Original research| Volume 98, ISSUE 9, P1821-1827, September 2017

Download started.


Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke

Published:January 24, 2017DOI:



      To determine the immediate effect of a portable, myoelectric elbow-wrist-hand orthosis on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors.


      Observational cohort study.


      Outpatient rehabilitation clinic.


      Participants exhibiting chronic, moderate, stable, poststroke, UE hemiparesis (N=18).


      Subjects were administered a battery of measures testing UE impairment and function. They then donned a fabricated myoelectric elbow-wrist-hand orthosis and were again tested on the same battery of measures while wearing the device.

      Main Outcome Measures

      The primary outcome measure was the UE Section of the Fugl-Meyer Scale. Subjects were also administered a battery of functional tasks and the Box and Block (BB) test.


      Subjects exhibited significantly reduced UE impairment while wearing the myoelectric elbow-wrist-hand orthosis (FM: t17=8.56, P<.0001) and increased quality in performing all functional tasks while wearing the myoelectric elbow-wrist-hand orthosis, with 3 subtasks showing significant increases (feeding [grasp]: z=2.251, P=.024; feeding [elbow]: z=2.966, P=.003; drinking [grasp]: z=3.187, P=.001). Additionally, subjects showed significant decreases in time taken to grasp a cup (z=1.286, P=.016) and increased gross manual dexterity while wearing a myoelectric elbow-wrist-hand orthosis (BB test: z=3.42, P<.001).


      Results suggest that UE impairment, as measured by the Fugl-Meyer Scale, is significantly reduced when donning a myoelectric elbow-wrist-hand orthosis, and these changes exceeded the Fugl-Meyer Scale's clinically important difference threshold. Further, utilization of a myoelectric elbow-wrist-hand orthosis significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects' ability to perform multijoint functional movements and attain consistent functional changes.


      List of abbreviations:

