Treatment options for stroke survivors with severe hand impairment are limited. Active task practice can be restricted by difficulty in voluntarily activating finger muscles and interference from involuntary muscle excitation. We developed a portable, actuated glove-orthosis, which could be employed to address both issues. We hypothesized that combining passive cyclical stretching (reducing motoneuronal hyperexcitability) imposed by the device with active-assisted, task-oriented training (rehabilitating muscle activation) would improve upper extremity motor control and task performance post-stroke. Thirteen participants who experienced a stroke 2-6 months prior to enrollment completed 15 treatment sessions over five weeks. Each session involved cyclically stretching the long finger flexors (30 min) followed by active-assisted task-oriented movement practice (60 min). Outcome measures were completed at six intervals: three before and three after treatment initiation. Overall improvement in post-training scores was observed across all outcome measures, including the Graded Wolf Motor Function Test, Action Research Arm Test, and grip and pinch strength (p ≤ 0.02), except finger extension force. No significant change in spasticity was observed. Improvement in upper extremity capabilities is achievable for stroke survivors even with severe hand impairment through a novel intervention combining passive cyclical stretching and active-assisted task practice, a paradigm which could be readily incorporated into the clinic.

Many mechatronic devices exist to facilitate hand rehabilitation, however few directly address deficits in muscle activation patterns while also enabling functional task practice. We developed an innovative voice and electromyography-driven actuated (VAEDA) glove, which is sufficiently flexible/portable for incorporation into hand-focused therapy post-stroke. The therapeutic benefits of this device were examined in a longitudinal intervention study. Twenty-two participants with chronic, moderate hand impairment [Chedoke-McMaster Stroke Assessment Stage of Hand (CMSA-H = 4)] enrolled > 8 months post-stroke for 18 1-h training sessions ( 3 × week) employing a novel hand-focused occupational therapy paradigm, either with (VAEDA) or without (No-VAEDA) actuated assistance. Outcome measures included CMSA-H, Wolf Motor Function Test (WMFT), Action Research Arm Test, Fugl-Meyer Upper Extremity Motor Assessment (FMUE), grip and pinch strength and hand kinematics. All outcomes were recorded at baseline and endpoint (immediately after and four weeks post-training). Significant improvement was observed following training for some measures for the VAEDA group (n = 11) but for none of the measures for the No-VAEDA group (n = 11). Specifically, statistically significant gains were observed for CMSA-H (p = 0.038) and WMFT (p = 0.012) as well as maximum digit aperture subset (p = 0.003, n = 7), but not for the FMUE or grip or pinch strengths. In conclusion, therapy effectiveness appeared to be increased by employment of the VAEDA glove, which directly targets deficits in muscle activation patterns.

Repetitive PROM stretching exhibited trends to be more effective than prolonged stretching for improving hand motor control. Although the results were highly variable and the effects are undoubtedly transient, an extended period of repetitive PROM stretching may prove advantageous prior to hand therapy sessions to maximize treatment.

An externally actuated glove, controlled by a microprocessor, is being developed to assist finger extension in stroke survivors. The goal of this device is to allow repeated practice of specific tasks for hand therapy in a home environment. The user can control the device by three different means: voice recognition, electromyography, or manual control. These inputs can be used either independently or in combination according to the needs of the user. Both position and force feedback are available for control and safety. Initial testing of the prototype has shown promising performance.