Upper extremity neurorehabilitation

Jan Kowalczewski
2009
The work presented in this dissertation was focused on developing an affordable, automated, upper extremity exercise system suitable for individuals with stroke and spinal cord injury (SCI). The three studies presented in this thesis demonstrated the efficacy of functional electrical stimulation-assisted exercise therapy (FES-ET). Furthermore a protocol was developed to implement FES-ET in participants' homes via tele-rehabilitation. The protocol included the use of an improved version of the
more » ... ionic glove", an FES device that enhanced hand grasp and release in SCI individuals in combination with a custom-built workstation that enabled task-oriented rehabilitation in the home setting, supervised over the Internet. In the course of these studies, an objective hand function assessment tool was developed to complement tele-supervised FES-ET and provide the therapist with an unbiased evaluation of the participant's impairment. A major section of this dissertation is concerned with the development and testing of a novel exercise workstation named the "ReJoyce" (Rehabilitation Joystick for Computer Exercise), that can assess hand function electronically. The ReJoyce is an instrumented workstation that provides standardized upper extremity rehabilitation based on ADLs, in the guise of computer games played by manipulating attachments on the device. The three studies presented in this thesis focus on the scientific merits and the logistics of providing tele-supervised FES-ET with this workstation. The first study demonstrated the feasibility of treating and assessing individuals who had recently suffered a stroke on the workstation. The second study explored the relationship between the quantitative assessment of hand function with the workstation and two widely-used clinical tests. The last study involved daily, telesupervised FES-ET or conventional exercises and therapeutic electrical stimulation (TES), maintained for 6 weeks, with SCI participants spread out over a large geographical area. FES-ET performed with the workstation resulted in statistically significant and clinically important improvements in hand function that were greater than those produced by the more conventional protocol. The results demonstrated the importance of including a range of exercises aimed at improving both strength and dexterity. It is concluded that tele-supervised FES-ET on a standardized workstation is feasible, effective and affordable in the current healthcare setting.
doi:10.7939/r3b334 fatcat:ck7toaewqzdcno3zz4ucrdhv6e