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Improving Hand Function After SCI: Using Science, Technology, & Patient Engagement

By: Kristina Kiner OTR/L CLT

Virtual Hand to Shoulder Fellow '22


I have been an Occupational Therapist for almost 11 years and have worked in various settings from skilled nursing facilities to inpatient rehab, and now outpatient rehab for upper limb and hand rehabilitation. I am the youngest, with 2 older brothers also in the medical field. The oldest a registered nurse, and the middle a physical therapist. Yet at times it seemed my family didn’t fully understand the importance and value of occupational therapy. Unfortunately, it took a serious accident and injury to a family member for them to realize and fully appreciate the scope and impact occupational therapy can have on recovery and quality of life.


In October 2022, my uncle suffered a spinal cord injury (SCI) after falling off a ladder. He fractured his C5 and C6 vertebrae and could not move his arms or legs after the fall. He underwent an anterior cervical discectomy with fusion (ACDF). We were all scared and concerned about what the outcome would be. His surgeon believed he could make a good recovery with a lot of hard work in rehabilitation. Throughout his rehabilitation journey, my uncle would often ask, “How do I get my hands working again?” and “Why can’t I feed myself or brush my teeth? My hands aren’t listening to my brain, what can I do?”


Over the past 4 months, along with his rehabilitation team, I have assisted my uncle and family in education to adaptive equipment and exercises. Between adaptive devices for eating such as lip plates/guards, built-up utensils, rocker knives, and a universal cuff for utensils or other tools, I had taken a vital role in increasing his independence with self-care tasks. I also educated him to gross motor and fine motor exercises. I even created a fine motor coordination “toolbox” for him to continue his therapy in his room along with the other exercises his therapists provided for him. His toolbox included - a deck of cards, pegs, and beans, coins, Thera putty, beads and string, paper clips, clothespins, dice, screws, rubber bands, tweezers, stress ball and pegs and board. I also sent him various games to play with visitors to pass the time and continue his gross and fine motor coordination training such as peg Tic Tac Toe, Connect Four, Trouble, and Yahtzee.


He has been a compliant patient with his therapist's exercises as well as the extra exercises I have provided for him. His surgeon has been amazed at how well he has progressed and encourages him to continue with everything he has been doing. Even though he has done well with the traditional fine motor coordination tools and exercises, he most recently reported he was feeling bored with it, as he has been doing them daily for 4 months. He will be discharged home soon, and I am concerned he will not perform his home exercise program religiously like he did in rehab. It isn’t uncommon for patients to lose motivation in their rehab once they are discharged from therapy. My cousin turned to me again for assistance asking what else they could do at home that would keep him challenged and motivated.



After some research, I believe I found one tool that could be the answer to our question: the Flint MusicGlove. “The MusicGlove uses an interactive and motivating medium to guide hand exercise and to quantitatively assess hand movement, such as gripping, pinch, and opposition, and overall recovery. The glove uses these movement to play different musical notes played along an interactive computer game” (Friedman et al 2014). The Flint MusicGlove not only makes therapy fun, but it has been proven to increase hand motor performance, increase motivation and increase compliance to home exercise programs than with conventional therapy and home exercise programs. (Friedman et al 2014, Friedman et al 2011, & Sanders et al 2022).


When I showed the MusicGlove to my uncle and cousin, he said “that looks like something fun and different.” As a lover of music, incorporating music into therapy would keep him entertained and focused. The traditional methods of fine motor coordination training have been very successful for him. But the MusicGlove will keep him motivated to continue with his home exercise program to progress strength, coordination, and functional use of his hands.

Hand therapy should be functional, highly repetitive, and promote afferent input to best stimulate hand motor recovery. Working in an outpatient clinic, I have encountered patients who struggle to follow their therapy guidelines and home exercise programs while in therapy or when discharged from therapy. I am not affiliated with the Flint MusicGlove, but I believe that it can be a valuable tool in a home setting for the rehabilitation of hand movement and fine motor control. The MusicGlove engages, motivates, and tracks progress for patients to become independent in simple ADL tasks that are taken for granted.


Through this lived experience of seeing occupational therapy in practice, my family now understands the importance and significance of my work and career. Occupational therapy re-teaches individuals not only how to function, and be independent, but it re-teaches individuals how to live. I am forever grateful I am in an occupation that can turn the impossible to possible.



References:

Friedman, N., Chan, V., Reinkensmeyer, A., Beroukhim, A., Zambrano, G., Backman, M., Reinkensmeyes, D., “Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training.” Journal of NeuroEngineering and Rehabilitation 2014, 11:76.


Friedman, N., Chan, V., Zondervan, D., Bachman, M., Reinkensmeyer, D. “MusicGlove: Motivating and Quantifying Hand Movement Rehabilitation by using Functional Grips to PLay Music.” 33rd Annual International Conference of the IEEE EMBS, Boston Massachuesetts, August 30- September 3, 2011.


Sanders, Q., Chan, V., Augsburger, R., Cramer, S., Reinkensmeyer, D., Sharp, K. “Feasibility of home hand rehabilitation using musicglove aer chronic spinal cord injury.” Journal of the International Spinal Cord Society 2022.


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