Phase I Safety Trial: Extended Daily Peripheral Sensory Stimulation Using a Wrist-Worn Vibrator in Stroke Survivors

The Use of TheraBracelet Upper Extremity Vibrotactile Stimulation in a Child with Cerebral Palsy-A Case Report

Background

TheraBracelet is peripheral vibrotactile stimulation applied to the affected upper extremity via a wristwatch-like wearable device during daily activities and therapy to improve upper limb function. The objective of this study was to examine feasibility of using TheraBracelet for a child with hemiplegic cerebral palsy.

Methods

A nine-year-old male with cerebral palsy was provided with TheraBracelet to use during daily activities in the home and community settings for 1.5 years while receiving standard care physical/occupational therapy.

Results

The child used TheraBracelet independently and consistently except during summer vacations and elbow-to-wrist orthotic use from growth spurt-related contracture. The use of TheraBracelet did not impede or prevent participation in daily activities. No study-related adverse events were reported by the therapist, child, or parent.

Conclusion

Future research is warranted to investigate TheraBracelet as a propitious therapeutic device with focus on potential impact of use to improve the affected upper limb function in daily activities in children with hemiplegic cerebral palsy.

Smartwatch-based functional assessment for upper extremity impairment after musculoskeletal injuries: A pilot study

Introduction

Wearable sensors are increasingly applied to rehabilitation for arm movement analysis. However, simple and clinically relevant applications are scarce.

Objectives

To investigate the feasibility of single smart watch-based parameters for functional assessment in upper limb rehabilitation for musculoskeletal injuries using a commercial smart watch.

Method

Ten patients with unilateral shoulder pain and range-of-motion limitations were enrolled. They wore Galaxy Watch® and performed three sets of upper extremity tasks consisting of gross activities-of-daily-living tasks, Wolf Motor Function Test (WMFT), and Upper Extremity Functional Index (UEFI), and the acceleration and angular velocities were acquired. The motion segment size (MSS), representing motion smoothness from a clinical perspective, and various sensor-based parameters were extracted. The correlation between the parameters and clinical outcome measures were analyzed. The percent relative range (PRR) of the significant parameters was also calculated.

Results

For overhead and behind body activity task set, mean MSS for elbow flexion/extension axis significantly correlated with WMFT score (R = 0.784, p = .012). For planar tasks, mean MSS for the forearm supination/pronation (R = 0.815, p = .007) and shoulder rotation (R = 0.870, p = .002) axes significantly correlated with WMFT score. For forearm and fine movement task set, mean MSS of the elbow flexion/extension angle showed significant correlation with WMFT (R = 0.880, p < .001) and UEFI (R = 0.718, p = .019). The total performance time (R = -0.741, p = .014) also showed significant correlation with WMFT score. The PRR for mean MSS in forearm supination (71.5%, planar tasks) and mean MSS in x-direction (49.8%, forearm and fine motor movements) were similar to the PRR of WMFT (58.5%), suggesting sufficient variation range across different degree of impairments.

Conclusion

The commercial smart watch-based parameters showed consistent potential for use in clinical functional assessments.

Wearable Sensor to Monitor Quality of Upper Limb Task Practice for Stroke Survivors at Home

Many stroke survivors experience persistent upper extremity impairment that limits performance in activities of daily living. Upper limb recovery requires high repetitions of task-specific practice. Stroke survivors are often prescribed task practices at home to supplement rehabilitation therapy. A poor quality of task practices, such as the use of compensatory movement patterns, results in maladaptive neuroplasticity and suboptimal motor recovery. There currently lacks a tool for the remote monitoring of movement quality of stroke survivors' task practices at home. The objective of this study was to evaluate the feasibility of classifying movement quality at home using a wearable IMU. Nineteen stroke survivors wore an IMU sensor on the paretic wrist and performed four functional upper limb tasks in the lab and later at home while videorecording themselves. The lab data served as reference data to classify home movement quality using dynamic time warping. Incorrect and correct movement quality was labeled by a therapist. The home task practice movement quality was classified with an accuracy of 92% and F1 score of 0.95 for all tasks combined. Movement types contributing to misclassification were further investigated. The results support the feasibility of a home movement quality monitoring system to assist with upper limb rehabilitation post stroke.

Effect of Using TheraBracelet on Grasping versus Reaching in Poststroke Rehabilitation

A peripheral sensory stimulation named TheraBracelet has recently been shown to have a potential to improve gross manual dexterity following stroke. Upper limb function requires both reach and grasp. It is unknown whether TheraBracelet affects one more than other. The objective of this study was to determine whether TheraBracelet improves reaching versus grasping. In a pilot randomized controlled trial, persons with stroke received TheraBracelet (treatment) or no stimulation (control) during task practice therapy (n = 6/group). Effects of TheraBracelet on reaching versus grasping were determined using breakdown of movement times in the Box and Block Test video recordings. Improvements in movement times for the treatment compared with control group were more pronounced for grasping than for reaching at both post and follow-up time points. TheraBracelet may be beneficial for persons with grasping deficits. This knowledge can guide clinicians for targeted use of TheraBracelet, resulting in effective implementation of the new treatment.

