| Hand impairment is a common condition that contributes substantially to disability in the U.S. and around the world. In the case of stroke alone, it is estimated that 80% of the 700,000 people who survive a stroke each year require hand therapy. Unfortunately, as soon as two weeks after the onset of stroke, people must perform hand therapy at home without professional assistance, even though therapy dose is known to significantly affect therapeutic outcomes. There currently exists little technology to either deliver effective and motivating therapy, or to objectively monitor hand use at home. We developed two devices to address these needs.;We developed the MusicGlove to help individuals with hand impairment achieve high numbers of functional gripping movements using a sensorized glove and a highly engaging, music-based, video game. In a usability study with 10 individuals with chronic stroke, we found that the MusicGlove could be used by individuals with severe hand impairment and could accurately measure clinical hand impairment level. In a follow-up pilot study with 12 people with chronic stroke, we compared the therapeutic efficacy of the MusicGlove with conventional hand therapy in a within-subjects design in the clinic. After 6, 45 minute sessions over 2 weeks, subjects improved hand function more after MusicGlove training compared to conventional training as measured by the Box and Blocks score (improvement of 3.21 +/- 3.82 vs. -0.29 +/-2.27 blocks; P = 0.010) and the 9 Hole Peg test (improvement of 2.14 +/- 2.98 vs. -0.85 +/-1.29 pegs/minute; P = 0.005). Subjects sustained improvements in hand function at a one month follow-up. In a pilot study after three weeks of training at home, people reported significant improvement in the quality of movement (MAL QOM gain of 0.88 +/- 0.60SD points, 17.6% improvement, P = 0.002, N = 11) and amount of use (MAL AOU gain of 0.87 +/- 0.56SD points, 17.4% improvement, P < 0.0001, N = 11) of their affected upper extremity.;We also developed the manumeter, an ergonomic, non-obtrusive device intended for daily monitoring of the hand and wrist in an uncontrolled environment packaged in a socially acceptable ring and watch-like unit. The device logs spontaneous use of the hand and wrist for up to 21 hours using two triaxial magnetometers, located in a sensorized watch, that respond to the magnetic field of a magnetic neodymium ring worn on the index finger. The manumeter can connect to an android tablet that recharges an onboard battery, transmits logged sensor data, and calculates wrist and finger joint angles using a radial basis function network. We tested the accuracy and reliability of measuring wrist flexion/extension, wrist ulnar/radial deviation and finger flexion/extension by comparing manumeter estimates with a passive goniometric exoskeleton. A total of 7 participants completed a series of 12 tasks at the low, medium, and high intensity conditions on a first testing day, then 1-2 days later, then 6-8 days later wearing both the manumeter and exoskeleton. On average total angular distance estimates with the manumeter were 92.5%, 98.3%, and 94.7% of the exoskeleton goniometer for days 1-3 respectively. |
