Effects of Device-assisted Practice of ADL on Arm/Hand Recovery in Individuals With Moderate to Severe Stroke

Prior treatment

• Severe concurrent medical problems (e.g. cardiorespiratory impairment, uncontrolled hypertension, inflammatory joint disease)
• Chemo denervation: botulinum toxin, dysport, or Myobloc or phenol block injection to any portion of the paretic UE within the last 6 months, or phenol/alcohol injections \<12 months before participation
• Participating in any experimental rehabilitation or drug studies
• Upper extremity musculoskeletal impairment limiting function prior to stroke
• Currently using oxygen

Other illness

• Motor or sensory impairment in the non-affected limb
• History of neurologic disorder other than stroke (Parkinson's Disease, Acute Lateral Sclerosis, Multiple Sclerosis, Traumatic Brain Injury, peripheral neuropathy, Amyotrophic lateral sclerosis, spinal cord injury, Dementia)
• Any acute or chronic painful condition in the upper extremities or spine, indicated by a score ≥5 on a 10-point visual analog scale
• Using cardiac pacemaker, implanted cardioverter defibrillator, neurostimulation system inside the brain or spinal cord, bone growth box fusion stimulation
• Seizure in the last 6 months
• Severe upper extremity sensory impairment indicated by absent sensation on the tactile sensation subscale (light touch and pressure items) of the Revised Nottingham Assessment of Somato-Sensations (score\<4)

Other

• Any brainstem and/or cerebellar lesion
• Unable to passively attain 90 degrees of shoulder flexion and abduction, measured using a goniometer based on adapted methods
• Flexion contractures larger than 45 degrees in the elbow, wrist, metacarpophalangeal joints (MCP) and interphalangeal joints (IP) of thumb and index finger
• Pregnant or planning to become pregnant
• Inability to attend intervention sessions 3 times a week during 8 weeks, as well as to assessments/evaluations and follow up
• Upper limb amputation

• Age between 21-80
• Paresis confined to one side, with substantial motor impairment of the upper limb and some residual voluntary movement (Upper Extremity Fugl-Meyer Assessment score in the range of 10-40/66, Chedoke McMaster Stroke Assessment - Stage of the hand section score \<=4)
• Capacity to provide informed consent
• Ability to elevate their limb against gravity up to at least 75 degrees of shoulder flexion and to generate some active elbow extension
• Ability to open hand with a thumb-to-index finger distance ≥4 cm, with the assistance of the ReIn-Hand device with the help of a physical therapist
• MRI compatible
• Discharged from all forms of physical rehabilitation
• Intact skin on the hemiparetic arm
• Be tolerate sitting for no less than 1 hour
• Montreal Cognitive Assessment (MoCA) score \>=23