Learn about why a biofeedback device might be a better option than a robotic hand for rehabilitation after a stroke from a therapist's perspective.

Is Biofeedback or a Robotic Hand Better for Rehabilitation After Stroke

A Therapist's Perspective - Learn if Biofeedback or a Robotic Hand is better for rehabilitation after stroke.

WHAT HAPPENS TO THE BRAIN DURING A STROKE

A stroke is caused by either a blockage of a blood vessel or bleeding in or
around the brain, which results in a lack of oxygen to the brain and the death
of brain cells. The residual physical effects of the loss of brain cells will
depend on the area of the brain that was affected.

One of the functions of the brain is sending messages to our muscles to move in
a coordinated way to complete functional activities. More than half of stroke
survivors experience a lasting hemiparesis
[https://www.neofect.com/us/blog/hemiplegia-vs-hemiparesis] due to the damage to
the brain. [1] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688261/#B125] 
Hemiparesis is weakness on one side of the body, and depending on what brain
cells died will determine which pathways to specific muscles will be affected.
Stroke is the leading cause of long term disability in the United States. [2]
[https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000659]

HAND FUNCTION AND ROBOTICS


We often don’t appreciate the complexity of what the arm and hand are able to
do. It’s incredibly complicated. There are 20 joints in the hand alone, and the
joints of the arm are able to move in over 40 different directions. Add in the
degrees of freedom of each joint, the coordination required to grade movement,
the alignment of joints, and exertion of force and you’ve got a very complex
physical system you’re trying to repair after a stroke. That doesn’t even take
into account all the other requirements of a task, such as your visual
perception, your sensation, and your understanding of where your body is in
space. Spasticity
[https://www.neofect.com/us/blog/how-to-improve-spasticity-spinal-cord-injury] 
also develops in stroke, which makes movement of the joint even more difficult.

Robotics used in rehabilitation has made a lot of progress in the last 10 years,
primarily with devices to assist with walking. Upper extremity robotics in
stroke range from full assistance with movement to tracking active movement.
While they are both important, there seems to be a disconnect between designers
and clinicians in the purpose of the device.

Of course it would be awesome if you could put on a robotic glove and suddenly
you would be able to do all the things you were able to do before a stroke, but
it just doesn’t work like that. Even if they were to develop an exoskeleton that
could capture the motor movement parameters of the arm, it wouldn’t be able to
feel and capture the proprioceptive and visual feedback that the neurologically
intact arm provides.

But the brain is an amazing thing! Even though we can’t repair the damage to the
brain, the brain has the capacity to rewire itself. This is called 
neuroplasticity
[https://www.neofect.com/us/blog/using-brain-plasticity-to-supercharge-your-brain]
.

WHAT WE KNOW ABOUT REHABILITATION IN STROKE


There are several evidence-based rehabilitation strategies in stroke that tap
into neuroplasticity including repetitive task practice, constraint-induced and
modified constraint-induced movement therapy, virtual reality, mirror therapy
[https://www.neofect.com/us/blog/stroke-exercises-using-mirror-therapy-and-mirror-neurons]
, and strengthening and exercise. [3]
[https://www.ncbi.nlm.nih.gov/pubmed/25553742] Many of the techniques overlap in
their concepts, and while research is still determining the specifics of which
components of these interventions makes the biggest difference in hand use and
function, it’s clear that you have to put the work in to make neurological
changes.

The commonality for all of the above interventions is frequent repetitions of
movement. We don’t know the magic number of repetitions, but it has to be enough
to create a signal from the brain to the muscle. Imagine you’re trying to build
a road from point A to point B through a pile of dirt with just a truck. The
first time you drive the truck over it’s going to be slow and kind of a bumpy
ride, but then you do it again and again. Each time your truck goes over the
path, it creates a smoother road and gets easier. This is how you train your
brain to send messages to the muscles. Your brain sends a signal to the muscle
to move. The more you do it, the easier it gets. It can be a foreign feeling to
try to isolate a muscle movement because for everyday tasks we use a combination
of muscles and joints to complete the requirements of the task. Creating those
neural pathways to the muscles is the first step of being able to use the
muscles of arm together.

You could sit there and move your hand and arm 200 times everyday for each
motion, but in practical application of rehab this just doesn’t happen. We also
know that initiating movement for a purpose is more likely to develop
neuroplasticity than straight repetitions alone. [3]
[https://www.ncbi.nlm.nih.gov/pubmed/25553742]

The Neofect Smart Glove [https://www.neofect.com/us/smart-glove] is a 
biofeedback
[https://www.neofect.com/us/blog/how-can-biofeedback-jumpstart-your-stroke-rehab-program] 
device that targets movements that are typically impaired for people with
stroke.





It’s training your brain to create those pathways to your muscles, and it does
it in a way that’s motivating and tracks your progress. A typical session will
have you complete 200-300 repetitions. It doesn’t move your hand for you, you
have to do the work. If you have visible movement of your wrist, forearm, and/or
fingers, there is a message that’s trying to get from the brain to the muscle.
The algorithm can create that “just right challenge” to push you just a little
further to really dig into making that path. A robotic hand that moves for you
and doesn’t make you work for it, isn’t sending the truck down the road.

