Journal Article Review, March 2020

Osuagwu B et al: Home-based rehabilitation using a soft robotic hand glove device leads to improvement in hand function in people with chronic spinal cord injury: a pilot study. Journal of NeuroEngineering and Rehabilitation (2020) 17:40.

Last week investigators from Britain published preliminary data on the rehabilitation potential of a soft robotic glove for patients with high spinal cord injuries (C2-C8). The soft extra muscle (SEM) glove provides extra finger strength (akin to how power brakes and power steering work). Artificial tendons attach alongside the thumb, middle finger and ring finger. The tendons connect to electric motors that increase the strength of digital flexion and are controlled by pressure sensors in the tips of the glove. The device detects the user’s intention to flex the fingers and applies proportional flexion strength to facilitate the motion. The SEM glove had been previously tested in geriatric individuals with impaired hand function.

Fifteen people (age range 33-60) participated in the current study, which spanned 18 weeks. The researchers collected measurements at base line and then at half way and full way through the 12-week trial and again 6 weeks after the trial was over. Assessments included the Toronto Rehabilitation Institute (TRI) test for manipulation of objects (wood block, cylinder, credit card, and wooden bar) and grip and pinch strength measurements. Satisfaction and health state outcomes questionnaires were also included.

Nine people completed the 18-week study. Most participants were able to don the glove independently, and only those with more severe hand impairment required the assistance of a care giver to don the glove. The investigators asked the participants to wear the glove a minimum of 4 hours a day. In addition to using the glove for daily activities, they were instructed in squeezing and releasing a ball 30 times and to perform 30 trials of picking up a soda can from a table, simulate taking a drink, and replacing the can on the table. They were also expected to eat a meal with a fork or spoon and to use a pen to write their name and address.

RESULTS: The participants’ improved their TRI scores significantly after 6 weeks, did not improve further between weeks 7 and 12, but maintained their gains 6 weeks later after they had discontinued use of the glove. The same pattern of improvement was generally noted for pinch strengths.

Here are before-and-after videoclips of book and credit card manipulation:

https://static-content.springer.com/esm/art%3A10.1186%2Fs12984-020-00660-y/MediaObjects/12984_2020_660_MOESM2_ESM.wmv

https://static-content.springer.com/esm/art%3A10.1186%2Fs12984-020-00660-y/MediaObjects/12984_2020_660_MOESM3_ESM.wmv

The participants informally commented that they found the glove useful although they would prefer it to be water resistant and more easily washable, if it covered all the fingers, and it it was even more compact. They indicated that they used the glove to eat, hold a handrail on the steps, groom, and drive. Overall, the participants were “quite satisfied” with the device, and several wanted to keep it after the study was complete.

DISCUSSION: The authors note that the study was uncontrolled and that they cannot be sure of the mechanism that led to the improvement in function and the maintenance of improvement 6 weeks after the participants stopped using the glove. Improvement may be at the level of the muscle since the glove encourages active use of the hand, or it may be at the brain or spinal cord level via improved neuroplasticity. They would like to be able to determine that with further study along with determining the minimal time of use necessary to gain and sustain strength and function.

COMMENT: The study is well-designed, executed, and reported. We should encourage any advances that can help individuals with high spinal cord injuries. What other conditions might such a “power-assist” glove might be useful?