Coordination changes demonstrated by subjects with hemiparesis performing hand-arm training using the NJIT-RAVR robotically assisted virtual rehabilitation system

Abstract

Various authors have described pre and post testing improvements in upper limb coordination as a result of intensive upper limb interventions. While the ability to alter coordination patterns as a result of repetitive hand-arm movement is established, patterns of change in the relationship between proximal and distal effectors of the UE over the course of multiple sessions of training have not been described in the rehabilitation literature. In this study eight subjects (5 male, 3 female) with a mean age of 56.4 years (SD=14.2) and a mean time since CVA of 54.7 months post-stroke (SD=51.7) were trained for eight, 2-3 hour sessions on four robotically facilitated virtual rehabilitation activities. This paper will present 1) Functional performance and pre and post testing kinematic analysis for the eight subjects 2) More extensive analysis of the change in hand and arm coordination over the course of the eight session intervention demonstrated by one of the subjects from this sample 3) Kinematic analysis of another subject from this sample performing an un-trained reaching and grasping activity, before and after training.

Figures

Fig. 1

a. Plasma Pong requires the appropriate integration of shoulder flexion and finger extension. b. Hummingbird Hunt provides a pleasant encouraging environment in which to practice repeated arm and hand movements. c. Hammer Task trains a combination of three dimensional reaching and repetitive finger flexion and extension d. Piano Trainer consists of a complete virtual piano that plays the appropriate notes as they are pressed by the virtual fingers

Fig. 2

a. Describes the daily changes in peak index finger extension for a representative subject during Hammer Task. Values approaching zero indicate finger extension b. demonstrates improvements in the same subject’s ability to maintain the Hammer over the target, once it was acquired. The smaller values indicate less movement away from the target

Fig. 3

Demonstrates changes in time to approach and press a virtual piano trainer key over the course of 600 to 800 repetitions for each of the four hemiparetic fingers of a representative subject during an 8 day training intervention.

Fig. 4

Relative shoulder and elbow angles of a subject as he performs a horizontal reach, grasp, release and return movement for ten repetitions. Top panels are the non paretic arm, bottom panels are the paretic arm. Pre-test data was collected one day prior to training and post test data was collected two days after.

Fig. 5

Pre and post-testing data for average time after peak velocity has been achieved until grasp has been completed for four different object shapes. Two left columns for each condition depict performance of the unimpaired hand. The two right columns depict performance of the impaired hand performance. Larger values indicate slower movement. Pre-test data was collected one day prior to training and post test data was collected two days after.