Rehabilitation of Finger Extension in Chronic Hemiplegia

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Rehabilitation of Finger Extension in Chronic
Hemiplegia
Derek Kamper1,5 Tiffany Kline4 Xun Luo3 Robert
Kenyon1,3 Heidi Fischer1 Kathy
Stubblefield1
William Z. Rymer1,2 1Sensory Motor
Performance Program 2Northwestern
University 3University of Illinois at
Chicago 4Marquette University 5Illinois Institute
of Technology
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Objectives

• Develop two types of externally powered devices
  to assist finger extension
• Incorporate these devices into an augmented
  reality training environment with performance
  feedback
• Test device efficacy and user acceptance with
  reach-to-grasp training paradigm
• 3 60-min sessions per week for 6 weeks
• 3 subject groups

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Background
Limited finger extension is the most common
chronic motor impairment following stroke
(Trombly, 1989).
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Background
Directionally dependent deficits
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Development
Body-powered orthosis

• Cable-driven
• Biscapular abduction/ shoulder flexion produce
  finger extension
• Figure 8 harness
• Force transducer measures assistance

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Development
Pneumatic orthosis
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Development
Augmented reality

• Glasstron head-mounted display
• Permits visibility of actual environment
• See own hand

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Pilot study

• 3 training groups of chronic stroke subjects
• Body-powered Orthosis
• Pneumatic Glove
• Control (no device)
• 6 week training protocol
• Reach-to-grasp
• Virtual and actual objects
• Evaluations pre, post, 1 month post

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Results
BPO Subjects
Control Subjects
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Results
BPO Subjects
Control Subjects
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Discussion

• Protocol well tolerated by subjects
• Small gains
• Often not maintained, even after only 1 month
• Need for higher extension forces
• Mass activation of arm musculature
• But must still prevent joint subluxation
• Limited head ROM impedes viewing of VR scene

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Education Dissemination

• Presentation at meeting of AOTA 2005 (Fischer and
  Stubblefield)
• Panel discussion of robotics in rehabilitation at
  ARCA 2005 (Kamper, Fischer, and Stubblefield)
• Lab tour for Marquette PT class
• RIC in-service presentations on clinical floors
  (Fischer)

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Short-term outcomes
Conference Papers

• ICORR 2005, Luo, et al.
• ICORR 2005, Kline, et al.
• IEEE EMBS 2005, Luo, et al.
• ICADI 2006, Fischer, et al.

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Future plans

• Initiate new study
• Sub-acute population (3-6 months)
• New AR environments
• More grasp repetitions
• Modify Pneu Glove
• Assist digits independently
• Increase air pressure

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Future plans
Modify BPO for trials of training at home
During training 8 blocks with orthosis
1-4 without