on Rehabilitation Robotics


The latest useless shit here:


Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Abstract

Background

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function.

Methods

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up.

Results

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot.

Conclusions

The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

Background

Stroke is one of the leading causes of adult disability. While there is strong evidence that physiotherapy promotes recovery, conventional therapy remains suboptimal due to limited financial and human resources, and there are many open questions, e.g. when therapy should be started, how to optimally engage the patient, what is the best dosage, etc. [13]. Furthermore, exercise therapy of the upper limb has been shown to be only of limited impact on arm function in stroke patients [4].

Robot-assisted rehabilitation can address these shortcomings and complement traditional rehabilitation strategies. Robots designed to accurately control interaction forces and progressively adapt assistance/resistance to the patients' abilities can record the patient's motion and interaction forces to objectively and precisely quantify motor performance, monitor progress, and automatically adapt therapy to the patient's state.

Studies with robots such as the MIT-Manus, the ARM Guide or the MIME have demonstrated improved proximal arm function after stroke [58], although these improvements did not transfer to the distal arm function which is necessary for most Activities of Daily Living (ADL) [911]. Robot-assisted training which specifically targets the hand might be required to achieve significant improvements in hand function. Furthermore, several studies indicate a generalization effect of distal arm training, e.g. hand and wrist, on proximal arm function, i.e. elbow and shoulder, which may lead to improved control of the entire arm [10, 12, 13].

We therefore focused on robot-assisted rehabilitation of the hand, adopting a functional approach based on the combined training of grasping and forearm pronation/supination, two critical functions for manipulation. This paper presents the results of a pilot study using the HapticKnob, a portable end-effector based robotic device to train hand opening/closing and forearm rotation. In contrast to robotic devices based on exoskeletons attached to the arm [14], the HapticKnob applies minimal constraints to the different joints of the upper arm, thus corresponding to situations encountered during ADL. The forearm rests on an adjustable padded support, while the shoulder and upper arm are not restrained.

The objectives of this pilot study were to determine the feasibility of training chronic stroke patients with the HapticKnob, and to reduce motor impairment of the upper limb in a safe and acceptable manner. Although a few studies have investigated post-stroke rehabilitation of the hand [12, 13], ours is the first to use robot-assisted training that combines grasp and forearm pronation/supination to perform functional tasks. With this pilot study, we tested the hypothesis that training the hand using this functional approach improves function of the entire arm.

More at link.

Thursday, May 16, 2024

Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: a randomised controlled trial

 I have zero grasping ability because first my finger spasticity needs to be cured so I can do the first step, which is to open the hand.

Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: a randomised controlled trial

Abstract

Background

Over 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia.

Methods

In this single-blinded randomised controlled trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment.

Results

Intra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group’s FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05).

Conclusion

Hand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction.

Clinical trial registration information

NCT05841108

Background

Stroke is a leading cause of morbidity worldwide and the primary cause of motor impairment [1]. More than 80% of stroke patients with hemiplegia experience hand dysfunctions, which not only affects the use of their arms and hands in activities of daily living (ADL), but also limits their participation in social life and quality of life [2, 3].

Being the basic function of the hand, grasping plays a very important role in the activities of daily life. Simple functional activities of daily living, such as eating, dressing, grooming, and drinking, rely on the grasping function of the fingers [4]. However, grasping is a complex process that requires proper grasping force and motor control ability. When grasping, it is necessary to gradually open the fingers to form an appropriate configuration of the target object (“preshaping”). The fingers then continue to open wider than the size of the target object and stop opening at approximately 60–70% of the movement, after which they enclose the object, and finally contact its surface for grasping with appropriate force [5]. However, the grasping force and hand motor control ability are often insufficient in stroke patients, which seriously reduces the quality of movement when grasping objects in activities of daily life. It seems that finger grasping training is particularly important for improving the ability of daily living in stroke patients with hand dysfunction.

Rehabilitation therapy is considered the foundation of stroke treatment to improve the motor skills and quality of life of survivors [6]. Furthermore, repetitive training is an effective method to facilitate recovery from stroke and assist in restructuring neural networks. As a newer rehabilitation method, hand rehabilitation robots are potential tools for stroke rehabilitation treatment because they can support stable and consistent training with highly repetitive movements compared with conventional therapy [7]. However, the commonly used hand function rehabilitation robots in clinical practice are typically based on the spatiotemporal tmovement trajectory predefined by the robot computer control system, allowing patients to passively complete repeated training without requiring their active contribution, resulting in low active participation of patients [8]. A bigger problem is that most rehabilitation robots still do not apply effective input and feedback channels of sensorimotor information. In this kind of robot training, patients can only rely on visual feedback to judge the object’s size and weight to be grasped, and lack other available sensory stimuli and feedback, which affects their movement adjustment and motor control, and is not conducive to completing more accurate grasping movements [9].

Force feedback rehabilitation robots can compensate for these defects. It is a new generation of rehabilitation robots based on force feedback technology. When the wearer begins to grasp an object, information from the tactile sensors determines how much additional force the wearer needs to grasp the object, and the glove ‘strengthens’ the hand accordingly [10]. On the one hand, it can apply proportional compensation to assist the patient in completing grasping movements. On the other hand, it can provide effective force feedback information for patients, so that they can further adjust their movements according to the feedback information to achieve more accurate grasping movements. Previous studies have shown that force feedback hand rehabilitation robot training improves grip strength and hand performance in patients with spinal cord injury, articular rheumatism, and other diseases, as well as in older adults [10]. Therefore, using force feedback hand rehabilitation robots for finger grasping training in stroke patients with hemiplegia is expected to be an effective method for improving their subjective initiative and grasping function.

In addition to repetitive exercise training, another requirement for successful rehabilitation is a goal-oriented and task-specific training program to help patients use the affected side and voluntarily perform motor functions, and there are a variety of physical intervention approaches [11]. Of those, task-oriented training has been reported to be effective in improving the functional motor skills required to perform ADLs in stroke patients [12]. Task-oriented training is a therapeutic model based on the systems theory of motor control, which uses a functional approach in rehabilitating neurological patients and teaches task-specific strategies to help them adapt to changing environments [13]. This approach involves having patients practice a skill essential for achieving the goal of a task to facilitate problem-solving by enhancing their ability to adapt to various situations and developing an effective reward strategy [14,15,16]. In addition, for maximal learning, the approach involves behaviourally motivating patients using tasks related to their daily lives and emphasising the interaction between patients and their environment. Van Peppen et al. stated that repetitive and focused task-oriented training improved the recovery of upper limb function and enhanced motor patterns, dexterity, and agility in the upper limb [17]. The treatment effects of task-oriented training methods for stroke-related limb dysfunction have been widely recognised and supported by authoritative guidelines and systematic reviews [18, 19].

Based on the characteristics of the force feedback hand rehabilitation robot and the task-oriented training method, this study combined them to explore the effectiveness and added value of the combination of force feedback hand rehabilitation robot and task-oriented training to provide an effective rehabilitation treatment method for the recovery of hand function in stroke patients with hemiplegia and to provide a reference for the clinical application of relevant force feedback hand rehabilitation robots.

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