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Device for acute rehabilitation of the paretic hand after stroke Team: Carly Brown, Sasha Cai Lesher-Perez, Lee Linstroth, and Nathan Kleinhans

Client: Dr. Michelle Johnson Medical College of Wisconsin - Milwaukee Advisor: Prof. Mitch Tyler University of Wisconsin - Madison

Stroke Demographics Paralysis Rehabilitation 72% over 65 years old hemiplegia Rehabilitation Tennis balls Electrical stimulation Robotics Stroke occurs when a blood vessel in the brain becomes blocked or bursts and stops the flow of oxygen to the brain. 700.000 suffer stroke every year. 72% over the age of 65. third leading cause of death in the US. Leading cause of serious, long-term disability in the US. Disability that usually results is hemiplegia: paralysis on one side of the body. Survivors must go through rehabilitation in order to relearn how to function in daily life or regain control. mL/100g/min Blood flow map of an ischemic stroke patient shows reduced blood flow in the right hemisphere of the brain (left side of the image) Image from: http://www.imaginginformatics.ca/research/stroke

Objective Recover motion of hand in acute phase Supination / pronation of wrist ±90º from neutral Flexion / extension of hand During rehabilitation, the acute phase (3 months post stroke) is a critical phase that usually determines whether a patient will regain motion in the paralyzed limbs or not. The task that our client set forth for us is to design a system that will be used in an inpatient rehabilitation setting that will work the supination/pronation of the wrist (90 degrees) and the flexion/extension of the hand.

Last semester’s work Mechanical wrist rotator Electrical stimulation hand extension Existing joystick for hand grasp assisted by FES Mechanical wrist rotator powered by torque motor Padded armrest We are continuing our work from last semester. Last semester we designed a mechanical wrist rotator and incorporated FES to assist with the hand grasping motion of the hand.

Design changes Fully mechanical system Separate systems Automated hand grasper This semester the big changes are that the system will be fully mechanical. We are also separating the motions into two systems. Eventually the systems could be used either alone or in conjunction with each other. The system will also be automated by incorporating a microprocessor.

PDS Summary Universal Portable Max 25 lbs $600 Mechanical mechanisms Wrist rotation Hand extension Our design must be accomodating for the wide range in hand, wrist and arm sizes throughout the population. It must be portable, such that it can work on a table, wheelchair tray and be moved between patients readily. Since the device will be moving around, the device should be no more than 25lbs. We will be working on a budget of $600. And due to client specifications, the device will incorporate mechanical systems to drive the motions of the wrist and hand.

Design components Wrist rotator Hand grasper Supination / pronation Flexion / extension Two designs The two systems that we have in this design are: wrist rotator and hand grasper

Power source (battery) Wrist rotator Padded PVC for wrist to sit in Power source (battery) Microprocessor Variables: Speed Degree of rotation This is the wrist rotator, it is similar to what the design was for last semester, but it is smaller and it will be sitting in a u-shaped track that will make the motion smoother, which was a concern of our client. The rotator will sit in btwn and be pulled by cables that are connected to the motor. Torque Motor Belt from torque motor will connect here Rollers

Hand Grasper: option 1 fingers Fingers, made of aluminum tubes Bottom is hollowed to allow full flexion of fingers Hole for the cable, and where springs will be placed Where the palm will sit: HDPE and padding Microprocessor Stepper motor

Hand Grasper: option 2 pump Holes for air Microprocessor Bladder -rubber Pneumatic actuator Air tube

Design Matrix Fingers Pump Cost 2 3 Manufacturing 1 4 Universality Weighted 1-5 Fingers Pump Cost 2 3 Manufacturing 1 4 Universality PT-friendly Additional movements Total 14 16

Budget $600 Projected costs: Total: $500 Wrist rotator: $200 Hand grasper: $150 Microprocessor: $150 Total: $500 The budget that we have left over from last semester is $600, we project that this semester we will spend….

Future Work This semester Future semesters Construct Client feedback Redesign based on client feedback Submission for intellectual property Future semesters Microprocessor Testing Mechanical Human For the rest of this semester, we plan to construct the two systems, present them to our client

References The American Heart Association (2006) www.americanheart.org (Oct. 17, 2006). Drabycz, S. 2006. Stroke. The University of Calgary. Retrieved from http://www.imaginginformatics.ca/research/stroke on 15 Oct 2006. Elhendy, A. Health Center Online. Stroke Symptoms. Retrieved from http://heart.healthcentersonline.com/stroke/stroke3.cfm on 7 Oct 2006. Hluštík, Petr, Mayer, Michal. 2006. Paretic hand in stroke: from motor cortical plasticity research to rehabilitation. Neuropsychiatry, Neuropyschology, and Behavioral Neurobiology 19: 34-40. O’Neal, Burke, PhD: UW-Madsion, Personal Communication Tompkins, Willis, PhD: UW-Madison, Personal Communication