STROKE REHABILITATION Health

It works hand in glove

SMART REHAB: Picture shows the inexpensive tele-rehabilitation system developed by the NYU team. Here, sensors in the jacket measure arm placement. — PHOTO: NYU  

A jacket and a glove, complete with an array of sensors, may be the next big thing as far as treating stroke patients is concerned. The apparel’s design — still being improved upon by a team that includes Indian-origin researchers at New York University — will be tweaked to make it affordable and amenable to Indian conditions. The research team included engineers and a rehabilitation medicine specialist.

A major challenge that lies in rehabilitating stroke patients is in ensuring that they continue their prescribed set of exercises even after they return home from hospitalisation. Studies show that patients are incentivised to follow their exercises if they were able to measure their progress.

How it works

Building on this, Preeti Raghavan and Vikram Kapila, of New York University, have developed the mechatronic device. After it is worn, the jacket measures arm placement, while the glove measures the movement of the wrist, finger placement and finger joints. The device comes with a finger trainer to guide the fingers.

When a patient is assigned an exercise by the therapist, the device registers movements such as how many degrees the wrist has moved or how far the arm has risen and even the amount of pressure exerted by the fingers.

Dr. Raghavan, of New York University Langone’s Rusk Rehabilitation Ambulatory Care Centre, helped build the prototype. In 2002, she started her research work on strokes when she “realised that there were so many gaps in treating patients”.

“Eighty six per cent of people might recover some ability to walk but may not recover hand function,” she says. She received a grant from the National Institutes of Health to be trained in rehab research, and the topic was “control of hand function after stroke”.

“We studied the movement of the hand in detail, the forces and the muscle activity and the patterns. We learnt that the series of information coming from the unaffected hand is shared by both sides of the brain. We learnt that the unaffected hand can teach and the two sides of the brain cooperate to aid recovery. This information could be used to improve the function of the affected hand. Because we do so many different things with the hand that we are constantly learning,” Dr. Raghavan explains.

Using the preliminary data that showed that even short periods of training by the unaffected hand led to changes in the function of the affected hand, she collaborated with Dr. Vikram Kapila, professor of Mechanical and Aerospace Engineering at NYU Tandon School of Engineering, and students Ashwin Raj Kumar and Sai Prasanth Krishnamoorthy, to convert the idea into a product.

Programme for India

The research team studied the effects of exercise and preliminary data showed that a short period of training, where the unaffected hand “teaches” the affected hand, can lead to changes in the functioning of the affected hand. A limitation is that for the treatment to be effective, persons ought to have at least limited mobility in their hands.

“We used this information to develop a platform by which training could be provided. That led to collaboration with engineers to develop interfaces to personalise the treatment approach,” Dr. Raghavan says.

During her talk at the World Stroke Congress in Hyderabad in October-end, she will be talking about introducing low-cost devices in India. In an e-mail interview, Prof. Kapila elaborated on plans to test the device in India.

Initially, 25 devices will be deployed to gauge their acceptability by physiotherapists, hospitals, clinics and patients. After workshops and promotional training during the control phase “we will deploy 50 devices during field testing phase in India. Based on the testing results, the device will be further enhanced,” says Dr. Kapila. The team has sought additional financial support for control and field testing. To a question on affordability, he says the device would cost under $500 (approximately Rs.33,000). “We envision our device to be used well beyond established health-care channels. Our solution reduces the travel costs and burden on patients and caregivers, promoting self-dependence. It allows patients to integrate rehabilitation with activities of daily living improving their quality of life,” he says.

Terming it a “research-proven, rehabilitation device, designed exclusively for stroke patients”, it would promote stroke awareness and offer a sense of confidence to their positive feelings/notion about recovery.

In parallel, Ashwin and Sai Prasanth are developing an app that can be used by physiotherapists and physicians to assess the benefit of the prescribed therapy.

Dr. Kapila says the broader business model of the device would be to promote employment through mobile and tele-rehabilitative solutions and is expandable to rural areas where physiotherapists can use a single device as a door-to-door service facilitating increase of their earning and supporting more patients.

Thus, the device’s low price and low per-session price Rs.200 ($4), serving 5-8 patients per visit, will allow recovery of initial investment within six months. “Progressively, we will directly target stroke survivors through wholesale distribution and tele-rehabilitative specialists,” he says.

On the kind of training required to handle the device, Prof. Kapila explains that “the training will focus on fixing technical problems, interpreting data and suggesting new training protocols”.

The future of the research-programme according to Dr. Raghavan lies in providing customised therapy to all those who suffer from paralysis caused by traumatic brain injury. The therapy could also be used to engage children with cerebral palsy, epileptic patients and those with brain tumours, she says.

sujatha.r@thehindu.co.in

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