Restoration of hand function in stroke and spinal cord injury

Abstract

Neurological injury, such as that resulting from stroke or spinal cord injury, often leads to impairment of the hand. Due to the importance of the hand in so many activities of our lives, diminished motor control can profoundly impact quality of life. In the past 25 years especially, robotic and mechatronic technology has been developed to alleviate some of the functional losses resulting from neurological injury. The devices generally fall into one of two categories based on intended use: assistive technology, programmed to perform specific tasks for the user, and therapeutic technology, designed to facilitate therapeutic practice. Assistive devices are intended for chronic use when neurological recovery has reached a plateau, while the goal of therapeutic devices is to enhance recovery to the point where the devices are no longer needed. In the past, actuated assistance has largely consisted of robotic arms and hands which perform a task for the user. A number of individuals, however, could benefit from actuated hand exoskeletons which make use of residual arm function to position and stabilize the user’s own hand. These devices would be much smaller and could exploit residual sensory information to provide feedback to the user. Recently, therapeutic devices for the hand have begun to utilize increasing knowledge of stroke to target specific impairment mechanisms. While, traditionally, assistive devices have been developed for individuals with spinal cord injury and therapeutic devices have been developed for stroke survivors, individuals with incomplete spinal cord injury may benefit from hand therapy, while stroke survivors with severe hand impairment may see functional benefits from using assistive devices.