Effects of contralesional robot-assisted hand training in patients with unilateral spatial neglect following stroke: a case series study

Abstract

BackgroundA reduction of hemispatial neglect due to stroke has been associated with activation of the contralesional hand in the contralesional hemispace. Robot-assisted upper limb training was found to effectively improve paretic arm function in stroke patients. To date no proof of concept of robot-assisted hemispatial neglect therapy has been reported in literature. This study aimed to determine whether robot-assisted left (contralesional) hand activation alone could lead to an improvement in hemispatial neglect following stroke.MethodsThree stroke patients with right brain injury underwent a 2-week training program of robotic left hand activation with the Gloreha® hand rehabilitation glove, which provides repetitive, passive mobilization of the fingers. Outcomes were assessed using the Line Crossing test, the Bells test, the Sentence Reading test, the Saccadic Training, the Sustained Attention to Response Task, and the Purdue Pegboard test.ResultsChanges were observed after treatment as follows. Line Crossing test: all patients showed improved performance (6.7%, 89.5% and 80% increase in lines crossed) with two patients reaching normal performance levels. Bells test: one patient improved performance (50% increase), while one patient showed no change and one patient declined (−10.3% change); no patient reached normal performance levels. Sentence Reading test: all patients showed improved performance (800%, 57.1% and 42.9% increase in number of sentences read) with no patient reaching normal performance level. Saccadic Training: all patients showed improved performance (−62.8%, −15.5% and −9.7% change of the left hemifield reaction time). Sustained Attention to Response Task: all patients showed improved performance (−20.5%, −5.8% and −10% change of the reaction time) with two patients reducing incorrect responses (−42.9% and −73.3%) and one patient increasing them (9.1%). Purdue Pegboard test: all patients showed improved performance (100%, 27.3% and 75% change in the left + right + both hands sub-item score).ConclusionsSome caution is warranted when interpreting our results, as the responses to the intervention were variable and might have been due to a placebo effect or fluctuating clinical conditions. However, robot-assisted hemispatial neglect therapy might be useful in stroke patients. Larger-scale investigations are needed to confirm our preliminary findings.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-160) contains supplementary material, which is available to authorized users.

The Effect of an Upper Limb Rehabilitation Robot on Hemispatial Neglect in Stroke Patients

“…Recently, a case study reported that the extent of hemispatial neglect decreased after passive joint movements of the left hand using a hand rehabilitation robot for two weeks in patients with left hemispatial neglect [34]. Although this case series study was the first study to use rehabilitation robots in the treatment of hemispatial neglect, it was limited in that there was no control group and only passive movements of the hand were performed.…”

A fabric-regulated soft robotic glove with user intent detection using EMG and RFID for hand assistive application

“…Therefore, these devices are normally restricted in clinical environments and are not suitable for use as an at-home assistive device that can provide assistance for activities of daily living (ADL) and task-specific training. In order to design exoskeletons that are more wearable and lightweight, alternative approaches that utilize compliant materials such as cables [9][10][11] and soft elastomeric actuators have been adopted. These approaches do not require complicated mechanical setups, which reduce the setup time and the possibility of misalignment.…”

mano: A Wearable Hand Exoskeleton for Activities of Daily Living and Neurorehabilitation

“…Each task was repeated 10 times (trials) for each condition. In the Exoskeleton trials, the device was worn on the right hand and the subject was instructed to restrain any voluntary hand motion in order to let the exoskeleton autonomously [11] Thumb, medium, ring Flexion 12 ∼650 ∼50 Absent Limited Nycz et al [12] All Flexion, extension n/a n/a ∼50 Absent Absent In et al [13] Thumb, index, medium Flexion, extension 20 n/a 194 Absent Absent Kang et al [14] Thumb, index, medium Flexion, extension 29.5 1630 ∼50 Absent Limited Polygerinos et al [15] All Flexion 40 3300 285 Full Absent Varalta et al [16] All Flexion, extension n/a 5000 ∼50 Full Absent implement the task. During the experiment, the beginning and the end of each trial were signaled by graphical cues on a computer screen.…”

“…Several studies have shown that manual tasks induce changes, with respect to baseline states, in the spectral power of sensorimotor cortex areas, for two characteristic frequency bands: µ ( [8,12] Hz) and β ( [16,32] Hz). Such results have been confirmed in invasive [23] and non-invasive [24] studies.…”

“…Although relatively lightweight on the hand (∼285 g), the actuation and control units of this system are rather heavy (∼3.3 kg), limiting the overall portability and usability in ADL. The Gloreha glove [16] is a commercial device which exploits bowden cables in a push-pull configuration to control both flexion and extension of fingers from the hand's dorso. Similarly to the previous device, this system has the advantage of being lightweight on the hand (∼50 g) but relies on bulky actuation and control units (∼5 kg) which make it non-portable.…”