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The Hand After Stroke and SCI: Restoration of Function with Technology

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Neurorehabilitation Technology

Abstract

Neurological injury, such as that resulting from stroke or spinal cord injury, often leads to impairment of the hand. As the hand is critical to performance of so many functional activities, diminished sensorimotor control of the distal upper extremity can profoundly impact quality of life. This is readily apparent in many stroke survivors and individuals with spinal cord injury. Technological advances have afforded promise that equipment could be developed to facilitate restoration of function. The last 30 years have seen exponential growth in robotic and mechatronic devices targeting impairment arising from neurological injury. Earlier efforts focused largely on external devices such as robotic arms that could either be used to perform tasks for the user or to facilitate movement practice. This technology was often intended to be purely assistive, helping the user to perform a specific task without addressing the underlying pathophysiology, or purely therapeutic, creating forces or motions that would help the user to regain sensorimotor control of their own limb through practice but not helping with performance of a functional task. Recent improvements in materials and actuators have spurred the development of devices that can be worn on the body. These wearable devices afford the possibility of seamlessly shifting between roles as a therapeutic or assistive device depending on the needs of the user, but potentially introduce disadvantages in terms of added mass and bulk. The optimal device remains dependent upon the needs and preferences of the specific user. For an individual with complete spinal cord injury, a robotic arm connected to their wheelchair may provide the best rehabilitation, while for a stroke survivor with good use of the proximal arm, a wearable hand exoskeleton may give the greatest benefit. This chapter describes hand physiology and pathophysiology and wearable and non-wearable robotic devices that have been developed to improve function.

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Authors and Affiliations

  1. Joint Department of Biomedical Engineering at University of North Carolina at Chapel Hill and North Carolina State University, Raleigh/Chapel Hill, NC, USA

    Mohammad Ghassemi & Derek G. Kamper

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  1. Mohammad Ghassemi
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  2. Derek G. Kamper
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Correspondence to Derek G. Kamper .

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  1. Department of Mechanical and Aerospace Engineering and Department of Anatomy and Neurobiology, University of California, Irvine, CA, USA

    David J. Reinkensmeyer

  2. Delft University of Technology, Delft, The Netherlands

    Laura Marchal-Crespo

  3. Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland

    Volker Dietz

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Ghassemi, M., Kamper, D.G. (2022). The Hand After Stroke and SCI: Restoration of Function with Technology. In: Reinkensmeyer, D.J., Marchal-Crespo, L., Dietz, V. (eds) Neurorehabilitation Technology. Springer, Cham. https://doi.org/10.1007/978-3-031-08995-4_6

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