A stroke causes necrosis of brain cells due to clogging or rupturing of blood vessels in the brain. It is estimated that about 300 thousand people suffer a stroke every year in Japan. Even if appropriate treatment is received upon occurrence and a dangerous condition is avoided, there are many cases of aftereffects including motor paralysis in the arms and legs. Recovery from such symptoms requires long-term rehabilitation.
During rehabilitation of the upper limbs after a stroke, special emphasis is placed on functional recovery of the fingers. This is because recovery of finger functions will increase the frequency for hand usage in daily life. It also enables the usage of diverse rehabilitation programs at medical institutions such as rehabilitation clinics, thus leading to early functional recovery for all of the upper limbs. However, the majority of finger rehabilitation training conducted at medical institutions consists of finger exercises conducted by the bare hands of a physical therapist or upper limb training using a peg board. Such training essentially requires constant one-to-one care attention. This often makes it difficult to conduct sufficient rehabilitation at hospitals with many patients. In view of the declining birth rate and aging population in Japan, there is a need for a rehabilitation method which can be implemented more effectively by fewer staff members.
Based on these conditions, my laboratory is cooperating with Professor Toshio Higashi at the Nagasaki University Graduate School of Biomedical Sciences to develop a motorized glove system for stroke patients. Despite featuring a compact and lightweight configuration, this glove system will enable complex finger exercises similar to those performed by physical therapists. In this article, I would like to introduce the system being developed, as well as the results of recent clinical testing.
Fig 2: Scene of clinical testing
Through cooperation from Miharadai Hospital in Nagasaki City, we performed tests to verify the efficacy of finger rehabilitation training using the glove system. The test subject was a 87-year old female who had suffered a stroke seven years ago. Since then, the subject suffered from right hemiplegia and had difficult grasping objects with her right hand. For only a 25-day period (intervention period) during daily upper limb rehabilitation training at the hospital, the system was used to perform an additional 20 minutes of fingertip circular movement training. A scene from rehabilitation training using the glove system is shown in Figure 2. In order to assess upper limb movement function, we used the Simple Test for Evaluating Hand Function (STEF), the Hemiparesis 10-Second Test, and the Motor Activity Log-Amount of Use (MAL-AOU) Test. All of these tests are widely used in the evaluation of upper limb movement function in stroke patients. Due to length limitations of this article, I will omit an explanation of test details.
The tests used AB design in single case study. In other words, a 15-day period (A) prior to intervention was established as the baseline. Then, scores for each test were compared with a 25-day period (B) after intervention. During a total 40-day period, upper limb function was evaluated every five days. Measurement data was obtained for a total of eight times: three times prior to intervention and five times during the intervention period. Data analysis was performed based on 2-standard deviation (SD) band analysis. In this analysis method, interpretation is based on graph readings instead of statistical methods. Rehabilitation was judged as effective if the score during intervention was higher than the average score (baseline) prior to rehabilitation intervention plus two times the standard deviation for that period.
Fig 3: Motor Activity Log-Amount of Use (MAL-AOU) during test period
All test scores show an increase during the intervention period when compared to the baseline period. Although testing was conducted for a single subject only, we confirmed outstanding results in finger movement rehabilitation when using the glove system. Figure 3 shows measurement results for the MAL-AOU Test. This data shows that functioning of fingers on the paralyzed side improved after beginning rehabilitation using the glove system. A significant increase in the frequency of use during daily life can also be observed.
The results of our research were presented last year at the International Conference on NeuroRehabilitation (ICNR 2014), an event which is related to cranial nerve engineering and was held in Aalborg City, Denmark.