ABSTRACT
OBJECTIVE: To determine feasibility of a randomised controlled trial (RCT) of home-based Reach-to-Grasp training after stroke. DESIGN: single-blind parallel group RCT. PARTICIPANTS: Residual arm deficit less than 12 months post-stroke. INTERVENTIONS: Reach-to-Grasp training in 14 one-hour therapist's visits over 6 weeks, plus one hour self-practice per day (total 56 hours). CONTROL: Usual care. MAIN MEASURES: Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), pre-randomisation, 7, 12, 24 weeks post-randomisation. RESULTS: Forty-seven participants (Reach-to-Grasp=24, usual care=23) were randomised over 17 months. Reach-to-Grasp participants received a median (IQR) 14 (13,14) visits, and performed 157 (96,211) repetitions per visit; plus 30 minutes (22,45) self-practice per day. Usual care participants received 10.5 (5,14) therapist visits, comprising 38.6 (30,45) minutes of arm therapy with 16 (6,24) repetitions of functional tasks per visit. Median ARAT scores in the reach-to-grasp group were 8.5 (3.0,24.0) at baseline and 14.5 (3.5,26.0) at 24 weeks compared to median of 4 at both time points (IQR: baseline (3.0,14.0), 24 weeks (3.0,30.0)) in the usual-care group. Median WMFT tasks completed at baseline and 24 weeks were 6 (3.0,11.5) and 8.5 (4.5,13.5) respectively in the reach-to-grasp group and 4 (3.0,10.0), 6 (3.0,14.0) in the usual care group. Incidence of arm pain was similar between groups. The study was stopped before 11 patients reached the 24 weeks assessment. CONCLUSIONS: An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe. With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial.
Subject(s)
Activities of Daily Living , Exercise Therapy/methods , Home Care Services/organization & administration , Stroke Rehabilitation/methods , Stroke/diagnosis , Aged , Female , Follow-Up Studies , Hand Strength/physiology , Humans , Male , Middle Aged , Pilot Projects , Risk Assessment , Single-Blind Method , Treatment OutcomeABSTRACT
This paper reports the integration of a kinematic model of the human hand during cylindrical grasping, with specific focus on the accurate mapping of thumb movement during grasping motions, and a novel, multi-degree-of-freedom assistive exoskeleton mechanism based on this model. The model includes thumb maximum hyper-extension for grasping large objects (~> 50 mm). The exoskeleton includes a novel four-bar mechanism designed to reproduce natural thumb opposition and a novel synchro-motion pulley mechanism for coordinated finger motion. A computer aided design environment is used to allow the exoskeleton to be rapidly customized to the hand dimensions of a specific patient. Trials comparing the kinematic model to observed data of hand movement show the model to be capable of mapping thumb and finger joint flexion angles during grasping motions. Simulations show the exoskeleton to be capable of reproducing the complex motion of the thumb to oppose the fingers during cylindrical and pinch grip motions.
Subject(s)
Hand/physiology , Robotics/instrumentation , Robotics/methods , Biomechanical Phenomena , Fingers/physiopathology , Humans , Models, Theoretical , Movement/physiology , Thumb/physiologyABSTRACT
Referred sensations are recognized as phenomena experienced after amputation of a limb and have been used as proof of the consequences of changes in somatosensory body part representation in the adult brain. Such changes may accompany interruption of afferent sensory projections after subcortical stroke. This report describes some misplaced localization to touch in a subject 15 months after cerebral haemorrhage involving the posterior limb of the right internal capsule and lateral thalamus. The results revealed the occurrence of referred sensations, indicating some scrambling of the somatosensory representation of the affected limbs. While many stimuli were localized correctly, there were a number of stimuli applied to the hand and foot that were referred to more proximal limb segments. Stimuli to the upper arm were sometimes felt in more distal parts of the limb. Stimuli to the face were localized to the arm and not the hand. With the aim of determining consistency of findings, testing of the upper limb was carried out on four separate occasions. The subject had less referred sensations in each test, possibly indicating some change in his somatosensory representation that occurred with experience.
Subject(s)
Arm/innervation , Cerebral Infarction/physiopathology , Leg/innervation , Nerve Regeneration/physiology , Neuronal Plasticity/physiology , Sensation Disorders/physiopathology , Adult , Afferent Pathways/physiopathology , Brain Mapping , Cerebral Infarction/diagnosis , Dominance, Cerebral/physiology , Humans , Internal Capsule/physiopathology , Magnetic Resonance Imaging , Male , Sensation Disorders/diagnosis , Thalamus/physiopathology , Tomography, X-Ray Computed , Touch/physiologyABSTRACT
Tests of upper limb function and an activities of daily living (ADL) index were selected to measure recovery following stroke. Thirty stroke patients were assessed at intervals for up to 6 months to 1 year post-stroke using the battery. The results showed the ADL index is insensitive to upper limb recovery. All the tests measured recovery in some of the patients after 24 weeks post-stroke. Since the presentation and recovery of patients was variable, it is argued that it is necessary to offer a selection of assessment tests to measure recovery and to aid treatment planning.
