The Hand After Stroke and SCI: Restoration of Function with Technology

Ghassemi, Mohammad M.; Kamper, Derek G.

doi:10.1007/978-3-031-08995-4_6

Cited by 1 publication

(1 citation statement)

References 117 publications

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“…Assistive FES has been employed to improve hand opening in individuals with stroke ( 13 ), but its functionality has been significantly limited by flexion synergy expression. There have been multiple attempts to reduce this synergy expression to increase hand opening outcomes, such as by also utilizing FES for shoulder muscles to reduce synergy presentation ( 15 ), or designing arm support devices ( 44 ) such as the SaeboMAS. The combination of flexor nerve block and extensor FES shown here addresses these prior limitations with FES interventions and improves the feasibility of using modern FES approaches ( 14 ) to enhance hand function following stroke, even in the most severely impaired individuals with tremendous extensor weakness.…”

Section: Discussionmentioning

confidence: 99%

Peripheral nerve blocks of wrist and finger flexors can increase hand opening in chronic hemiparetic stroke

Dewald,

Yao,

Dewald

et al. 2024

Front. Neurol.

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IntroductionHand opening is reduced by abnormal wrist and finger flexor activity in many individuals with stroke. This flexor activity also limits hand opening produced by functional electrical stimulation (FES) of finger and wrist extensor muscles. Recent advances in electrical nerve block technologies have the potential to mitigate this abnormal flexor behavior, but the actual impact of nerve block on hand opening in stroke has not yet been investigated.MethodsIn this study, we applied the local anesthetic ropivacaine to the median and ulnar nerve to induce a complete motor block in 9 individuals with stroke and observed the impact of this block on hand opening as measured by hand pentagonal area. Volitional hand opening and FES-driven hand opening were measured, both while the arm was fully supported on a haptic table (Unloaded) and while lifting against gravity (Loaded). Linear mixed effect regression (LMER) modeling was used to determine the effect of Block.ResultsThe ropivacaine block allowed increased hand opening, both volitional and FES-driven, and for both unloaded and loaded conditions. Notably, only the FES-driven and Loaded condition’s improvement in hand opening with the block was statistically significant. Hand opening in the FES and Loaded condition improved following nerve block by nearly 20%.ConclusionOur results suggest that many individuals with stroke would see improved hand-opening with wrist and finger flexor activity curtailed by nerve block, especially when FES is used to drive the typically paretic finger and wrist extensor muscles. Such a nerve block (potentially produced by aforementioned emerging electrical nerve block technologies) could thus significantly address prior observed shortcomings of FES interventions for individuals with stroke.

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