Case Study Report
Population: Adult
Andrew John Butler, Ph.D., Professor, Georgia State University andrewbutler@gsu.edu
Maysam Ghovanloo, Ph.D., Professor, Georgia Tech mgh@gatech.edu
David Wu, BS, Research Associate, Georgia State University Dave154@gsu.edu
Kimberly Richards, DPT, OCS, Research Associate, Georgia State University kmr2102@gmail.com
Sarah Ostadabbas, Ph.D., Post-doctoral fellow, Georgia Tech ostadabbas@gmail.com
Keywords: Plasticity, Stroke, Upper Limb, Motor
ABSTRACT BODY: Many stroke survivors are left with severe impairments to one or both upper extremities (UE), requiring long term rehabilitation in an attempt to regain function. Current evidence supports using robotic devices, such as the hand mentor (HM), in therapy to improve UE function. However, some stroke survivors will not be able to use the HM due to UE paralysis impairing their range of motion and strength. To combat this deficit, we used a tongue drive system (TDS), to control the HM (TDS-HM). The tongue and hand representations are adjacent in the motor cortex providing potential for neuroplastic changes. The change in cortical representation could lead to voluntary activation of the hand and wrist and facilitate reduction of UE deficits.
Case Description: We tested six able-bodied individuals (as controls) and two stroke survivors to determine if functional and performance (RMSE tracking) improvements were made following use of the TDS-HM. Functional improvements were measured by the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (FMA), Stroke Impact Scale (SIS), and active range of motion (AROM) measures. Participants include two individuals who previously suffered a stroke and experience moderate upper limb disability. Participant 1 was a 50-year-old male who is 20 months out from the initial insult. Participant 2 was an 80-year-old male whose stroke occurred 32 months ago.
Outcomes: Significant decreases were observed in both stroke survivors’ RMSE tracking (p<0.001), with the stroke survivors achieving similar RMSE by the end of the intervention when compared to the able-bodied participants. Post-intervention improvements on the stroke survivors’ WMFT (28% and 56%), FMA (10 and 11 points), and SIS scores (all dimensions) revealed clinically meaningful changes that surpassed previously validated levels. Varied yet improving AROM measures were observed in both stroke survivors (28 and 4 deg respectivly).
Discussion: A decrease in movement error (RMSE) in able-bodied participants and the stroke survivors suggests that there were improvements in motor performance after training with the TDS-HM. In the stroke survivors, decreased RMSE transferred into clinically improved UE function, as seen by improved FMA and WMFT performance and increased AROM. The TDS-HM intervention also has the capacity to increase QOL measures, according to the changes in SIS scores. The TDS in conjunction with the HM provides the opportunity to utilize robotic assisted therapy in stroke survivors who have minimal to no AROM of the wrist, which previously excluded many from multiple rehabilitation options, and facilitates possible neuroplastic changes in the motor cortex. Therefore, TDS-HM provides a potential treatment option for a population that could benefit from the conceivable neuroplastic effects of the combined tongue and hand movements.
Citation:
Butler, Andrew John, Ph.D.; Ghovanloo, Maysam , Ph.D.; Wu, David , BS; Richards, Kimberly , DPT, OCS; Ostadabbas, Sarah , Ph.D.. Improved upper extremity function in stroke patients using the tongue drive system and hand mentor: a preliminary study.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/031_butler-et-al/