Handgrip Device Helps Stroke Patients Access Hand/Arm Rehab

May 21, 2015

VIENNA, Austria — A new handgrip device can improve the accessibility of mobile gaming technology among stroke patients for self-rehabilitation of arm function, a new study has shown.

The device, developed by scientists at Imperial College London in the United Kingdom, allows patients with severe hand and arm impairment to practice exercises and interact with rehabilitation gaming programs on smart phones or tablets.

Presenting the study at the recent 24th European Stroke Conference (ESC), Paul Rinne, MSc, Imperial College Human Robotics Group, said, "We have shown that patients with severe hand and arm disability can use this device to interact with computer training exercise games. It allows patients to engage with the disabled hand and focus on controlling it."

Paul Rinne

Commenting during the discussion period, Catherine Sackley, chair in rehabilitation and head of physiotherapy, King's College London, said the device looked interesting. Noting that "nothing we do at the moment seems to improve arm function" but that in other areas "you get what you train," she said she would look forward to seeing functional outcome data with the handgrip device.

Rinne explained that physiotherapy is severely underused for stroke patients, with only around half of patients in the United Kingdom receiving the recommended 45 minutes of physiotherapy per day in the stroke unit. Attention to hand and arm function is minimal.

To increase dosage, the use of self-rehabilitation involving mobile technology on smart phones or tablets has been introduced. This complements traditional therapy and motivates patients to increase repetition of movements, and it can also record outcomes and feedback, Rinne noted.

New hand-grip device for self-rehabilitation after stroke. Imperial College London

However, such mobile technology is often accessible only to patients with relatively high function, and it can be very costly.

The new handgrip device is operated by detecting the grip force. It has a wireless Bluetooth connection to the mobile technology and allows patients to move the cursor by adjusting their grip strength, which involves flexion and extension. The device can be calibrated to each patient to accommodate all levels of impairment and is relatively inexpensive, costing around &163;100, Rinne reported.

For the current feasibility study, the researchers screened 342 patients presenting with arm weakness on admission to their stroke unit. Patients with cognitive impairment, language barrier, and pre-existing weakness were excluded; 89 patients were included in the study.

Baseline functional measures were recorded by using standard scales, including Fugl-Meyer (FM) upper extremity, short FM, FM handscale, and National Institutes of Health Stroke Scale. Patients were then given different methods of controlling a standard game: swipe, pressing, tilting motions, or operating a joystick, or the new handgrip controller device. Patients were scored from 0 to 3 on how much control over the cursor they could achieve.

The four standard methods of interacting with the mobile technology did not significantly differ in cursor control. Most patients with mild hand /arm impairment had good control but none of the severely impaired patients attained any control.

However, results were much better with the hand-grip device, with all patients having more control success with this method. For example, 56% of patients achieved a control score of 3 with the swipe motion vs 95% of patients with the hand-grip device. Among patients with severe arm/hand impairment, 89% could use the handgrip whereas none could use the tablet swipe motion.

"The handgrip device allows a much higher percentage of patents to engage with mobile rehabilitation technology," Rinne commented to Medscape Medical News. The goal is to work with both physical and cognitive functioning, he added.

"The device captures a spectrum of patients from the weakest to the strongest," he said. "Patients who have severe deficits and are cognitively impaired can use its most basic functions to play a simple game while those with minimal weakness can work on fine control with games involving fine cognitive details."

He added: "In this feasibility study, we looked at which patients can interact with this device and who can therefore have the relevant training games developed for them. We found that 90% of the most severely impaired patients can use this grip device to interact with such technology. This will allow the vast majority of patients to be sent home with a rehabilitation program to practice on their smart phone or tablet."

The researchers are now seeking funding for a clinical trial with functional outcome measures.

Paul Rinne has disclosed no relevant financial relationships.

24th European Stroke Conference (ESC). Presented May 15, 2015.

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