CONTINUING THE REHABILITATION JOURNEY


Repetitive movements are only one piece of the puzzle when it comes to stroke
rehabilitation. Your brain can create pathways to the muscles, but all
functional activities require a variety of muscles and joint movements. You also
have to practice the functional task you want to achieve over and over again
until your brain can learn to do it without thinking about it. It’s not just
about improving your movement, it’s about being able to do the things that give
you quality of life. You don’t have to have full range of motion of each joint
and muscle to be able to do your favorite things, there are a lot of different
ways to accomplish a task.

Depression and a decrease in social activity are common in people with stroke
and impact their quality of life [4]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018998/]. Discover the activities
that make you happy and give you life. As we age we all have to re-evaluate
what’s important to us and grieve the things that are harder than they used to
be. But that doesn’t mean we can’t find new versions and new things that make us
happy. Regardless of the function of your hand, you can live a beautiful,
fulfilling life.

Here at Neofect [https://www.neofect.com/us/], we're committed to supporting you
in your rehabilitation journey. If you have had a stroke and are looking for an
effective solution for your rehabilitation needs, please look into NEOFECT's
line of Smart Rehabilitation Solutions [https://www.neofect.com/en/pt-solution/]
.

To learn more, please call (866) 534-4989 or email contactus@neofect.com.

References

 1. Yue Z, Zhang X, Wang J. (2017) Hand Rehabilitation Robotics on Poststroke
    Motor Recovery [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688261/#B125].
    Behavioral Neurology
 2. Benjamin, E. J. et al. (2019) Heart Disease and Stroke Statistics—2019
    Update: A Report From the American Heart Association
    [https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000659].
    Circulation
 3. Nilsen, D. M., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T.
    (2015). Effectiveness of interventions to improve occupational performance
    of people with motor impairments after stroke: An evidence-based review
    [https://www.ncbi.nlm.nih.gov/pubmed/25553742]. The American Journal of
    Occupational Therapy, 69(1), 1-5A.
 4. Opara, J. A., & Jaracz, K. (2010). Quality of life of post-stroke patients
    and their caregivers.
    [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018998/] Journal of medicine
    and life, 3(3), 216–220.

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the Neofect website
[https://www.neofect.com/us/] is solely at your own risk.

Robotic Hand

Is Biofeedback or a Robotic Hand Better for Rehabilitation After Stroke: a Therapist's Perspective

A Therapist's Perspective - Learn if Biofeedback or a Robotic Hand is better for Rehabilitation After Stroke

The NeoMano is a soft, wearable robotic glove that allows for grasp of everyday objects using the thumb post and the pointer and middle fingers with use of titanium wires and a small motor and battery pack.

NeoMano: A Grasp Assist Device Gets Ready to Make a Debut!

A Grasp Assist Device Gets Ready to Make a Debut!
The hand is involved for so much of our daily, routine and meaningful activities
that it’s difficult to imagine how to manage without the functional use of a
hand. For individuals that have lost hand function due to an illness or injury,
those functions that some of us take for granted, including grasping an object
to pick it up or keeping a hand securely on an object for self care or leisure,
can become very frustrating.



Neofect, the creators of other rehabilitation tools such as the Smart Glove
[https://shop.neofect.com/collections/smart-rehab-solution/products/neofect-smart-glove]
, Smart Board [https://www.neofect.com/us/smart-board] and Smart Pegboard
[https://shop.neofect.com/collections/smart-rehab-solution/products/neofect-smart-pegboard]
, have created a tool to assist! The NeoMano is a soft, wearable robotic glove
that allows for grasp of everyday objects using the thumb post and the pointer
and middle fingers with use of titanium wires and a small motor and battery
pack. The controller that allows for closure and release of the fingers is
wireless, which is a new feature based on user feedback and function. The
controller can be placed on the table, on a band attached to the arm, belt or
wheelchair or on a belt clip for user accessibility.

We recently did a video shoot to get ready to launch our Kickstarter campaign,
which starts on October 30th. See some of our behind the scenes pictures and
user profiles to get an idea of how the NeoMano might work for you or someone
you know that has challenges with hand function.

Remember to join our email list in order to receive regular updates on our
progress and to become a backer on the Kickstarter campaign in order to help
bring this important device to those in need! Visit neofect.neomano.com to sign
up!



Mark, one of our test users, has ALS (also known as Lou Gehrig’s disease) which
impairs the use of his left hand and arm. He and his occupational therapist,
Kenny, use the NeoMano device to assist Mark in grasping a water bottle prior to
his exercise routine. Mark also uses the NeoMano for maintaining grasp on his
elliptical machine, walking the dog, holding and stabilizing objects. Mark is
excited to be able to use the NeoMano regularly to allow him to continue to
participate in his active lifestyle with as much independence as possible.





Rachel has also been involved in the prototype testing of our NeoMano device.
Rachel has a C4 ASIA A spinal cord injury and continues to work to improve her
upper body function. She is an accomplished photographer and uses the NeoMano to
hold her iphone in order to take pictures as well as other everyday tasks like
writing and eating. Rachel is able to access the switch for the NeoMano from the
table or the armrest of her wheelchair to control the grasp and release.

NeoMano indiegogo begins on October 30th, 2018. Please subscribe NeoMano
newsletter on neomano.neofect.com [https://neomano.neofect.com/]


*To Learn More about the NeoMano:

 * Website: www.neofect.com [https://www.neofect.com/us/neomano]
 * Phone: (888) 623-8984 [tel:+18886238984]