Grant: Operating Grant

Electrical stimulators are sometimes used in clinics to improve hand function for a short time after stroke, but they are too cumbersome to be used in daily life. We have developed a device that can be used on a permanent basis, called the HandStim. It consists of a wristlet with an in-built stimulator that is controlled by tooth-clicks detected by a sensor similar to a blue-tooth earpiece. Participants will be randomized into three groups. The control group will be provided with conventional exercise equipment with which they will be trained to do exercises at home for 1 hour/day for the first 6 weeks. They will be encouraged to use their more affected hand in daily life during this time and for the remaining 20 weeks. The second group will receive HandStims and the same exercise regime for the first 6 weeks, followed by 20 weeks of self-directed HandStim usage in daily life. The third group will receive HandStims and a ReJoyce system, on which they will perform exercises 1 hour/day for 6 weeks, two sessions per week being tele-supervised. They will also be encouraged to use their HandStims in daily life for the remaining 20 weeks. The exercises in all three groups will involve shoulder, elbow and wrist movements as well as grasp-release and dexterous manipulation. The first two groups will be contacted by phone twice a week for 6 weeks and all three groups fortnightly for the remaining 20 weeks, to monitor compliance and compile motor activity logs. In the FES groups, usage (number and duration of grasp-release cycles) will be captured by counters in the stimulators and downloaded when the participants return to the laboratory for assessments. This will provide data for health-care providers on the likely usage of the HandStim by stroke survivors. The premise of this study is that the HandStim/ReJoyce combination will become a model for the future of upper extremity rehabilitation after stroke and spinal cord injury.