Study on self-management of real-time and individualized support in stroke patients based on resilience: a protocol for a randomized controlled trial

BACKGROUND

The transitional period from hospital to home is vital for stroke patients, but it poses serious challenges. Good self-management ability can optimize disease outcomes. However, stroke patients in China have a low level of self-management ability during the transitional period, and a lack of effective support may be the reason. With the rapid development of technology, using wearable monitors to achieve real-time and individualized support may be the key to solving this problem. This study uses a randomized controlled trial design to assess the efficacy of using wearable technology to realize real-time and individualized self-management support in stroke patients' self-management behavior during the transitional period following discharge from hospital.

METHODS

This parallel-group randomized controlled trial will be conducted in two hospitals and patients' homes. A total of 183 adult stroke patients will be enrolled in the study and randomly assigned to three groups in a 1:1:1 ratio. The smartwatch intervention group (n = 61) will receive Real-time and Individualized Self-management Support (RISS) program + routine care, the wristband group (n = 61) will wear a fitness tracker (self-monitoring) + routine care, and the control group (n = 61) will receive routine stroke care. The intervention will last for 6 months. The primary outcomes are neurological function status, self-management behavior, quality of life, biochemical indicators, recurrence rate, and unplanned readmission rate. Secondary outcomes are resilience, patient activation, psychological status, and caregiver assessments. The analysis is intention-to-treat. The intervention effect will be evaluated at baseline (T0), 2 months after discharge (T1), 3 months after discharge (T2), and 6 months after discharge (T3).

DISCUSSION

The cloud platform designed in this study not only has the function of real-time recording but also can push timely solutions when patients have abnormal conditions, as well as early warnings or alarms. This study could also potentially help patients develop good self-management habits through resilience theory, wearable devices, and individualized problem-solution library of self-management which can lay the foundation for long-term maintenance and continuous improvement of good self-management behavior in the future.

TRIAL REGISTRATION

The ethics approval has been granted by the Ethics Committee of West China Hospital, Sichuan University (2022-941). All patients will be informed of the study details and sign a written informed consent form before enrollment. The research results will be reported in conferences and peer-reviewed publications. The trial registration number is ChiCTR2300070384 . Registered on 11 April 2023.

Effect of Self-Directed Home Therapy Adherence Combined with TheraBracelet on Poststroke Hand Recovery: A Pilot Study

Hand impairment is a common consequence of stroke, resulting in long-term disability and reduced quality of life. Recovery may be augmented through self-directed therapy activities at home, complemented by the use of rehabilitation devices such as peripheral sensory stimulation. The objective of this study was to determine the effect of adherence to self-directed therapy and the use of TheraBracelet (subsensory random-frequency vibratory stimulation) on hand function for stroke survivors. In a double-blind, randomized controlled pilot trial, 12 chronic stroke survivors were assigned to a treatment or control group (n = 6/group). All participants were instructed to perform 200 repetitions of therapeutic hand tasks 5 days/week while wearing a wrist-worn device 8 hours/day for 4 weeks. The treatment group received TheraBracelet vibration from the device, while the control group received no vibration. Home task repetition adherence and device wear logs, as well as hand function assessment (Stroke Impact Scale Hand domain), were obtained weekly. Repetition adherence was comparable between groups but varied among participants. Participants wore the device to a greater extent than adhering to completing repetitions. A linear mixed model analysis showed a significant interaction between repetition and group (p = 0.01), with greater adherence resulting in greater hand function change for the treatment group (r = 0.94; R 2 = 0.88), but not for the control group. Secondary analysis revealed that repetition adherence was greater for those with lower motor capacity and greater self-efficacy at baseline. This pilot study suggests that adherence to self-directed therapy at home combined with subsensory stimulation may affect recovery outcomes in stroke survivors. This trial is registered with NCT04026399.

Development and evaluation of an efficient training program to facilitate the adoption of a novel neurorehabilitation device

Many rehabilitation devices are not adopted by therapists in practice. One major barrier is therapists' limited time and resources to get training. The objective of this study was to develop/evaluate an efficient training program for a novel rehabilitation device. The program was developed based on structured interviews with seven therapists for training preference and composed of asynchronous and in-person trainings following efficient teaching methods. The training program was evaluated for six occupational therapy doctoral students and six licensed therapists in neurorehabilitation practice. Training effectiveness was evaluated in a simulated treatment session in which 3 trainees shifted their roles among therapist applying the device, client, and peer assessor. In results, 11 of the 12 trainees passed the assessment of using the device in simulated treatment sessions. One trainee did not pass because s/he did not plug in the device to charge at the end. The in-person training fit within 1-h lunch break. All trainees perceived that they could effectively use the device in their practice and both asynchronous and in-person training easily fit into their schedule. This project serves as an example for development of an efficient and effective training program for a novel rehabilitation device to facilitate clinical adoption.

