Compliance to strict home exercise programs is understood to be a mainstay of post-surgical flexor tendon rehabilitation. Therapists recognise the potential of poor compliance (overuse or under-use of prescribed exercise) and spontaneous movements during rehabilitation. Some therapists may suggest that compliance to specific exercise regimens and control of spontaneous or general movements are fundamentally important in optimising the rehabilitation outcomes and minimising the potential of adverse events. Yet there is little objective data to document the actual levels of exercise or spontaneous finger movement performed outside the clinical setting. The purpose of this study was to document both diary and instrumented methods of reporting finger movement during a 48hr period. Following surgical repair of the flexor tendon, subjects attending a private hand therapy clinic provided consent and reported subjective diary (n=16) data of sets and repetitions of exercise for up to 6 weeks post-operatively. Nine subjects also had instrumented data logged on 3 occasions during the first 6 weeks of rehabilitation and were not fully aware of the purpose of the instrumentation. All subjects were instructed to perform 10 passive followed by 10 active exercises every waking hour, for the first 6 weeks and were assessed on range of motion, DASH, pain and strength. Results demonstrated that patients reported, via their diaries, that they are on average 80% compliant. Parallel data logger information suggests that this figure is more likely to reflect 50% compliance. A significant (p< .05) increase in spontaneous movements in the last 2 weeks of the 6 week assessment period was detected. No significant correlation between patient's level of compliance or spontaneous movement and their outcome were detected.

No description available.

No description available.

Doctor of Philosophy (PhD) / With improvements in actuation technology and sensory systems, it is becoming increasingly feasible to create powered exoskeletal garments that can assist with the movement of human limbs. This class of robotics referred to as human-machine interfaces will one day be used for the rehabilitation of paralysed, damaged or weak upper and lower extremities. The focus of this project was the development of an exoskeletal interface for the rehabilitation of the hands. A novel sensor was designed for use in such a device. The sensor uses simple optical mechanisms centred on a spring to measure force and position simultaneously. In addition, the sensor introduces an elastic element between the actuator and its corresponding hand joint. This will allow series elastic actuation (SEA) to improve control and safely of the system. The Hand Rehabilitation Device requires multiple actuators. To stay within volume and weight constraints, it is therefore imperative to reduce the size, mass and efficiency of each actuator without losing power. A method was devised that allows small efficient actuating subunits to work together and produce a combined collective output. This work summation method was successfully implemented with Shape Memory Alloy (SMA) based actuators. The actuation, sensory, control system and human-machine interface concepts proposed were evaluated together using a single-joint electromechanical harness. This experimental setup was used with volunteer subjects to assess the potentials of a full-hand device to be used for therapy, assessment and function of the hand. The Rehabilitation Glove aims to bring significant new benefits for improving hand function, an important aspect of human independence. Furthermore, the developments in this project may one day be used for other parts of the body helping bring human-machine interface technology into the fields of rehabilitation and therapy.

Doctor of Philosophy (PhD) / With improvements in actuation technology and sensory systems, it is becoming increasingly feasible to create powered exoskeletal garments that can assist with the movement of human limbs. This class of robotics referred to as human-machine interfaces will one day be used for the rehabilitation of paralysed, damaged or weak upper and lower extremities. The focus of this project was the development of an exoskeletal interface for the rehabilitation of the hands. A novel sensor was designed for use in such a device. The sensor uses simple optical mechanisms centred on a spring to measure force and position simultaneously. In addition, the sensor introduces an elastic element between the actuator and its corresponding hand joint. This will allow series elastic actuation (SEA) to improve control and safely of the system. The Hand Rehabilitation Device requires multiple actuators. To stay within volume and weight constraints, it is therefore imperative to reduce the size, mass and efficiency of each actuator without losing power. A method was devised that allows small efficient actuating subunits to work together and produce a combined collective output. This work summation method was successfully implemented with Shape Memory Alloy (SMA) based actuators. The actuation, sensory, control system and human-machine interface concepts proposed were evaluated together using a single-joint electromechanical harness. This experimental setup was used with volunteer subjects to assess the potentials of a full-hand device to be used for therapy, assessment and function of the hand. The Rehabilitation Glove aims to bring significant new benefits for improving hand function, an important aspect of human independence. Furthermore, the developments in this project may one day be used for other parts of the body helping bring human-machine interface technology into the fields of rehabilitation and therapy.

Problématique : Les lésions nerveuses périphériques peuvent entraîner une allodynie mécanique (AM) qui est une douleur neuropathique provoquée par le toucher. L’AM peut limiter les activités et les habitudes de vie des patients. Les approches de stimulation tactiles sont des interventions prometteuses pour traiter l’AM. Cependant, aucune étude n’a encore investigué l’intégration d’une telle approche dans un programme de réadaptation multimodal. De plus, il n’existe aucune synthèse des connaissances sur ces approches pour le traitement de l’AM. Objectifs : 1- Décrire l’intégration d’une approche de stimulation tactile dans un programme de réadaptation multimodal; 2- Recenser les approches de stimulation tactiles et évaluer les évidences de ces approches pour traiter l’AM à la main suite à une lésion nerveuse périphérique. Méthodologie : 1- Étude de cas. 2- Recension systématique sur les approches de stimulation tactile. Résultats : L’étude de cas montre une diminution de l’AM et une amélioration des incapacités chez un patient présentant un syndrome de douleur régionale complexe qui a participé à un programme de réadaptation multimodal intégrant une approche de stimulation tactile. La recension systématique montre qu’il existe deux approches de stimulation tactiles (la désensibilisation et la rééducation sensitive de la douleur) pour traiter l’AM à la main. Ces approches ne se distinguent pas quant au niveau d’évidence de leur efficacité pour traiter l’AM suite à une lésion nerveuse périphérique. Conclusion : Les deux approches peuvent être utilisées par les cliniciens pour traiter l’AM en fonction de leur raisonnement clinique et des caractéristiques des patients. / Context: Peripheral nerve lesions can lead to mechanical allodynia (MA), that is a neuropathic pain provoked by touch. MA can limit patients’ activities and life habits. Tactile stimulations are promising approaches to treat MA. However, to our knowledge, there is no study that has investigated how such approaches can be integrated into a multimodal rehabilitation program. In addition, there is no synthesis of current knowledge on the tactile stimulation approaches for treating MA. Objectives: 1- To describe the integration of a tactile stimulation approach in a multimodal rehabilitation program; 2- To identify existing tactile stimulation approaches and to assess evidences of the use of these approaches to MA in the hand following a peripheral nerve lesion. Method: 1- Case report. 2- Systematic review on tactile stimulation approaches. Results: The case report shows an abolition of MA and an improvement of incapacities in a patient with a complex regional pain syndrome who participated in a multimodal rehabilitation program including a tactile stimulation approach. The systematic review identified two tactile stimulation approaches (desensitization and somatosensory rehabilitation of pain). Those approaches do not differ in their level of evidence in the treatment of MA following a peripheral nerve lesion. Conclusion: The two approaches can be used by clinicians to treat MA. The choice of these approaches should be based on clinical reasoning and patients’ characteristics.