Assistive Technology for Upper Limb Function

"The ability to use your hands is essential to perform activities of daily living and for people with a spinal cord injury (SCI), recovery of impaired hand function is vital as paralysis is rated as the most devastating consequence of SCI.  During rehabilitation it is important that you are consciously activating your hand muscles.  This study will promote active engagement between the brain and the hand muscles which is important during hand movement rehabilitation." Dr Bethel Osuagwu, Research Project Manager

The need for research

The loss of hand function is considered by SCI individuals as one of the most devastating consequences of their injury.  Many daily living tasks such as feeding, bathing and dressing become difficult without the normal function of the hands.  Intricate movements which may be taken for granted but are required for various object manipulations are impaired with people with tetraplegia.  These impairments of hand function significantly reduce independence making an individual reliant on a caregiver even for the most basic activity of daily living.

SMSR-funded research

Stoke Mandeville Spinal Research (SMSR) is currently supporting two clinical trials, SEM Glove and Active FES, focusing on rehabilitation of hand function following spinal cord injury:

SEM Glove study for spinal cord injury (SEM Glove)

Rehabilitation of the impaired hand function is a priority following SCI and intensive hand therapy is provided for individuals with SCI during the sub-acute stage of the injury.  However individuals with chronic SCI require orthotic and rehabilitation devices that can help with activities of daily living, help them to integrate back into the community and find employment.  One such device is the soft extra muscle (SEM) Glove that detects the intention to grip an object and 'strengthens' the hand to generate adequate grip force.

A clinical trial was undertaken to determine whether the SEM Glove has an orthotic and/or long-term rehabilitative effect on hand grasp function in individuals with chronic incomplete tetraplegia.  

It was shown that the participants benefited from using the glove, with study outcome measures showing improved strength and ability to perform activities of daily living.  Moreover, participants' testimonials demonstrated the usefulness of the glove therapy with many believing that it has significantly helped them  both as an assistive and rehabilitation tool in several activities.  Some said they could properly grasp and eat a burger, prepare tea, do gardening and vacuuming and so on, while others could confidently hold the hand rail while climbing the stairs - important for the prevention of falls.

The study was published in March 2020 in the Journal of NeuroEngineering and Rehabilitation, and is available at https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00660-y

Videos from the study, demonstrating the function and effectiveness of the glove can be viewed at https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00660-y#Sec25

In addition to information on the orthotic and rehabilitative potential of the glove, the results of this study will inform home-based self- administered therapy which is important for non-hospitalised patients with impaired hand function.

A second analysis, exploring the glove's possible effects on Neuroplasticity is underway and expected later in 2020.

The study was initiated by the Occupational therapy team at the National Spinal Injuries Centre (NSIC) and is supported by the Buckinghamshire Healthcare NHS Charitable Fund (Ann Masson Research Award) and SMSR.

Active Functional Electrical Stimulation (Active FES)

Functional electrical stimulation (FES) is a technique of using small electrical current to activate muscle nerves in such a way to accomplish a useful movement.  The technique has been shown to lead to improvement of movement impairment.  In the current usage of FES, patients do not have complete control of when the device starts and stops. This means that the device does not work according to a patient's movement intention.  But it will be better if the FES can work in accordance with the patient's intent. For example, when the patient attempts to move, the FES starts and helps to support the movement. And when the patient stops , the FES stops.  This method is very intuitive and works better with the brain. In fact research has shown that it is a better method that could lead to movement recovery.  This study aims to develop an FES system that works according to a patient's movement intention.  The first design developed at the NSIC has been tested on people with spinal cord injury and the research team are currently analysing results which will be published in the coming months.