National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, HP21 8AL, UK.
Bucks Healthcare Plastics, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, HP21 8AL, UK.
J Neuroeng Rehabil. 2020 Mar 5;17(1):40. doi: 10.1186/s12984-020-00660-y.
Loss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation. Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual's capability to perform essential activities of daily living (ADL).
This pilot study investigated the therapeutic effect of a self-administered home-based hand rehabilitation programme for people with cervical SCI using the soft extra muscle (SEM) Glove by Bioservo Technologies AB.
Fifteen participants with chronic cervical motor incomplete (AIS C and D) SCI were recruited and provided with the glove device to use at home to complete a set task and perform their usual ADL for a minimum of 4 h a day for 12 weeks. Assessment was made at Week 0 (Initial), 6, 12 and 18 (6-week follow-up). The primary outcome measure was the Toronto Rehabilitation Institute hand function test (TRI-HFT), with secondary outcome measures including pinch dynamometry and the modified Ashworth scale.
The TRI-HFT demonstrated improvement in hand function at Week 6 of the therapy including improvement in object manipulation (58.3 ±3.2 to 66.9 ±1.8, p ≈ 0.01), and palmar grasp assessed as the length of the wooden bar that can be held using a pronated palmar grip (29.1 ±6.0 cm to 45.8 ±6.8 cm, p <0.01). A significant improvement in pinch strength, with reduced thumb muscle hypertonia was also detected. Improvements in function were present during the Week 12 assessment and also during the follow-up.
Self-administered rehabilitation using the SEM Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home. Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to improve long-term neuromuscular activity. Future studies should characterise the neuromuscular mechanism of action and the minimal rehabilitation programme necessary with the assistive device to improve ADL tasks following chronic cervical SCI.
Trial registration: ISRCTN, ISRCTN98677526, Registered 01/June/2017 - Retrospectively registered, http://www.isrctn.com/ISRCTN98677526.
高位脊髓损伤（SCI）后手部功能丧失被认为是康复的重点领域。出院后，对于居住在慢性 SCI 患者家中的专业护理中心来说，提供持续的治疗往往不切实际，这会导致手部功能进一步恶化，并直接影响个人进行日常基本活动（ADL）的能力。
本研究旨在使用 Bioservo 技术公司的软外肌（SEM）手套，调查一种针对慢性颈段 SCI 患者的自我管理家庭手部康复方案的治疗效果。
招募了 15 名慢性颈段运动不完全性 SCI（AIS C 和 D）患者，为其提供手套设备，以便在家中完成设定任务并进行日常 ADL，每天至少 4 小时，持续 12 周。在第 0 周（初始）、第 6 周、第 12 周和第 18 周（6 周随访）进行评估。主要结局测量指标是多伦多康复研究所手部功能测试（TRI-HFT），次要结局测量指标包括捏力测试和改良 Ashworth 量表。
治疗 6 周后，TRI-HFT 显示手部功能有所改善，包括物体操作能力提高（58.3 ±3.2 至 66.9 ±1.8，p ≈ 0.01），以及用手掌掌侧抓握可握住的木制棒的长度增加（29.1 ±6.0 cm 至 45.8 ±6.8 cm，p <0.01）。拇指肌肉张力过高的捏力也显著增强。第 12 周和随访时仍存在功能改善。
在家中使用 SEM 手套进行自我管理康复治疗，可有效改善和维持慢性脊髓损伤患者的手部粗大运动和精细运动功能。手部功能的改善得以维持，提示在特定个体中进行强化基于活动的康复方案足以改善长期神经肌肉活动。未来的研究应描述神经肌肉作用机制和使用辅助设备改善慢性颈段 SCI 后 ADL 任务所需的最小康复方案。
试验注册：ISRCTN，ISRCTN98677526，注册日期：2017 年 6 月 1 日-回顾性注册，http://www.isrctn.com/ISRCTN98677526。
