Treatment of severe hand impairment following stroke by combining assisted movement, muscle vibration, and biofeedback.
OBJECTIVE
Few studies have addressed the rehabilitation of hand function in persons with severe impairment following stroke, and few therapeutic options are available for treatment. We investigated whether an intervention of robot-assisted movement and muscle vibration could reduce impairment and enable hand-opening to a greater extent when combined with torque biofeedback or electromyographic (EMG) biofeedback.


METHODS
Forty-three participants with severe hand impairment due to chronic stroke (≥1 year poststroke) were randomized to 1 of 2 treatment groups receiving assisted movement and muscle vibration combined with either torque or EMG biofeedback. Each participant received 30 sessions (30 minutes duration per session) directed at the impaired hand over 10 to 12 weeks. Outcomes were assessed using the Upper Extremity Fugl-Meyer Assessment (UE-FMA), Stroke Impact Scale, and Box-and-Block Test scores.


RESULTS
Twenty-eight of 43 participants had no baseline finger extension; the remainder had an average of 23 ± 26 mm extension in the most active finger. Assisted movement and muscle vibration were associated with a significant increase in all outcome measures across both treatment groups, and for the UE-FMA and Stroke Impact Scale within treatment groups, with no significant difference between groups. Based on the Box-and-Block Test scores, the assisted movement and muscle vibration intervention did not restore functional hand-opening to participants with baseline UE-FMA scores less than 17/66, regardless of the form of biofeedback.


CONCLUSIONS
Assisted movement and muscle vibration, combined with either EMG or torque biofeedback, appears to reduce upper limb impairment, improve volitional activation of the hand muscles, and restore a modicum of hand function in some persons with severe hand impairment due to chronic stroke.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A64) for more insights from the authors.
Department of Biomedical Engineering, Oregon Health & Science University, Beaverton, and AMES Technology, Inc, Portland, Oregon (P.C.); Departments of Rehabilitation Medicine, Medicine and Cell Biology, Emory University School of Medicine, Atlanta, Georgia (S.L.W.); Department of Neurology, Oregon Health & Science University, Beaverton (J.-S.L.); Department of Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center at Dallas (R.B.); College of Medicine, University of Illinois, Chicago (M.S.); School of Optometry, Pacific University, Forest Grove, Oregon (J.H.); and Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, and Rehabilitation Institute of Chicago, Chicago, Illinois (E.R.).
Paul
P
Cordo
Steven
S
Wolf
Jau-Shin
JS
Lou
Ross
R
Bogey
Matthew
M
Stevenson
John
J
Hayes
Elliot
E
Roth
D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods*; D003131:Combined Modality Therapy; D004576:Electromyography; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014732:Vibration / Q000627:therapeutic use*