Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Yip CT (1), Chan KK (1), Lee HS (1), Mok WS (1), Hui N (1), Cheung KY (2)
Affiliation :
(1) Occupational Therapy Department (2) Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Hemiparesis of the upper limb is a common and debilitating complication after stroke. The ability to actively initiate extension movement at the wrist and fingers is one of the indicators of the motor recovery. Regaining hand function and activities of daily living is particularly impervious to therapy owing to fine motor control needed for the distal-joints. Base on the principles of neuroplasticity, rehabilitation strategies designed to maximize hand and finger-related functional abilities in stroke are predominantly founded on intensive and repeated exercises or activity-based therapy. In fact, these strategies are time-consuming and labor-intensive. Robotic-assisted trainings for hemiplegic upper limb have been developed to provide repetitive training of normal movement patterns, sensory stimulation and feedback, promote motor control remapping, and also alleviating the effort for therapists. The integration of electromyography (EMG) can maximize voluntary effort for hand and fingers motor recovery.
In this study, we aim to investigate the effectiveness of EMG-driven hand robotic therapy in regaining hand motor function in stroke patients.
Objectives :
To investigate the effectiveness of EMG-driven hand robotic therapy in regaining hand motor function of acute & sub-acute stroke patients in UCH.
Methodology :
With the collaboration of occupational therapist and rehab physician, recruitment of acute or sub-acute stroke patients was commenced from June to November 2023.
Participants with hemiplegic upper limb at Functional Test for the Hemiplegic Upper Extremity (FTHUE) levels 1 to 4 received 10-sessions (5 days a week for 2 weeks) of EMG-driven hand robotic therapy. A EMG-driven hand robotic glove was employed, which would actively assist hand motion when enough EMG signals of corresponding muscles were generated and sensed. During the program, participants also received conventional hand function training to further promote their independence in activities of daily living. Pre-and-post outcome measurements including hand grip strength, Functional Test for the Hemiplegic Upper Extremity (FTHUE), Action Research Arm Test (ARAT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE) were adopted. For data analysis, paired samples T-test (for hand grip strength, ARAT scores, FMA-UE scores) and Wilcoxon signed rank test (for FTHUE) were utilised.
Result & Outcome :
Results:
A total of 13 stroke patients (mean age: 63.69, 6 male, 7 female) were recruited and completed in the program from June to November 2023. At baseline, there were 2 patients at FTHUE level 1, 9 patients at FTHUE level 2 and 2 patients at FTHUE level 3. During the program, all 13 patients had adequate EMG signals sensed for the EMG-driven hand robotic therapy. The preliminary results showed significant improvement (p=0.005, SD: 2.871) in hand grip strength. In functional aspect, significant improvement was found in all outcome measures, including FTHUE score (Z=-2.829, p=0.005), ARAT total score (p=0.008, SD: 17.879), FMA total score (p<0.001, SD: 15.358), FMA upper arm sub-score (p=0.001, SD: 7.794) and FMA wrist & hand sub-score (p<0.001, SD: 9.250).
Conclusion:
Significant improvement in grip strength and functional performance were showed for acute and sub-acute stroke patients after completing the EMG-driven hand robotic therapy. It can deliver an evidence-based and high-intensity repetitive training with reducing workforce demand, to promote the upper limb recovery especially in wrist and fingers function. A larger sample size with control group will provide more insight for the clinical evidence of EMG-driven hand robotic therapy.
