rehabilitation of finger extension in chronic hemiplegia derek kamper 1,2 tiffany kline 4 xun luo 3...
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![Page 1: Rehabilitation of Finger Extension in Chronic Hemiplegia Derek Kamper 1,2 Tiffany Kline 4 Xun Luo 3 Robert Kenyon 1,3 Heidi Waldinger 1 Erik Cruz 1 William](https://reader036.vdocuments.net/reader036/viewer/2022062804/56649f395503460f94c5595a/html5/thumbnails/1.jpg)
Rehabilitation of Rehabilitation of Finger Extension in Finger Extension in
Chronic Chronic HemiplegiaHemiplegia
Derek KamperDerek Kamper1,21,2 Tiffany KlineTiffany Kline44 Xun LuoXun Luo3 3
Robert KenyonRobert Kenyon1,31,3 Heidi WaldingerHeidi Waldinger1 1 Erik CruzErik Cruz11
William Z. RymerWilliam Z. Rymer1,21,2
11Sensory Motor Performance ProgramSensory Motor Performance Program22Northwestern UniversityNorthwestern University
33University of Illinois at ChicagoUniversity of Illinois at Chicago44Marquette UniversityMarquette University
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BackgroundBackground
Limited finger extension is the most common chronic motor impairment following stroke (Trombly, 1989).
Friedland, F., “Physical Therapy,” in Stroke and its Rehabilitation
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BackgroundBackgroundPreferential extensor weakness
24 stroke subjects, 6 control subjects
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BackgroundBackgroundFlexor hypertonicity
Attempted voluntary isometric extensionAttempted voluntary isometric flexion
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RationaleRationale
Evidence that sustained voluntary contractions can Evidence that sustained voluntary contractions can increase excitability of involved corticospinal pathways increase excitability of involved corticospinal pathways (Sacco et al., 1997)(Sacco et al., 1997)
Repetitive practice seems to lead to improvement, as Repetitive practice seems to lead to improvement, as shown with constraint-induced therapy (Page et al., shown with constraint-induced therapy (Page et al., 2004)2004) However, CTI may not be viable for subjects with However, CTI may not be viable for subjects with
severe impairment (Bonifer and Anderson, 2003)severe impairment (Bonifer and Anderson, 2003)
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Aim: Develop device to Aim: Develop device to assist finger extension for assist finger extension for
rehabilitation therapy rehabilitation therapy
Assist extension onlyAssist extension only Externally actuatedExternally actuated LightweightLightweight SafeSafe Provide feedback of assistanceProvide feedback of assistance
Criteria
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Current technologiesCurrent technologies
Functional Tone Management System
Hand Mentor, Kinetic Muscles, Inc.
Hand Master, Rutgers University
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Development activitiesDevelopment activities
Body-powered orthosis (HandAid)
• Cable-driven• Biscapular abduction/
shoulder flexion produce finger extension
• Figure 8 harness• Force transducer
measures assistance
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Development activitiesDevelopment activities
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Development activitiesDevelopment activities
Pneumatically-powered hand (PneuHand)
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ControlControl
Create desired trajectory from Create desired trajectory from object sizeobject size
Servo about desired trajectoryServo about desired trajectory Electro-pneumatic valveElectro-pneumatic valve
Provide assistance only when Provide assistance only when extensor EMG above threshold valueextensor EMG above threshold value
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Subject populationSubject population
Chronic hemiplegia following stroke (> 9 months)Chronic hemiplegia following stroke (> 9 months) Stage 2 or 3 for hand on Chedoke-McMaster scale (< Stage 2 or 3 for hand on Chedoke-McMaster scale (<
50% full finger extension)50% full finger extension) Absence of visuoperceptual disturbanceAbsence of visuoperceptual disturbance Absence of fixed contractureAbsence of fixed contracture Capacity to provide informed consentCapacity to provide informed consent
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Training paradigmTraining paradigm
3 groups3 groups HandAid, PneuHand, No assistanceHandAid, PneuHand, No assistance
Attempt to grasp virtual targets (30 min) and actual Attempt to grasp virtual targets (30 min) and actual objects (30 min)objects (30 min)
24 training sessions24 training sessions 3 sessions/week3 sessions/week 8 weeks total8 weeks total
Tests pre- and post-trainingTests pre- and post-training Kinetics (servomotor)Kinetics (servomotor) Kinematics (CyberGlove)Kinematics (CyberGlove) Function (Wolf Motor Function Test)Function (Wolf Motor Function Test)
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Augmented reality Augmented reality
Glasstron head-mounted Glasstron head-mounted displaydisplay CAVElibraryCAVElibrary
Menu-driven object selectionMenu-driven object selection Object moves and rotates with Object moves and rotates with
hand once acquiredhand once acquired Flock of birds sensors on head Flock of birds sensors on head
and handand hand
Training
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Augmented reality Augmented reality environmentenvironment