Rehabilitation of Finger Extension in Chronic Hemiplegia Derek Kamper 1,5 Tiffany Kline 4 Xun Luo 3 Robert Kenyon 1,3 Heidi Fischer 1 Kathy Stubblefield 1 William Z. Rymer 1,2 William Z. Rymer 1,2 1 Sensory Motor Performance Program 2 Northwestern University 3 University of Illinois at Chicago 4 Marquette University 5 Illinois Institute of Technology

Objectives  Develop two types of externally powered devices to assist finger extension  Incorporate these devices into an augmented reality training environment with performance feedback  Test device efficacy and user acceptance with reach-to- grasp training paradigm 3 60-min sessions per week for 6 weeks 3 60-min sessions per week for 6 weeks 3 subject groups 3 subject groups

Background Limited finger extension is the most common chronic motor impairment following stroke (Trombly, 1989).

Background Directionally dependent deficits

Development   Cable-driven   Biscapular abduction/ shoulder flexion produce finger extension   Figure 8 harness   Force transducer measures assistance Body-powered orthosis

Development Pneumatic orthosis

Development  Glasstron head-mounted display  Permits visibility of actual environment See own hand See own hand Augmented reality

Pilot study  3 training groups of chronic stroke subjects Body-powered Orthosis Body-powered Orthosis Pneumatic Glove Pneumatic Glove Control (no device) Control (no device)  6 week training protocol Reach-to-grasp Reach-to-grasp Virtual and actual objects Virtual and actual objects  Evaluations pre, post, 1 month post

Results BPO SubjectsControl Subjects

Results BPO SubjectsControl Subjects

Discussion  Protocol well tolerated by subjects  Small gains Often not maintained, even after only 1 month Often not maintained, even after only 1 month  Need for higher extension forces Mass activation of arm musculature Mass activation of arm musculature But must still prevent joint subluxation But must still prevent joint subluxation  Limited head ROM impedes viewing of VR scene

Education & Dissemination Presentation at meeting of AOTA 2005 (Fischer and Stubblefield) Panel discussion of robotics in rehabilitation at ARCA 2005 (Kamper, Fischer, and Stubblefield) Lab tour for Marquette PT class RIC in-service presentations on clinical floors (Fischer)

Short-term outcomes ICORR 2005, Luo, et al. ICORR 2005, Luo, et al. ICORR 2005, Kline, et al. ICORR 2005, Kline, et al. IEEE EMBS 2005, Luo, et al. IEEE EMBS 2005, Luo, et al. ICADI 2006, Fischer, et al. ICADI 2006, Fischer, et al. Conference Papers:

Future plans  Initiate new study Sub-acute population (3-6 months) Sub-acute population (3-6 months) New AR environments New AR environments More grasp repetitions More grasp repetitions  Modify Pneu Glove Assist digits independently Assist digits independently Increase air pressure Increase air pressure

Future plans During training: 8 blocks with orthosis 1-4 without Modify BPO for trials of training at home