Background and purposeStroke rehabilitation does not often integrate both sensory and motor recovery. While subthreshold noise was shown to enhance sensory signal detection at the site of noise application, having a noise-generating device at the fingertip to enhance fingertip sensation and potentially enhance dexterity for stroke survivors is impractical, since the device would interfere with object manipulation. This study determined if remote application of subthreshold vibrotactile noise (away from the fingertips) improves fingertip tactile sensation with potential to enhance dexterity for stroke survivors.MethodsIndex finger and thumb pad sensation was measured for ten stroke survivors with fingertip sensory deficit using the Semmes-Weinstein Monofilament and Two-Point Discrimination Tests. Sensation scores were measured with noise applied at one of three intensities (40%, 60%, 80% of the sensory threshold) to one of four locations of the paretic upper extremity (dorsal hand proximal to the index finger knuckle, dorsal hand proximal to the thumb knuckle, dorsal wrist, volar wrist) in a random order, as well as without noise at beginning (Pre) and end (Post) of the testing session.ResultsVibrotactile noise of all intensities and locations instantaneously and significantly improved Monofilament scores of the index fingertip and thumb tip (p < .01). No significant effect of the noise was seen for the Two-Point Discrimination Test scores.ConclusionsRemote application of subthreshold (imperceptible) vibrotactile noise at the wrist and dorsal hand instantaneously improved stroke survivors’ light touch sensation, independent of noise location and intensity. Vibrotactile noise at the wrist and dorsal hand may have enhanced the fingertips’ light touch sensation via stochastic resonance and interneuronal connections. While long-term benefits of noise in stroke patients warrants further investigation, this result demonstrates potential that a wearable device applying vibrotactile noise at the wrist could enhance sensation and grip ability without interfering with object manipulation in everyday tasks.

Stroke survivors' difficulty in releasing grasped objects may be attributable not only to impaired finger extension but also to delays in terminating activity in the gripping flexor muscles. This study was undertaken 1) to quantify the time needed to initiate and terminate grip muscular activity following stroke and 2) to examine effects of arm support, grip location, and active muscle stretch on the delays recorded in the paretic hand. Delays in initiation and termination of finger flexor muscle activity in response to an auditory stimulus were measured for both paretic and nonparetic hands of ten stroke survivors with chronic hemiparesis and the dominant hand of five neurologically intact subjects. Additionally, the delays for the paretic hand were recorded while an external arm support was used and after 30 min of active muscle stretch. We found that delays in grip initiation and termination were greatest for the paretic hand (1.9 and 5.0 s), followed by the nonparetic hand (0.5 and 1.6 s), and least for the control hand (0.2 and 0.4 s). Arm support reduced delay in grip termination 37% for the paretic hand. Repeated active muscle stretch resulted in 24% reduced delay in grip initiation and 32% increased delay in grip termination for the paretic hand. Therapies and interventions reducing these delays may improve the ability to grasp and release objects and thus increase functional independence for stroke survivors.

The quantitative relationships described in this paper can be used in the design of objects and hand tools to determine optimal handle sizes for maximizing grip force, total normal force, or contact area.

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This study examined grip force development in individuals with hemiparesis following unilateral stroke. Eleven patients with chronic stroke with severe hand impairment and five age-matched neurologically intact subjects grasped an instrumented object between the index finger and thumb while fingertip forces, digit posture, and muscle electromyographic activity were recorded. We tested a range of different grip conditions with varying grip sizes, object stability, and grip force level. We found that fingertip force direction in the paretic digits deviated from the direction normal to the grip surface by more than twice as much as for asymptomatic digits. Additionally, the paretic thumb had, on average, 18% greater deviation of grip force direction than the paretic index finger. This large deviation of finger force direction for the paretic digits was consistently observed regardless of grip size, grip force level, and object stability. Due to the large deviation of the force direction from the normal direction, the paretic digits slipped and moved more than 1 cm during 55% of all grasping trials. A regression analysis suggests that this altered grip force direction was associated with altered hand muscle activation patterns, but not with the posture at which the digit made contact with the object. Therapies to redirect the force direction at the digits may improve stroke survivors' ability to stably grip an object.