Effectiveness of a Self-Controlled Soft Robotic Glove on Activities of Daily Living (ADL) Performance and Grasp and Pinch Force in Individuals With Cervical Spinal Cord Injury (SCI)

Abstract

Date Presented 03/26/20

Thirteen participants with cervical SCI used a soft robotic glove in a variety of tests compared to their baseline function. Results included a 50% improvement on the Jebsen-Taylor Hand Function Test from baseline to glove trial and significant increases in grasp and pinch forces with the active glove. The glove was controlled by the participants with an external button pushed by the nontested hand. In the future, this device could be portable and used in the home or community.

Primary Author and Speaker: Kristin Nuckols

Contributing Authors: Carolina Correia, Kate Zhou, Diana Wagner, Conor Walsh

Every year, over 17,000 Americans suffer a spinal cord injury (SCI) [1]. Cervical spinal injuries are the most frequent type of SCI. The loss of hand function is particularly devastating to these individuals, as it affects the ability to perform activities of daily living (ADLs) and leads to decreased life satisfaction and quality of life (QoL) [2]. As less than 1% of individuals with SCI regain premorbid mobility status, assistive devices that augment hand function are highly desirable.

Over the past fifteen years, robotic devices have emerged as an exciting prospect for augmenting and restoring movement to the limbs. Initially, rigid systems were developed but can be uncomfortable, must be strictly aligned with the biological structures, and tend to be large and stationary. Soft robotic devices are a promising response to the limitations of rigid systems as they are lightweight, non-restrictive to movement, and can be portable. A variety of soft robotic devices have been developed to assist and restore hand function [3] but only a few groups have formally investigated efficacy in targeted clinical populations. We previously tested the sensor-based controls of this glove in a small cohort of individuals with SCI [4]. This most recent study aims to increase the literature base by performing a clinical study of a self-controlled soft robotic glove to support ADL in the SCI population.

DESIGN: This clinical study followed a one-group repeated measures design and included participants recruited from Boston-area rehabilitation hospitals and clinics through Harvard IRB approved methods. The inclusion criteria included: 18-85 years old; SCI diagnosis with grasping deficits, ROM, and/or ADL; 23 or greater on Mini Mental State Exam; at least one upper extremity with motor level between C4 and C7 (assessed with a portion of the ISNCSCI); fluency in English; agreeable to photos, audio and video taken. The exclusion criteria included: missing upper extremities; joint stiffness, spasticity or contractures that prevents participation; open wounds.

METHOD: The following data was collected in baseline: spasticity (Modified Ashworth Scale), pain (Visual Analog Scale), baseline ADL ability (Neuro-Quality of Life Self Care subtest), and motor function score (portion of the International Standards for Neurological Classification of SCI). The following data was collected in baseline and active (glove) states: active/passive index finger and thumb range of motion (goniometry), grasp/pinch force (pressure mat), and ADL (Jebsen-Taylor Hand Function Test (JHFT)). Between the baseline testing and active glove trial of the JHFT, there was a brief (20 minute) training on the functions of the glove and one trial of the JHFT to allow for adaptation to the glove.

RESULTS: Thirteen participants with cervical SCI demonstrated up to 50% improvement in ADL participation during the active glove trial compared to their baseline attempt. Additionally, the maximum grasp strength at baseline increased significantly with glove-assistance for both power grasp and pinch grasp, by an average of 9.5 N and 2.7 N, respectively.

CONCLUSION: According to JHFT scores, participants were significantly more effective in ADL performance with glove assistance than at baseline. There were also significant improvements in grasp and pinch strength. Restoring the ability to grasp and manipulate objects is transformative for individuals who depend on others for ADL. In the future, we will work to make this device portable such that it can be used in the home or community and need to optimize the controls. We hope to see this device to market in the coming years to give life-altering assistance to individuals with cervical SCI.

References

National Spinal Cord Injury Statistical Center. (2019). Facts and Figures at a Glance. University of Alabama at Birmingham. Birmingham, AL, USA.

Snoek, G, IJzerman, M, Hermens, H, Maxwell, D, & Biering-Sorensen, F. (2004). Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord. 42. 526–532. doi: 10.1038/sj.sc.3101638

Chu, C, & Patterson, R. (2018). Soft robotic devices for hand rehabilitation and assistance: a narrative review. Journal of Neuroengineering and Rehabilitation. 15: 9. doi: 10.1186/s12984-018-0350-6.

Zhou, Y, Wagner, D, Nuckols, K, Heimgartner, R, Correia, C, Clarke, M, Orzel, D, O’Neill, C, Solinsky, R, Paganoni, S, & Walsh, C. (2019). Soft Robotic Glove with Integrated Sensing for Intuitive Grasping Assistance Post Spinal Cord Injury. IEEE International Conference on Robotics and Automation (ICRA). Montreal, Canada.