Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME)

Area of Science:

• Rehabilitation Engineering
• Neurorehabilitation
• Wearable Technology

Background:

• Previous development of a lightweight wearable hand exoskeleton (Hand Spring Operated Movement Enhancer) demonstrated improved range of motion and function in laboratory settings.
• Chronic stroke survivors often experience persistent motor deficits, necessitating effective and accessible rehabilitation strategies.

Purpose of the Study:

• To evaluate the efficacy of a wearable hand exoskeleton combined with home-based practice for improving motor function in chronic stroke survivors.
• To assess the impact of the device on impairment, functional ability, and proximal arm control.
• To investigate the relationship between training dosage and functional gains.

Main Methods:

• A pilot study involving ten chronic stroke subjects using the Hand Spring Operated Movement Enhancer for 1.5 hours/day, 5 days/week, for 4 weeks during home-based reach and grasp practice.
• Movement data logging was incorporated to quantify training dosage.
• Standardized clinical assessments including the Fugl-Meyer test and Action Research Arm Test were used to measure impairment and function.

Main Results:

• Seven subjects completed the study, averaging 448 ± 651 hand movements per training day.
• Significant improvements were observed in Fugl-Meyer test scores (gain = 4.9 ± 4.1, p = .039) and Action Research Arm Test scores (gain = 3.3 ± 2.6, p = .032).
• A strong positive correlation was found between Action Research Arm Test gains and the number of movements during training (r = 0.90, p = .005). Proximal arm control also improved, indicated by a reduced reach path ratio (p = 0.038).
• Five subjects showed substantial gains (≥6 points on outcome measures), with significant improvements in digit extension (gain = 19.8 ± 10.2°, p = 0.024).
• Crucially, all significant gains observed immediately post-training were lost by the three-month follow-up.

Conclusions:

• Home-based rehabilitation using a wearable hand exoskeleton shows promise for improving motor function and reducing impairment in chronic stroke survivors.
• The number of practice movements correlates with functional improvements, highlighting the importance of training dosage.
• The lack of sustained gains suggests that current home training durations may be insufficient for long-term recovery, warranting further investigation into extended or modified training protocols.