Simulated Home Therapy Program for the Hand After Stroke

Study Overview
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Brief Summary
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The purpose of this study is to investigate the benefits of incorporating an actuated, EMG-controlled glove into occupational therapy of the hand.

Detailed Description
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Stroke survivors with chronic hemiparesis of the upper extremity undertook 18 one-hour training sessions over a 6-week period. Participants received occupational therapy focusing on grasp-and-release using a task-oriented protocol developed at the Rehabilitation Institute of Chicago by Dr. Mary Ellen Stoykov. Over 90% of all repetitions performed during each session were focused on functional activities, as opposed to active exercise. The skills and strategies developed in therapy were then implemented into activities identified as goals by the participant, such as donning socks. Difficulty of the task, activity, or exercise was progressed for each participant to provide optimal challenge to enhance skill. Subjects were assigned to one of two groups by casting lots. One group (VAEDA Glove) performed all tasks while wearing a custom Voice And EMG-Driven Actuated glove, the VAEDA Glove. The other group (No-Glove) performed the same types of tasks without use of the VAEDA Glove. The VAEDA Glove is a portable active-assistance glove, designed to assist digit extension in order to allow repeated practice of specified tasks. The glove contains cables traversing the dorsal side of the digits in order to provide extension and resist flexion. Forces are transmitted through the cables from a servomotor located remotely to the digits. The servomotor controls torque or displacement in the cable. Along the digits, the cables traverse through custom plastic blocks, which serve both to guide the cable and to prevent joint hyperextension. The VAEDA Glove can be controlled with up to 3 channels of electromyography (EMG). For this study, electrodes were placed above flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC). The group using the J-Glove could receive assistance during hand opening, but only if appropriate EMG activity was detected. The EDC EMG activity had to reach a prescribed threshold before extension assistance would be provided. Similarly, FDS EMG activity had to surpass a threshold level during hand closing before the user was allowed to flex the digits. Feedback of muscle activity was available to the user through a custom graphical user interface.

Official Title
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Simulated Home Therapy Program for the Hand After Stroke

Conditions
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Stroke

Intervention / Treatment
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* Other: VAEDA Glove
* Other: Occupational Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: chronic upper extremity hemiparesis subsequent to stroke (minimum of 6 months post-stroke) moderate hand impairment classified as Stage 4 on the Chedoke McMaster Stroke Assessment Exclusion Criteria: anti-spasticity medications/injections taken less than 6 month prior to enrollment contractures greater than 20 degrees inability to follow single-step commands significant upper extremity pain (self-reported pain of greater than 6 on a 10-point scale)

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: VAEDA Glove<br>Voice And EMG-Driven Actuated glove used during hand occupational therapy training | Other: VAEDA Glove<br>* Voice And EMG-Driven Actuated glove used during training<br>Other: Occupational Therapy<br>* novel upper extremity occupational therapy focused on the hand<br>|
| Active Comparator: No-glove<br>hand occupational therapy sessions without assistive device | Other: Occupational Therapy<br>* novel upper extremity occupational therapy focused on the hand<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Action Research Arm Test (ARAT) |  | Change from Baseline after 6 weeks of training | 
| Wolf Motor Function Test (WMFT) |  | Change from Baseline after 6 weeks of training | 
| Fugl-Meyer Upper Extremity Motor Assessment (FMUE) |  | Change from Baseline after 6 weeks of training | 
| Chedoke McMaster Stroke Assessment Stage of Hand (CMSA-H) |  | Change from Baseline after 6 weeks of training | 
| Action Research Arm Test (ARAT) |  | Change from Baseline to 1 month following training completion | 
| Wolf Motor Function Test (WMFT) |  | Change from Baseline to 1 month following training completion | 
| Fugl-Meyer Upper Extremity Motor Assessment (FMUE) |  | Change from Baseline to 1 month following training completion | 
| Chedoke McMaster Stroke Assessment Stage of Hand (CMSA-H) |  | Change from Baseline to 1 month following training completion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hand Kinematics | hand kinematics were measured explicitly with a CyberGlove (CyberGlove Systems LLC, San Jose, CA). From an initially relaxed, resting posture, participants were asked to extend the digits fully (open) and then flex fully (close) their affected hand into a fist. The CyberGlove measured joint displacement for each digit during task performance. | Change from Baseline after 6 weeks of training and 1 month follow up | 
| 3-point (palmar) Pinch Strength (PPS) | using a pinch gauge (PG-60, B&L Engineering) | Change from Baseline after 6 weeks of training and 1 month follow up | 
| Lateral Pinch Strength (LPS) | using a pinch gauge (PG-60, B&L Engineering) | Change from Baseline after 6 weeks of training and 1 month follow up | 
| Grip Strength (GS) | JAMAR 5030J1 Hand Dynamometer | Change from Baseline after 6 weeks of training and 1 month follow up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hand, fingers, rehabilitation, training, stroke