Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke

Publication date: Available online 25 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Heather T. Peters, Stephen J. Page, Andrew Persch
ObjectiveDetermine the immediate impact of a portable, myoelectric elbow-wrist-hand orthosis (MEWHO) on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors.DesignObservational cohort study Setting: Outpatient rehabilitation clinicParticipants18 participants exhibiting chronic, moderate, stable, post-stroke, UE hemiparesis.InterventionsSubjects were administered a battery of measures testing UE impairment as well as UE function. They then donned a fabricated MEWHO and were again tested on the same battery of measures while wearing the device.Main Outcome MeasuresThe primary outcome measure was the UE section of the Fugl-Meyer Impairment Scale (FM). Subjects were also administered a battery of functional tasks and the Box and Blocks test (BB).ResultsSubjects exhibited significantly reduced UE impairment while wearing the MEWHO (FM: t {17} = 8.56, p < .0001), and increased quality in performing all functional tasks while wearing the MEWHO, with three subtasks showing significant increases (Feeding {grasp}: Z=2.251, p=.024; Feeding {elbow}: Z=2.966, p=.003; Drinking {grasp}: Z= 3.187, p=.001). Additionally, subjects showed significant decreases in time taken to grasp a cup (Z=1.286, p=.016) and increased gross manual dexterity while wearing a MEWHO (BB: Z =3.42, p < .001).ConclusionResults suggest that UE impairment, as measured by the FM, is significantly reduced when donning a MEWHO and these changes exceeded the FM's clinically important difference threshold. Further, utilization of a MEWHO significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects' ability to perform multi-joint functional movements and attain consistent functional changes.



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