Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training
Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training
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DOI：
10.1186/1743-0003-11-76
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发表时间：
2014-04-30
影响因子：
5.1
通讯作者：
Reinkensmeyer, David J.
中科院分区：
文献类型：
--
作者：
Friedman, Nizan;Chan, Vicky;Reinkensmeyer, David J.
背景：人们认为治疗应该是功能性的，高度重复的，并促进传入输入，以最好地刺激中风后的手部运动恢复，然而患者很难获得这样的治疗。我们开发了MusicGlove，这是一款乐器手套，用户需要练习类似抓握的动作和拇指与手指的对抗，才能玩一款非常吸引人的、基于音乐的视频游戏。本研究的目的是：1)比较MusicGlove训练与传统手部疗法的效果；2)确定MusicGlove训练是否比匹配形式的等距手部运动训练更有效；3)确定MusicGlove游戏得分是否能预测临床结果。方法：在受试者内设计中，12名慢性卒中中度偏瘫幸存者被随机分配接受MusicGlove、等距测量和常规手部治疗。每名受试者参加6次1小时的治疗，每周3次，持续两周，针对每种训练类型，总共18次治疗。在每个训练类型之前和之后以及在一个月的随访中，盲法评分者评估了手损伤，包括盒子和块（B & B）测试作为主要结果测量。受试者还完成了内在动机量表（IMI）。结果：与常规训练相比，音乐手套训练后受试者在抓握小物体方面的手功能得到了更多的改善，通过B & B评分（改善3.21 +/- 3.82比-0.29 +/- 2.27块，P=0.010）和9孔Peg测试（改善2.14 +/- 2.98比-0.85 +/- 1.29块/分钟，P=0.005）来衡量。在更广泛的手功能评估中，训练类型之间没有显著差异。与音乐手套训练相比，受试者从等长训练中获益较少，但差异不显著（P < 0.09）。在一个月的随访中，受试者的手部功能持续改善，并发现音乐手套比其他两种疗法更有动力。MusicGlove的游戏得分与B & B得分密切相关。结论：这些结果支持了一个假设，即手部治疗是一种有吸引力的，包含大量重复的握紧和拇指-手指对立运动，并促进传入输入的方法，可以提高个体操纵小物体的能力。MusicGlove提供了一种简单的方式来获得这种治疗。
Background: It is thought that therapy should be functional, be highly repetitive, and promote afferent input to best stimulate hand motor recovery after stroke, yet patients struggle to access such therapy. We developed the MusicGlove, an instrumented glove that requires the user to practice gripping-like movements and thumb-finger opposition to play a highly engaging, music-based, video game. The purpose of this study was to 1) compare the effect of training with MusicGlove to conventional hand therapy 2) determine if MusicGlove training was more effective than a matched form of isometric hand movement training; and 3) determine if MusicGlove game scores predict clinical outcomes.Methods: 12 chronic stroke survivors with moderate hemiparesis were randomly assigned to receive MusicGlove, isometric, and conventional hand therapy in a within-subjects design. Each subject participated in six one-hour treatment sessions three times per week for two weeks, for each training type, for a total of 18 treatment sessions. A blinded rater assessed hand impairment before and after each training type and at one-month follow-up including the Box and Blocks (B & B) test as the primary outcome measure. Subjects also completed the Intrinsic Motivation Inventory (IMI).Results: Subjects improved hand function related to grasping small objects more after MusicGlove compared to conventional training, as measured by the B & B score (improvement of 3.21 +/- 3.82 vs. -0.29 +/- 2.27 blocks; P=0.010) and the 9 Hole Peg test (improvement of 2.14 +/- 2.98 vs. -0.85 +/- 1.29 pegs/minute; P=0.005). There was no significant difference between training types in the broader assessment batteries of hand function. Subjects benefited less from isometric therapy than MusicGlove training, but the difference was not significant (P>0.09). Subjects sustained improvements in hand function at a one month follow-up, and found the MusicGlove more motivating than the other two therapies, as measured by the IMI. MusicGlove games scores correlated strongly with the B & B score.Conclusions: These results support the hypothesis that hand therapy that is engaging, incorporates high numbers of repetitions of gripping and thumb-finger opposition movements, and promotes afferent input is a promising approach to improving an individual's ability to manipulate small objects. The MusicGlove provides a simple way to access such therapy.