MyHand: An Active Hand Orthosis for Stroke Patients

Overview

This study seeks to explore the efficacy of several control mechanisms for the device and the impact of a device training program on its utility as a neuroprosthetic and training tool for upper limb recovery.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: June 27, 2019

Detailed Description

Hand rehabilitation through occupational therapy is critical for many stroke survivors, but it is also greatly limited by insurance coverage, shortage of therapists, and logistic constraints. To address this, stroke patients need a rehabilitation method they can use on their own, without direct clinical supervision, and for activities of daily living. MyHand is a wearable and active hand orthosis consisting of a glove and forearm splint, equipped with actuators and tendons which connect to the fingers.

Interventions

  • Device: EMG Band
    • The MyHand orthosis provides tension to the digits to open the fingers on demand. This group will wear an EMG band to control and activate the MyHand orthosis.
  • Device: Shoulder harness
    • The MyHand orthosis provides tension to the digits to open the fingers on demand. This group will wear a shoulder strap to control and activate the MyHand orthosis, either with shoulder elevation or shoulder depression.

Arms, Groups and Cohorts

  • Experimental: MyHand orthosis
    • Subjects are trained to control and use the MyHand orthosis either with a shoulder harness or an electromyography (EMG) band. The MyHand orthosis aims to aid in fine motor skills such as picking up and holding items of varying shape, size and weight.

Clinical Trial Outcome Measures

Primary Measures

  • Score on Action Research Arm Test (ARAT)
    • Time Frame: Baseline; Post-test at Week 4
    • The ARAT is a 19-item measure that assesses upper limb functioning. The ARAT is divided into 4 sub-tests (grasp, grip, pinch, and gross arm movement). Performance on each item is rated on a 4-point ordinal scale ranging from 0 (cannot perform) to 3 (normal performance). Scores on the ARAT range from 0-57 points, with higher scores indicating better performance.
  • Score on the Upper Extremity Component of the Fugl-Meyer Scale (UEFM)
    • Time Frame: Baseline; Post-test at Week 4
    • The Fugl-Meyer (FM) Assessment of Motor Recovery evaluates and measures recovery in post-stroke hemiplegic patients. The FM uses a 3-point ordinal scale from 0 (cannot perform) to 2 (performs fully). The FM has 5 domains with a maximum score of 226 points. Subscales can be administered with out using the full FM. The Upper Extremity component (UEFM) consists of 33 items with a score range of 0-66. Higher score indicate better performance. Please note: An a prior decision was made to only perform the UEFM once at post-testing: post test without robotic assistance. The UEFM assesses capacity of the arm primarily through gross motor tasks, and comparatively few grasping and pinching tasks. Thus, it was presumed that robotic assistance would have minimal influence on UEFM scores. In other words, the UEFM was intended as a outcome measure to primarily evaluate the rehabilitative effects of training with the device, as opposed to evaluating the assistive capacity of using the device.

Secondary Measures

  • Score on Modified Ashworth Scale (MAS)
    • Time Frame: Baseline
    • The Ashworth or Modified Ashworth Scale (MAS) is a measure of spasticity originally developed as a simple clinical classification to assess the anti-spastic effects of carisoprodol in multiple sclerosis. It is rated on a 5-point nominal scale using subjective clinical assessments of tone ranging from 0 (no increases in tone) to 4 (limb rigid in flexion/extension or abduction/adduction). Please note: MAS is officially scored on a 5-point scale that includes “1+” (full range: 0, 1, 1+, 2, 3, 4). However non-numeric scores are not allowable in the Outcome Measure Data Table. Therefore, the scores were transformed from a 0-4 scale (including 1+) to a 0-5 scale (excluding 1+). The reported medians for all but Finger Flexors were not impacted by the scale transformation. Finger Flexor median is reported as 2 in the Outcome Measure Data Table, but this can be understood as a true median of 1+ if using the original MAS scoring scale.
  • Score on Box and Blocks Test (BBT)
    • Time Frame: Baseline; Post-test at Week 4
    • The BBT measures unilateral gross manual dexterity using blocks and a 2-compartment box. At the start, there are 150 blocks in one compartment and the score represents the number of blocks transferred from one compartment to the other compartment in 60 seconds. Each hand is scored separately, however only scores for the impaired (hemiplegic) hand are reported. Scores can range from 0-150, with higher scores indicating better performance of manual dexterity.
  • Number of Participants Completing Treatment Protocol
    • Time Frame: 4 Weeks
    • The number of participants who completed the full treatment protocol (12 training sessions).
  • Total Number of Adverse Events During Intervention
    • Time Frame: 4 Weeks
    • All adverse events will be tracked during the course of the intervention. The Principal Investigator will review any event and assess it as either adverse or non-significant.

Participating in This Clinical Trial

Inclusion Criteria

  • Subjects over 18 years of age – History of stroke resulting in significant upper limb impairment – Full passive range of motion – Gross control of the proximal upper extremity – Lacks timely grasp/release – No more than moderate flexor tone – Intact cognition Exclusion criteria include: – Other Neurological/orthopedic disorders – Excessive spasticity/contracture

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Columbia University
  • Collaborator
    • Wallace H. Coulter Foundation
  • Provider of Information About this Clinical Study
    • Principal Investigator: Joel Stein, MD, Simon Baruch Professor of Physical Medicine and Rehabilitation – Columbia University
  • Overall Official(s)
    • Joel Stein, MD, Principal Investigator, Columbia University

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