Study of multi-sensory stimulation for the design of hand rehabilitation equipment for stroke patients

1. 日經管碩一甲
Cai-xuan Pan 潘采萱
M1231011
Study of multi-sensory stimulation for
the design of hand rehabilitation
equipment for stroke patients
Yu-Hsiu Hung, Hsueh-Yi Lai & Chien-Hung Shih
1

2. 01
Introduction
2

3. Introduction
• Chronic diseases impact the ability of people to live.
• Stroke (中風) often causes chronic disability.
• Stroke Rehabilitation Methods: Multisensory Stimulation
Therapy (多感官刺激治療)
Recent studies have indicated a strong relationship between sensory
and motion in stroke rehabilitation, showing that adding sensory
stimulation could enhance both sensory and motor abilities, as well as
daily life ability.
• Purpose：compare the efficacy of current rehabilitation
approaches and techniques along with differing hand
gestures.
3
Hung, Y. H., Lai, H. Y., & Shih, C. H. (2015). Study of multi-sensory stimulation for the design of hand rehabilitation
equipment for stroke patients. Journal of Industrial and Production Engineering, 32(7), 425-431.

4. Stroke
• Stroke is the severe restriction or
complete cessation of blood flow
to the brain as the result of any
cerebrovascular disease or
neurological insult (brain injury)
is commonly referred to as
stroke.[1]
4
[1] Hademenos, G. J., & Massoud, T. F. (1997). Biophysical mechanisms of stroke. Stroke, 28(10), 2067-2077.
Source: Wikipedia (2023)

5. post stroke disability
Stroke often causes chronic disability
● The strong associations between neuropsychological
impairment and other functional outcomes and body
functioning, activity, and participation.[2]
● Deficits in somatic sensations (body senses such as touch,
temperature, pain and proprioception) [3]
○ numbness
○ weakness of the face or arm
● The sensory loss puts the arm at risk for injury and impacts
functional use of the arm and the survivors' level of
independence during daily activities.
5
[3]Doyle, S., Bennett, S., Fasoli, S. E., & McKenna, K. T. (2010). Interventions for sensory impairment in the upper
limb after stroke. Cochrane Database of Systematic Reviews, (6).

6. types of stroke
Two types of stroke
• ischemic stroke (缺血性中風)
• hemorrhagic stroke (出血性中風)
Identified and recognized clinically correspond to their characteristic
mechanisms of flow obstruction or neuronal damage.[2]
6
[2] Feigin, V. L., Barker-Collo, S., Parag, V., Senior, H., Lawes, C. M. M., Ratnasabapathy, Y., ... & ASTRO Study
Group. (2010). Auckland Stroke Outcomes Study: Part 1: Gender, stroke types, ethnicity, and functional outcomes 5
years poststroke. Neurology, 75(18), 1597-1607.

7. types of stroke
Two types of stroke
• ischemic stroke (缺血性中風)
• hemorrhagic stroke (出血性中風)
Identified and recognized clinically correspond to their characteristic
mechanisms of flow obstruction or neuronal damage.[2]
7
[2] Feigin, V. L., Barker-Collo, S., Parag, V., Senior, H., Lawes, C. M. M., Ratnasabapathy, Y., ... & ASTRO Study
Group. (2010). Auckland Stroke Outcomes Study: Part 1: Gender, stroke types, ethnicity, and functional outcomes 5
years poststroke. Neurology, 75(18), 1597-1607.
Source: Healthline (2023)

8. stroke rehabilitation
Common stroke rehabilitation[4]：
• physical therapy
• occupational therapy
• speech therapy
• stroke rehabilitation has been on treating physical and
functional impairments.
• through upper/lower limb strengthening exercises
e.g., passive range of motion technique, resistance
training, and active assistive range of motion technique.
8
[4] Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702.

9. stroke rehabilitation
through upper/lower limb strengthening exercises.
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[4] Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702.
Source: UCLH (2017)

10. 02
Literature review
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11. Recovery of motor function through
sensorimotor rehabilitation
Past Research:
Emphasized physical strengthening exercises, but modern
studies highlight the importance of sensory motor
rehabilitation.
• The hand rehabilitation techniques for stroke patients emphasize
physical strengthening exercises.
• Recent research demonstrated that sensory re-education and
sensorimotor rehabilitation enhances a patient’s ability to localize a
touch stimulus.
Sensory Re-education and Sensorimotor Rehabilitation :
• sensory exercises induce neuroplasticity in the brain, thus enabling
hand function recovery.
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12. Sensorimotor rehabilitation(1)
Sensorimotor rehabilitation approaches:
• top-down
• bottom-up
12
[5] Qi, F., Nitsche, M. A., Ren, X., Wang, D., & Wang, L. (2023). Top-down and bottom-up stimulation techniques
combined with action observation treatment in stroke rehabilitation: a perspective. Frontiers in Neurology, 14.

13. Sensorimotor rehabilitation(2)
Comparison of sensorimotor rehabilitation approaches
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Top-down Bottom-Up
Definition Stimulating at the cognitive level
(visual and auditory areas) to influence
the central neural system, without
directly targeting the physical level.
Initiating changes at the central neural
system level (brain's sensory receptive
areas) through exercises and
stimulation at the distal physical level
(limbs).
Techniques 1. mirror therapy
2. noise stimulation
1. electrical stimulation
2. vibration stimulation
3. thermal stimulation (熱刺激)
4. tactile stimulation (觸覺刺激)
Objective Impact the central neural system
through visual and auditory cues
without direct physical manipulation.
Improve tactile function, thereby
affecting the central neural system.

