||Training Effects of a Novel Biofeedback System on Hand Function for Stroke Patients
||Department of BioMedical Engineering
Stroke patients usually suffer from poor hand function which causes significant inconvenience in their daily activities. The abnormal synergy pattern and impaired sensation result in the deficits of force control especially poor digit independence, and poor digit coordination. Clinically, task oriented training is widely used for post-stroke recovery. There are also several novel hand coordination trainings had been proposed. However, there’s still lacking a strongly recommended training method that’s effective and specific for digit force control and finger independence.
In this study, 15 stroke patients voluntarily involved in this experiment. Grasping Training System (GTS) with visual biofeedback was used to train and evaluate finger function. All subjects finished 12 times 30 minutes training with the frequency of 2 to 3 times per week. The training program consisted two parts: (1) stably meet target force and (2) accurately meet target angle. To evaluate participants’ hand function improvements, besides clinical assessments, GTS and Pressing Evaluation Training System (PETS) were also used in evaluation. The evaluations were conducted before, after and 1 month after training.
The results showed that subjects’ performance generally improved after GTS training. Patients’ digit independence and hand steadiness were significantly improved after training and the training effects could be maintained in follow-up test. The temporal coupling between grip force and load force was also significantly decreased. Clinical hand function test and grasping and pinch force showed trend of improvement but no statistical difference. However, the GTS training didn’t have effect on sensory improvement which is reasonable as the training programs were not focus on sensory function.
Overall, GTS provide clinicians and stroke patients an effective and innovative way to train hand function and digit control. Moreover, it can also be used to quantify patients’ performance which provide clinicians a clearer image of patients’ rehabilitation progress. In the future, studies can increase the sample size of subjects which can possibly lower the variability of stroke patients. Furthermore, to make GTS training and evaluation system more widely used in clinics and commercialized, the device can be simplified so that it can be cheaper and easier for therapists to operate.
List of Tables VIII
List of Figures IX
Chapter 1 Introduction 1
1.1 Importance of hand function 1
1.1.1 Role of grasping position 1
1.1.2 Grasping planning and adjustment 2
1.2 Hand function of stroke patients 3
1.3 Synergy pattern 3
1.4 Sensorimotor deficit in stroke patients 5
1.5 Digital force control deficit in stroke patients 5
1.6 Finger independence 6
1.7 Hand function intervention for stroke patients 7
1.7.1 Post stroke recovery: brain plasticity 7
1.7.2 Traditional task-oriented training 8
1.7.3 Biofeedback training 8
1.7.4 Novel hand coordination training 9
1.8 Grasping Training System (GTS) and Pressing Evaluation and Training System (PETS) 10
1.9 Motivation 11
1.10 Purpose 12
Chapter 2 Materials and Methods 13
2.1 Participants 13
2.2 Equipment 14
2.2.1 Grasping Training System (GTS) 14
2.2.2 Pressing Evaluation and Training System (PETS) 17
2.2.3 Visual feedback system 18
2.3 Experimental setting and procedure 19
2.3.1 The experimental setting 19
2.3.2 The experiment procedure 20
2.4 Outcome measures 22
2.4.1 GTS evaluation 22
2.4.2 PETS evaluation - FTT 23
2.4.3 Clinical assessment – strength test 25
2.4.4 Clinical assessment – hand function test 28
2.4.5 Clinical assessment – sensory test 31
2.5 Training program 32
2.5.1 Target force training program 33
2.5.2 Target angle training program 35
2.6 Data processing and analysis 36
2.6.1 Parameters of PETS – EN 36
2.6.2 Parameter of PETS - RMSD 37
2.6.3 Parameter of GTS – grasping efficiency 38
2.6.4 Parameter of GTS – reaction time 39
2.6.5 Parameter of GTS – coefficient variance of force 39
2.6.6 Parameter of GTS – coefficient variance of acceleration 40
2.7 Statistical analysis 40
Chapter 3 Results 41
3.1 Training effects on EN 41
3.2 Training effects on RMSD 42
3.3 Training effects on grasping efficiency 44
3.4 Training effects on reaction time 45
3.5 Training effects on coefficient variance of force 46
3.6 Training effects on coefficient variance of acceleration 49
3.7 Training effects on clinical assessments – strength 51
3.7 Training effects on clinical assessments – hand function 52
3.7.1 Box and blocks (B&BT) 52
3.7.2 Purdue 53
3.8 Training effects on clinical assessments – sensory 54
3.8.1 Semmes-Weinstein (S-W) test 54
3.8.2 Two-point discrimination (2-PD) test 55
Chapter 4 Discussion 58
4.1 EN improvement 58
4.2 Anticipatory grip force modulation 58
4.3 Force adjustment 59
4.4 Force smoothness 61
4.5 Hand steadiness 62
4.6 Limitations and future works 63
Chapter 5 Conclusion 64
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