Biomechanical evaluation of wrist-driven flexor hinge orthosis in persons with spinal cord injury.

The wrist-driven flexor hinge orthosis (WDFHO) is a device used to restore hand function in persons with tetraplegic spinal cord injury by furnishing three-point prehension. We assessed the effectiveness and biomechanical properties of the WDFHO in 24 persons with cervical 6 or 7 tetraplegia who have severely impaired hand function. This study introduces a mechanical operating model to assess the efficiency of the WDFHO. Experimental results showed that pinch force increased significantly (p < 0.001) after using the WDFHO and was found to positively correlate with the strength of wrist extensor muscles (r = 0.41, p < 0.001). However, when the strength of the wrist extensors acting on the WDFHO was greater, the reciprocal wrist and finger motion that generates three-point prehension was less effective (r = 0.79, p < 0.001). Reliable and valid biomechanical evaluation of the WDFHO could improve our understanding of its biomechanics.

[1]  J C Pryce,et al.  The wrist position between neutral and ulnar deviation that facilitates the maximum power grip strength. , 1980, Journal of biomechanics.

[2]  V L Nickel,et al.  Carbon dioxide-powered arm and hand devices. , 1969, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[3]  T. Brown,et al.  Articulated external fixation of the ankle: minimizing motion resistance by accurate axis alignment. , 1999, Journal of biomechanics.

[4]  T J ENGEN,et al.  DEVELOPMENT OF EXTERNALLY POWERED UPPER EXTREMITY ORTHOTIC SYSTEMS. , 1965, The Journal of bone and joint surgery. British volume.

[5]  Early complications of key grip hand surgery for tetraplegia , 1981, Paraplegia.

[6]  Rogers Jc,et al.  Traumatic quadriplegia: follow-up study of self-care skills. , 1980 .

[7]  Lisa Diponio,et al.  Pinch and elbow extension restoration in people with tetraplegia: a systematic review of the literature. , 2009, The Journal of hand surgery.

[8]  H. Hislop,et al.  Daniel's and Worthingham's muscle testing : techniques of manual examination , 1995 .

[9]  Hans Richard Lehneis Application of External Power in Orthotics , 2011 .

[10]  C. Sabine,et al.  A PLASTIC TENODESIS SPLINT; PRELIMINARY EVALUATION OF A FUNCTIONAL BRACE FOR A PARALYZED HAND WITH EFFECTIVE WRIST EXTENSORS. , 1965, The Journal of bone and joint surgery. American volume.

[11]  Maurizio Ferrarin,et al.  Functional electrical stimulation reinforced tenodesis effect controlled by myoelectric activity from wrist extensors. , 2006, Journal of rehabilitation research and development.

[12]  J. Fridén,et al.  Rebalancing the tetraplegic wrist using extensor carpi ulnaris-tenodesis , 2013, The Journal of hand surgery, European volume.

[13]  I. Čižmář,et al.  Possible restorations of the upper extremity motion in tetraplegic patients - 5-year clinical experience. , 2006, Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia.

[14]  E. Delagi,et al.  Anatomical guide for the electromyographer : the limbs and trunk /by Edward F. Delagi [et al.] ; illustrated by Phyllis B. Hammond, Aldo O. Perotto, and Hugh Thomas , 2005 .

[15]  P. Nichols,et al.  The value of flexor hinge hand splints ∗ , 1978, Prosthetics and orthotics international.

[16]  Follow-up study of wrist-driven flexor-hinge-splint use. , 1971 .

[17]  Miles Harrison Anderson Upper Extremities Orthotics , 1979 .

[18]  V. L. Nickel,et al.  DEVELOPMENT OF USEFUL FUNCTION IN THE SEVERELY PARALYZED HAND. , 1963, The Journal of bone and joint surgery. American volume.

[19]  V. Dietz,et al.  Transcutaneous functional electrical stimulation for grasping in subjects with cervical spinal cord injury , 2005, Spinal Cord.

[20]  Silvestro Micera,et al.  A hybrid tool for reaching and grasping rehabilitation: The ArmeoFES , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[21]  J Stenehjem,et al.  Wrist driven flexor hinge orthosis: linkage design improvements. , 1983, Archives of physical medicine and rehabilitation.

[22]  H. V. van Hedel,et al.  Upper Extremity Function in Persons with Tetraplegia: Relationships Between Strength, Capacity, and the Spinal Cord Independence Measure , 2009, Neurorehabilitation and neural repair.

[23]  M. Braun,et al.  Occupational therapy management of the acute spinal cord-injured patient. , 1986, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[24]  R. Buschbacher Anatomical Guide for the Electromyographer: The Limbs and Trunk , 2007 .

[25]  V. Mathiowetz,et al.  Grip and pinch strength: normative data for adults. , 1985, Archives of physical medicine and rehabilitation.

[26]  A. Siebens,et al.  Results of a survey on the use of a wrist-driven splint for prehension. , 1971, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[27]  Maude H. Malick,et al.  Manual on management of the quadriplegic upper extremity : using available modular splint and arm support systems , 1978 .

[28]  Wendy M Murray,et al.  The unoperated hand: the role of passive forces in hand function after tetraplegia. , 2002, Hand clinics.

[29]  H. Seelen,et al.  Evaluation of upper extremity motor function tests in tetraplegics , 2002, Spinal Cord.

[30]  P H Peckham,et al.  A comparison between control methods for implanted FES hand-grasp systems. , 1998, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[31]  R. Brumfield,et al.  A biomechanical study of normal functional wrist motion. , 1984, Clinical orthopaedics and related research.

[32]  R. Waters,et al.  International Standards for Neurological and Functional Classification of Spinal Cord Injury , 1997, Spinal Cord.

[33]  Barber Lm,et al.  Carbon dioxide-powered arm and hand devices. , 1969 .

[34]  S Saxena,et al.  An EMG-controlled grasping system for tetraplegics. , 1995, Journal of rehabilitation research and development.

[35]  P. London Injury , 1969, Definitions.

[36]  C. Shepherd,et al.  Tenodesis brace use by persons with spinal cord injuries. , 1991, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.