A Wearable Sensing System for Continuous Assessment of Outcomes of Orthotic Hand Users in Real-World Settings

In the United States, about 16,000 Service Members and Veterans each year suffer a cerebral stroke. Since 9/11, 18,000-25,000 Service Members each year suffer a traumatic brain injury (TBI), and 11% of them are moderate or severe TBI. Following a brain injury, approximately 66% of them show impaired hand functions, and the recovery of hand function is most challenging among different functions, despite extensive therapy. As a result, independent living and return to Service duty or to the workforce is severely limited. Different hand orthoses are commercially available, which can improve the efficacy of rehabilitation, facilitate active involvement of patients, and assist users completing daily tasks. However, we currently lack a continuous monitoring of hand usage during daily activities when orthotic hand users return to their home environment. A lack of such critical information in the real world could prevent clinicians from making decisions regarding the type of the orthosis prescription and the timing of subsequent adjustment, therefore reducing the efficacy of orthoses functions. Accordingly, our objective is to establish integrated real-time outcome measures for stroke and TBI patients with hand impairment based on continuous monitoring of hand utility in daily life.

In a 4-year period, we will first validate our continuous measurement of hand functions using existing standardized clinical outcome assessments (2.5 years). Concurrently, we will optimize our wearable sensor sleeve system that can be used for continuous tracking of daily use of the hand. In the remaining 1.5 years, we will establish an assessment toolkit integrating continuous hand tracking with standard clinical assessments and user feedback. The integrated outcomes will capture different aspects of hand performance and the most severe aspect of motor deficit that should be targeted.

The clinical applicability of our proposed work is high. The optimized sensing system, with highly stretchable sensors and textile sleeve, low profile electronics, and cloud computing, will have minimal interference to users using daily activities, and thus presents a low barrier for clinical adoption. The integrated outcome measures will capture critical aspects of hand performance including mechanisms of impairments. These outcome measures will be highly informative and intuitive to both patients and clinicians.

Our proposed work has several impacts. Our proposed research will provide high-quality continuous data for hand outcome evaluations. A continuous assessment of the hand functions in daily life can maximize the clinical efficacy of orthoses functions with more personalized orthoses prescription and more timely adjustment of the orthoses functions. Without the need of dedicated assessment time and effort, the continuous outcome assessment during daily activities can transform the current standard of care to restore hand functions in Service Members and Veterans with brain injuries. By continuously quantifying hand functions in real-world settings, our findings can facilitate development of adaptive and personalized orthoses, promote and improve the quality of telerehabilitation, and provide guidance for policymaking regarding patient outcome evaluations.

Although we target stroke and TBI patients in the project as exemplar clinical conditions, the proposed sensing system and assessment toolkit are readily applicable to individuals with motor deficits in the hand, such as individuals with spinal cord injury or overuse syndrome. Both conditions are common in Service Members and Veterans. In particular, both brain and spinal cord injuries lead to similar motor deficits, and similar therapeutic and assistive strategies are adopted to address their deficits. The outcome measures established in our proposed work can provide continuous evaluation of outcomes of these patient populations. Overuse syndrome due to military training, exercise, sustained hand use in compact situation are common in military Service Members. Hand overuse is also common in Veterans who use manual wheelchairs. Our proposed sensing sleeve system can help detect early signs of overuse, which can then be used to establish preventive or therapeutic strategies to reduce the adverse impact of overuse.