Influence of vibrotactile random noise on the smoothness of the grasp movement in patients with chemotherapy-induced peripheral neuropathy

Patients with chemotherapy-induced peripheral neuropathy (CIPN) often suffer from sensorimotor dysfunction of the distal portion of the extremities (e.g., loss of somatosensory sensation, numbness/tingling, difficulty typing on a keyboard, or difficulty buttoning/unbuttoning a shirt). The present study aimed to reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor dysfunction in CIPN patients without exacerbating symptoms. Twenty-five patients with CIPN and 28 age-matched healthy adults participated in this study. To reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor function, participants were asked to perform a tactile detection task and a grasp movement task during random noise stimulation delivered to the volar and dorsal wrist. We set three intensity conditions of the vibrotactile random noise: 0, 60, and 120% of the sensory threshold (Noise 0%, Noise 60%, and Noise 120% conditions). In the tactile detection task, a Semmes-Weinstein monofilament was applied to the volar surface of the tip of the index finger using standard testing measures. In the grasp movement task, the distance between the thumb and index finger was recorded while the participant attempted to grasp a target object, and the smoothness of the grasp movement was quantified by calculating normalized jerk in each experimental condition. The experimental data were compared using two-way repeated-measures analyses of variance with two factors: experimental condition (Noise 0, 60, 120%) × group (Healthy controls, CIPN patients). The tactile detection threshold and the smoothness of the grasp movement were only improved in the Noise 60% condition without exacerbating numbness/tingling in CIPN patients and healthy controls. The current study suggested that the development of treatment devices using stochastic resonance can improve sensorimotor function for CIPN patients.

Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke

Background

Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone.

Methods

A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication.

Discussion

This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden.

Trial registration

NCT04569123. Registered on September 29, 2020

Effect of Sensory Impairment on Hand Functional Improvement with Therapy and Sensory Stimulation

Sensory impairment may impact individual stroke survivors' motor recovery as well as their response to peripheral sensory stimulation treatment. The objective of this study was to determine the effect of sensory impairment level of individual stroke survivors on motor improvement with therapy and peripheral sensory stimulation. A secondary analysis of a pilot triple-blind randomized controlled trial was used. Twelve chronic stroke survivors were randomly assigned to the treatment group receiving peripheral sensory stimulation or the control group receiving no stimulation during 2-week hand task practice therapy. Sensory impairment level was quantified as the pre-intervention sensory threshold. Motor improvement was assessed as change in the Box and Block Test score from pre- to post-intervention. The association between sensory impairment level and motor improvement was examined using a regression analysis, accounting for groups. This study found that participants with better sensation (i.e., with lower sensory threshold) had better motor improvement than patients with worse sensation (i.e., with higher sensory threshold). Sensory impairment level did not alter the effect of peripheral sensory stimulation. These findings suggest that the level of sensory impairment may predict recovery potentials and direct rehabilitation treatment for stroke survivors.

Using Subthreshold Vibratory Stimulation During Poststroke Rehabilitation Therapy: A Case Series

Subthreshold vibratory stimulation to the paretic wrist has been shown to prime the sensorimotor cortex and improve 2-week upper extremity (UE) therapy outcomes. The objective of this work was to determine feasibility, safety, and preliminary efficacy of the stimulation over a typical 6-week therapy duration. Four chronic stroke survivors received stimulation during 6-week therapy. Feasibility/safety/efficacy were assessed at baseline, posttherapy, and 1-month follow-up. For feasibility, all participants wore the device throughout therapy and perceived the stimulation comfortable/safe. Regarding safety, no serious/moderate intervention-related adverse events occurred. For efficacy, all participants improved in Wolf Motor Function Test and UE use in daily living based on accelerometry and stroke impact scale. Mean improvements at posttherapy/follow-up were greater than the minimal detectable change/clinically important difference and other trials with similar therapy without stimulation. In conclusion, the stimulation was feasible/safe for 6-week use. Preliminary efficacy encourages a larger trial to further evaluate the stimulation as a therapy adjunct.

Integrating Tactile Feedback Technologies Into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic

The COVID-19 pandemic has highlighted the need for advancing the development and implementation of novel means for home-based telerehabilitation in order to enable remote assessment and training for individuals with disabling conditions in need of therapy. While somatosensory input is essential for motor function, to date, most telerehabilitation therapies and technologies focus on assessing and training motor impairments, while the somatosensorial aspect is largely neglected. The integration of tactile devices into home-based rehabilitation practice has the potential to enhance the recovery of sensorimotor impairments and to promote functional gains through practice in an enriched environment with augmented tactile feedback and haptic interactions. In the current review, we outline the clinical approaches for stimulating somatosensation in home-based telerehabilitation and review the existing technologies for conveying mechanical tactile feedback (i.e., vibration, stretch, pressure, and mid-air stimulations). We focus on tactile feedback technologies that can be integrated into home-based practice due to their relatively low cost, compact size, and lightweight. The advantages and opportunities, as well as the long-term challenges and gaps with regards to implementing these technologies into home-based telerehabilitation, are discussed.