The purpose of this study is to investigate learning transfer from the healthy hand to the paretic hand in stroke patients. EMG signals from the healthy hand - while performing wrist dorsi flexion movement - will be used to activate electric muscles stimulation of the dorsi flexors of the paretic hand.
14 post-stroke subjects will be recruited from neurological rehabilitation department at Loewenstein rehabilitation hospital, Ra`anana, Israel. The patients will be randomly assigned to one of two groups: 1) Experimental group. 2) Control group. The 3 weeks intervention (15 sessions) in each group will include electric muscles stimuli (pulse rate 35-100Hz pulse width 200 microseconds, 5 sec on and 10 sec rest ) of the hemiparetic hand for 15 minutes. The patients in the experimental group will wear a wireless Bluetooth EMG ("Myo" bracelet) on their healthy forearm and when they will execute wrist dorsi flexion, the data will be transmitted to a PC which will be used to activate (via Arduino controller) a Transcutaneous Electric Nerve Stimulator (TENS) that is attached to the paretic dorsi flexors (electrodes are placed on the paretic forearm). The control group will get only automatic stimuli on the paretic forearm via the TENS.
The assessments will be done before the intervention, at the end of three weeks of intervention, and after 1 month from the end of the intervention (follow up).
The outcomes will include: active range of motion of fingers and wrist dorsi flexion (using cybermin 5DT glove for digital measures), upper limb section of Fugl-Meyer test, Box and Blocks test and Jebsen Taylor Hand Function Test. Only before the beginning of the intervention the sensory ability of the patient will be assessed using the Sensory section of Fugl-Meyer (FM) and Semmes-Weinstein filaments for superficial sensation. Normalized lesion data will be computed using the ABLE module within MEDx software (Medical Numerics).
Differences between groups will be calculated using t-tests or Mann-Whitney, depending on distribution of normality with corrections for multiple comparisons.
- EMG and TENS Device
Intervention Desc: Healthy hand EMG signal measured while making voluntarily wrist dorsi flexion will activate TENS, which will be placed on the paretic forearm and will produce wrist dorsi flexion. ARM 1: Kind: Experimental Label: EMG and TENS Description: Wireless Bluetooth EMG ("Myo") bracelet will be placed on the healthy forarm. A voluntary dorsi flexion of the healthy wrist produces data that will be transmitted to a PC and will be used to activate (via Arduino controller) a Transcutanus Electric Nerve Stimulator (TENS), placed on the paretic forearm, that will stimulate wrist dorsi flexsores. 5 days per week, for 3 weeks, 15 minutes per day.
- TENS only Device
Intervention Desc: Automatic TENS stimuli to the paretic dorsi flexors (i.e., producing wrist dorsi flexion). ARM 1: Kind: Experimental Label: TENS only Description: Custom-built software & hardware: PC + Arduino controller and Transcutanus Electric Nerve Stimulator (TENS) device, will be used to stimulate wrist dorsi flexsores of the paretic forarm. 5 days per week, for 3 weeks, 15 minutes per day.
|Type||Measure||Time Frame||Safety Issue|
|Primary||Change in active range of motion of wrist dorsi flexion and fingers extension||Before the intervention, after 3 weeks of intervention and one month after the end of the intervention (follow up).|
|Secondary||Change in Fugl-Meyer Assessment||Before the intervention, after 3 weeks of intervention and one month after the end of the intervention (follow up).|
|Secondary||Change in Box and Blocks test||Before the intervention, after 3 weeks of intervention and one month after the end of the intervention (follow up).|
|Secondary||Change in Jebsen Taylor Hand Function Test|