Original research
Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke

https://doi.org/10.1016/j.apmr.2016.12.016Get rights and content

Abstract

Objective

To determine the immediate effect of a portable, myoelectric elbow-wrist-hand orthosis on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors.

Design

Observational cohort study.

Setting

Outpatient rehabilitation clinic.

Participants

Participants exhibiting chronic, moderate, stable, poststroke, UE hemiparesis (N=18).

Interventions

Subjects were administered a battery of measures testing UE impairment and function. They then donned a fabricated myoelectric elbow-wrist-hand orthosis and were again tested on the same battery of measures while wearing the device.

Main Outcome Measures

The primary outcome measure was the UE Section of the Fugl-Meyer Scale. Subjects were also administered a battery of functional tasks and the Box and Block (BB) test.

Results

Subjects exhibited significantly reduced UE impairment while wearing the myoelectric elbow-wrist-hand orthosis (FM: t17=8.56, P<.0001) and increased quality in performing all functional tasks while wearing the myoelectric elbow-wrist-hand orthosis, with 3 subtasks showing significant increases (feeding [grasp]: z=2.251, P=.024; feeding [elbow]: z=2.966, P=.003; drinking [grasp]: z=3.187, P=.001). Additionally, subjects showed significant decreases in time taken to grasp a cup (z=1.286, P=.016) and increased gross manual dexterity while wearing a myoelectric elbow-wrist-hand orthosis (BB test: z=3.42, P<.001).

Conclusions

Results suggest that UE impairment, as measured by the Fugl-Meyer Scale, is significantly reduced when donning a myoelectric elbow-wrist-hand orthosis, and these changes exceeded the Fugl-Meyer Scale's clinically important difference threshold. Further, utilization of a myoelectric elbow-wrist-hand orthosis significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects' ability to perform multijoint functional movements and attain consistent functional changes.

Section snippets

Participants

Subjects were recruited from regional outpatient rehabilitation and orthotics/prosthetics clinics and support groups, or had previously participated in trials led by this laboratory. Based on previous work using myoelectrics,13 the inclusion criteria were (1) volitionally activated paretic biceps brachii electromyographic amplitude ≥5μV, (2) 1 stroke (hemorrhagic or ischemic) experienced ≥12 months prior to study enrollment, (3) score ≥24 on the Mini-Mental State Examination, (4) age ≥21 and

Participant demographics

There were 45 candidates screened; 27 were excluded because they did not meet study inclusion criteria (eg, no electromyographic signal, contractures), yielding a final sample size of 18. Sample demographics are depicted in table 1.

Behavioral outcomes

A Shapiro-Wilk test verified the normality of Fugl-Meyer Scale data with (W=.93, P=.21) and without (W=.92, P=.12) the myoelectric elbow-wrist-hand orthosis. These data were determined to have equal variances (F17,17=1.25, P=.33). There was a significant difference

Discussion

Most stroke survivors exhibit limited active movement in their paretic UEs. Devices that are easily integrated into community-based use and that confer immediate reductions in UE impairment are vital to increasing independence in this population. This study investigated the immediate benefits associated with donning a myoelectric elbow-wrist-hand orthosis in chronic, moderately impaired stroke survivors.

Subjects exhibited significant UE impairment reductions (mean Fugl-Meyer Scale score

Conclusions

Myoelectric elbow-wrist-hand orthosis use significantly reduces UE impairment and increases performance of certain functional tasks in chronic, moderately impaired stroke. Although performance on these functional tasks was inconsistent, this is likely caused by the complex movements needed to complete these tasks, coupled with subjects' lack of training on the device. Future work will incorporate standardized myoelectric elbow-wrist-hand orthosis training to more closely resemble how this

Supplier

  • a.

    MyoPro Motion-G; Myomo, Inc.

Acknowledgment

We thank Jonathon Naft, certified prosthetist/orthotist, for provided technical support and consultation on study design.

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    Supported by Myomo, Inc.

    Disclosures: Peters, Page, and Persch have provided consultation services to Myomo, Inc.

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