14. Sensorimotor rehabilitation(3)
Top-down：mirror therapy
14
Source: strokeot (2023)

15. Research purposes
The aims of this study were the following:
1. to explore the differences in the efficacy of differing
rehabilitation approaches and techniques along with
commonly used hand gestures and
2. to propose rehabilitation equipment based on multi-sensory
therapy.
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16. 03
Method
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17. Research material
Research object
• Seventeen professional occupational therapists from the
rehabilitation departments of three general hospitals were
recruited.
• Each therapist had a minimum of five years of working
experience.
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18. Research design
Independent Variables:
• Hand Gestures: Seven commonly used hand gestures in
rehabilitation, including tip pinch, lateral pinch, lateral pinch and
rotation, palmar pinch, palmar pinch and rotation, cylindrical
grasp, and spherical grasp.
• Rehabilitation Approaches: Both top-down and bottom-up
methods.
• Rehabilitation Techniques: Including mirror therapy, auditory
stimulation, tactile stimulation, thermal stimulation, electrical
stimulation, and vibration stimulation.
Dependent Variable:
Effectiveness of Hand Rehabilitation: Measuring the improvement in
sensorimotor ability.
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19. Method
Participant Evaluation:
• Participants: Patients at Brunnstrom stages 4-5.
• Assessment Tool: Utilized a Likert scale (from 1 to 5, with 1
indicating least effectiveness and 5 indicating most
effectiveness).
• Assessment Process: Conducted brief interviews with
participants after the experiment to gather their ratings for
each experimental condition.
Data Analysis: Analysis Tool: Utilized SAS 9.3 with Proc GLM for
data analysis.
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20. Table 1. Within-subject partial hierarchical
design used in this study.
• A :Rehabilitation Approaches
• B :Rehabilitation Techniques
• C :Hand Gestures
• P :participants
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21. 21
treatment levels
e.g., A1B1C1, A1B1C2, A1B1C3...,
Likert scale
the effectiveness of each
experimental condition
(for patients at
*Brunnstrom stage 4–5)
randomly
professional
occupational
therapists

22. *Brunnstrom stages(1)
• Brunnstrom stages classification is one of the most common measures
of stroke patients’ rehabilitation progress and usually can only be
performed by experienced physicians.(Zhang, Z., Fang, Q., & Gu, X.
,2014)
• Brunnstrom stages are very commonly adopted clinically to classify
stroke patient’s rehabilitation progress due to its simplicity and
validity. (Celik et al., 2008, Hwang et al., 2005, Miyano, 2007,
Muslumanoglu et al., 2004, Shah et al., 1986, Yavuzer et al., 2002)
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23. *Brunnstrom stages(1)
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Source: ptjournal (2023)

24. Table 2. Descriptive statistics
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***

25. Table 3. Post hoc analysis
The average score of rehabilitation technology is higher than 3
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26. Result
• Significance:
Rehabilitation Approaches and gestures have no significant
impact on hand rehabilitation effects
• Efficiency comparison：
Vibration Stimulation > mirror therapy >
tactile stimulation = auditory stimulation = electrical
stimulation did >Thermal Stimulation
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27. Conclusion
Research Objectives：
designed multi-sensory stimulation equipment to improve the
sensorimotor ability of stroke patients.
Result：
• rehabilitation approach (top-down and bottom-up) and hand gesture
did not make a difference in terms of the effectiveness of hand
rehabilitation.
• Technique nested with Treatment Approach made a significant
difference.
• vibration stimulation (bottom-up) and mirror therapy (top-down)
were the most effective rehabilitation techniques
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28. Discussion(1)
rehabilitation techniques：
• the six rehabilitation techniques do not work the same way in
inducing sensorimotor ability.
• vibration provides stimulations on both the cutaneous sense and
kinesthesis, particularly on the pacinian corpuscles (FA II) located
deep in the dermis.
• Thermal stimulation and tactile stimulation can only influence the
tactile somatosensory system.
• the patients sometimes felt uncomfortable with differing levels of
electrical currents.
from the perspective of the bottom-up rehabilitation approach,
vibration stimulation is an intervention technique to be used more
often in stroke rehabilitation.
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29. Discussion(2)
mirror therapy :
• its clinical efficacy in enhancing motor capacity.
auditory stimulation
• needs more studies providing clinical evidence on its efficacy.
• Some participants said that auditory stimulation might introduce
unwanted sound/noises in the rehabilitation center/room, which
would cause complaints from other patients.
mirror therapy could be an effective top-down rehabilitation
technique to improve the sensorimotor ability and motor function
of the patients.
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30. Research limited
limited：
• the expertise and the number of professional occupational
therapists recruited.
• The results require inputs from clinical trials to validate the
findings.
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31. Recommendation(1)
developed conceptual equipment for hand rehabilitation
• combination of various forms of sensory stimulation
(top-down and bottom-up)
• targeting those whose motor recovery stage is
at Brunnstrom stage 4–5.
• a patient follow a repeated voice instruction to hold, grab,
and put down the cup with both hands simultaneously and
repeatedly.
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32. Recommendation(2)
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vibration
stimulation
mirror therapy
add visual stimulation

33. Thank you
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