Effects of Wrist Tendon Vibration on Targeted Upper-Arm Movements in Poststroke Hemiparesis
Megan O. Conrad, Robert A. Scheidt, Brian D. Schmit
Abstract
Background. Impaired motor control of the upper extremity after stroke may be related to lost sensory, motor, and integrative functions of the brain. Artificial activation of sensory afferents might improve control of movement by adding excitatory drive to sensorimotor control structures. The authors evaluated the effect of wrist tendon vibration (TV) on paretic upper-arm stability during point-to-point planar movements. Methods. TV (70 Hz) was applied to the forearm wrist musculature of 10 hemiparetic stroke patients as they made center-out planar arm movements. End-point stability, muscle activity, and grip pressure were compared as patients stabilized at the target position for trials completed before, during, and after the application of the vibratory stimulus. Results. Prior to vibration, hand position fluctuated as participants attempted to maintain the hand at the target after movement termination. TV improved arm stability, as evidenced by decreased magnitude of hand tangential velocity at the target. Improved stability was accompanied by a decrease in muscle activity throughout the arm as well as a mean decrease in grip pressure. Conclusions. These results suggest that vibratory stimulation of the distal wrist musculature enhances stability of the proximal arm and can be studied further as a mode for improving end-point stability during reaching in hemiparetic patients.
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The objective of Physical rehabilitation is to return the patients performance of everyday functional and vocational tasks to their pre injury level. The key element of Physical rehabilitation is intensive active exercise practice. Most importantly for upper limb rehabilitaion is isolated and combined finger and wrist intensive exercises provided by the HandTutor. The HandTutor is a glove and software that provides hand biofeedback. Challenging games and biofeedback provide patients with the motivation to continue intensive repetitive fine motor finger and wrist exercises. The HandTutor is used in hospitals and community hand therapy clinics as well as through tele rehabilitation. Examples of patients that are treated include Stroke, TBI, spinal cord injury CP, Orthopedic hand and arm surgery, development co-ordination disorders in children etc
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