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Improving Hand Function Through the Use of the FES Hand Glove 200
Yasmin Gonzalez, OTR/L, ABDA, CLT, Lisa Gould, MD, PhD, John Merritt, MD, Wanda VanHarlinger, OTR/L, ABDA, CLT, Kevin White, MD, Jill Massengale, MS, ARNP-C and Steven Scott, DO
Spinal Cord Injury, James A Haley Veterans Hospital, Tampa, FL
Capitalizing upon technologic advances used in the movie Jurassic Park, the FES Hand Glove 200 system (Integrated Technology LLC) is a prototypic device that incorporates both active Functional Electrical Stimulation and passive robotic bio-mechanic movement. This combination is the first of its kind in hand and upper extremity rehabilitation. Unique to this device is the inclusion of the thumb in passive and active range of motion and the functional biomechanical robotic passive motor support that allows the user to complete a full length therapy session in spite of early muscle exhaustion. This may provide more rapid gain in strength and functional muscle mass. In this study we evaluate the safety and impact on hand function of the FES Hand Glove 200 for patients with tetraplegia.
Methods: Veteran or active duty personnel, age 18-85, with spinal cord injury C4-6 of at least 1 month duration and documented impairment of the upper extremity were solicited for the study. Upon successful screening, subjects underwent an initial assessment with fitting of the Hand Glove on the extremity to be treated. The treatment protocol included a 1 hour therapy session consisting of 30 minutes of passive range of motion followed by 30 minutes of functional electrical stimulation for a total of 24 sessions over 6 weeks. Final evaluation and discharge included re-assessment and questionnaires. Measured outcomes included passive and active range of motion; wrist, hand and digit circumference; pain; skin integrity; hand and pinch strength; manual muscle test, Jebson-Taylor, 9-Hole Peg test, Box and Block test, DASH, and FIM.
Results: 14 patients, C4-6, between the ages of 22 and 66 were enrolled. 3 of 14 subjects did not complete the 6 week trial due to medical co-morbidities. Active flexion and extension was improved in the majority of patients in all digits treated. 3 of the 4 patients with upper extremity pain reported improvement. Skin integrity improved in 6 of 11 and edema improved in most digits. The Manual Motor Test improved 1-3 points, especially in the thumb. Jebson-Taylor test improved in 8 of 11. DASH was improved in 10 of 11 (range 1.8-21.7%) and FIM scores improved in 7 of 11.
Conclusion: The FES Hand Glove 200 is safe for use in tetraplegic patients with impaired hand function. Our data suggest that the device objectively improves hand function, particularly fine motor skills, dexterity and speed, resulting in improved quality of life for patients with tetraplegia.
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