      BB (Box and Block), RTP (repetitive task-specific practice), UE (upper extremity)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Broeks J.G.
        • Lankhorst G.J.
        • Rumping K.
        • Prevo A.J.
        The long-term outcome of arm function after stroke: results of a follow-up study.
        Disabil Rehabil. 1999; 21: 357-364
        • Mayo N.
        Activity, participation, and quality of life 6 months poststroke.
        Arch Phys Med Rehabil. 2002; 83: 1035-1042
        • Wolf S.L.
        • Binder-MacLeod S.A.
        Electromyographic biofeedback applications to the hemiplegic patient: changes in upper extremity neuromuscular and functional status.
        Phys Ther. 1983; 63: 1393-1403
        • Wolf S.L.
        • Winstein C.J.
        • Miller J.P.
        • et al.
        Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.
        JAMA. 2006; 296: 2095-2104
        • Page S.J.
        • Levine P.
        • Leonard A.
        Mental practice in chronic stroke: results of a randomized, placebo controlled trial.
        Stroke. 2007; 38: 1293-1297
        • Page S.J.
        • Boe S.
        • Levine P.
        What are the “ingredients” of modified constraint-induced therapy? An evidence based review, recipe, and recommendations.
        Restor Neurol Neurosci. 2013; 31: 299-309
        • Heller A.
        • Wade D.T.
        • Wood V.A.
        • Sunderland A.
        • Hewer R.L.
        • Ward E.
        Arm function after stroke: measurement and recovery over the first three months.
        J Neurol Neurosurg Psychiatry. 1987; 50: 714-719
        • Hendricks H.T.
        • van Limbeek J.
        • Geurts A.C.
        • Zwarts M.J.
        Motor recovery after stroke: a systematic review of the literature.
        Arch Phys Med Rehabil. 2002; 83: 1629-1637
        • Reinkensmeyer D.J.
        • Kahn L.E.
        • Averbuch M.
        • McKenna-Cole A.
        • Schmit B.D.
        • Rymer W.Z.
        Understanding and treating arm movement impairment after chronic brain injury: progress with the ARM guide.
        J Rehabil Res Dev. 2000; 27: 653-662
        • Richards L.G.
        • Senesac C.R.
        • Davis S.B.
        • Woodbury M.L.
        • Nadeau S.E.
        Bilateral arm training with rhythmic auditory cueing in chronic stroke: not always efficacious.
        Neurorehabil Neural Repair. 2008; 22: 180-184
        • Volpe B.T.
        • Lynch D.
        • Rykman-Berland A.
        • et al.
        Intensive sensorimotor arm training mediated by therapist or robot improves hemiparesis in patients with chronic stroke.
        Neurorehabil Neural Repair. 2008; 22: 305-310
        • McLean L.
        • Scott R.N.
        The early history of myoelectric control of prosthetic limbs (1945 – 1970).
        in: Muzumdar A. Powered upper limb prostheses. Springer-Verlag, Berlin2004: 1-2
        • Page S.J.
        • Hill V.
        • White S.
        Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial.
        Clin Rehabil. 2013; 27: 494-503
        • Kim G.
        • Rivera J.
        • Stein J.
        Combined clinic-home approach for upper limb robotic therapy after stroke: a pilot study.
        Arch Phys Med Rehabil. 2015; 96: 2243-2248
        • World Health Organization
        How to use the ICF: a practical manual for using the International Classification of Functioning, Disability and Health (ICF). Exposure draft for comment.
        WHO, Geneva2013
        • Page S.J.
        • Levin L.
        • Hermann V.
        • Dunning K.
        • Levine P.
        Longer versus shorter daily durations of electrical stimulation during task specific practice in moderately impaired stroke.
        Arch Phys Med Rehabil. 2012; 93: 200-206
        • Persch A.
        • Page S.J.
        • Murray C.
        Paretic upper extremity movement gains are retained 3 months after training with an electrical stimulation neuroprosthesis.
        Arch Phys Med Rehabil. 2012; 93: 2122-2125
        • Duncan P.W.
        • Propst M.
        • Nelson S.G.
        Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident.
        Phys Ther. 1983; 63: 1606-1610
        • DiFabio R.P.
        • Badke R.B.
        Relationship of sensory organization to balance function in patients with hemiplegia.
        Phys Ther. 1990; 70: 542-548
        • Desrosiers J.
        • Bravo G.
        • Hébert R.
        • Dutil E.
        • Mercier L.
        Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies.
        Arch Phys Med Rehabil. 1994; 75: 751-755
        • Chen H.M.
        • Chen C.C.
        • Hsueh I.P.
        • Huang S.L.
        • Hsieh C.L.
        Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke.
        Neurorehabil Neural Repair. 2009; 23: 435-440
        • Page S.J.
        • Hade E.M.
        • Persch A.C.
        Psychometrics of the wrist stability and hand mobility subscales of the Fugl-Meyer Assessment in moderately impaired stroke.
        Phys Ther. 2014; 95: 103-108
        • Zumbo B.D.
        • Gadermann A.M.
        • Zeisser C.
        Ordinal versions of coefficients alpha and theta for Likert rating scales.
        J Mod App Stat. 2007; 6: 21-29
        • Gugiu C.
        • Coryn C.L.
        • Applegate B.
        Structure and measurement properties of the Patient Assessment of Chronic Illness Care instrument.
        J Eval Clin Pract. 2010; 16: 509-516
        • Page S.J.
        • Fulk G.
        • Boyne P.
        Clinically important differences for the upper extremity Fugl-Meyer in minimally to moderately impaired, chronic stroke.
        Phys Ther. 2012; 92: 791-798
        • Sheffer L.R.
        • Bailey S.N.
        • Wilson R.D.
        • Chae J.
        Spatiotemporal, kinematic, and kinetic effects of a peroneal nerve stimulator versus an ankle foot orthosis in hemiparetic gait.
        Neurorehabil Neural Repair. 2013; 27: 403-410
        • Esquenazi A.
        • Ofluoglu D.
        • Hirai B.
        • Kim S.
        The effect of an ankle-foot orthosis on temporal spatial parameters and asymmetry of gait in hemiparetic patients.
        PM R. 2009; 1: 1014-1018