Feasibility of home hand rehabilitation using musicglove after chronic spinal cord injury

Abstract

Study design: Randomized, controlled single-blind cross over study. This study was registered on ClinicalTrials.gov (NCT02473614).

Objectives: Examine usership patterns and feasibility of MusicGlove for at home hand rehabilitation therapy following chronic spinal cord injury.

Setting: Homes of participants.

Methods: Ten participants with chronic spinal cord injury completed two baseline assessments of hand function. After a stable baseline was determined all participants were randomized into two groups: Experimental and Control. Each group was given a recommended therapy dosage. Following this participants switched interventions.

Results: On average participants had higher levels of compliance (6.1 ± 3.5 h.), and completed more grips (15,760 ± 9,590 grips) compared to participants in previous stroke studies using the same device. Participants modulated game parameters in a manner consistent with optimal challenge principles from motor learning theory. Participants in the experimental group increased their prehension ability (1 ± 1.4 MusicGlove, 0.2 ± 0.5 Control) and performance (1.4 ± 2.2 MusicGlove, 0.4 ± 0.55 Control) on the Graded and Redefined Assessment of Strength, Sensibility, and Prehension subtests. Increases in performance on the Box and Blocks Test also favored the experimental group compared to the conventional group at the end of therapy (4.2 ± 5.9, -1.0 ± 3.4 respectively).

Conclusions: MusicGlove is a feasible option for hand therapy in the home-setting for individuals with chronic SCI. Participants completed nearly twice as many gripping movements compared to individuals from the sub-acute and chronic stroke populations, and a number far greater than the number of movements typically achieved during traditional rehabilitation.

Fig. 1. Consort flow diagram.

The diagram displays the phases in which the study progresses, beginning with patient screening, followed by randomization, and subsequent analysis.

Fig. 2. Summary of usership of the MusicGlove device.

(Left) The cumulative number of grips completed by each subject in the group that received the MusicGlove first (MusicGlove), and the group that used the MusicGlove second, after three weeks of conventional home therapy (Control). (Right) The average cumulative number of grips completed by the subjects from the current study compared to number completed by chronic and subacute stroke survivors from two previous studies [30]. Bars show ± 1 SE.

Fig. 3. Analysis of adjustments made to game parameters across songs, as well as analysis of success at the game.

A A bar plot of song difficulty (1: easiest, 3: hardest) versus frequency. Each bar is representative of the number of grip types used. B Fraction of different types of parameter changes made during gameplay. The percent of games were a parameter was not changed was 67%. C Fraction of songs played at different success levels. D MusicGlove device.

Fig. 4. Probability of increasing (solid line) or decreasing (dashed line) game difficulty (via song difficulty or number of grips) as a function of success on previous song.

Each point is the probability calculated based on all songs played within 10 points of success at that point. We required at least 100 songs to plot a point. Since subjects rarely played at low success levels, no points below 65% success were included.

Fig. 5. Individual trajectories of both primary and secondary outcome measures throughout the study.

Vertical lines represent one SD. Additionally the average change in score was calculated relative to the baseline evaluation.