Post-stroke rehabilitation of right hand with a SaeboFlex

Background

On 16 July 2016 P had a left MCA stroke rendering her temporarily hemiplegic on her right side. Twelve weeks later her walking was greatly improved and some right arm mobility had been regained, but paresis and spasticity of the right hand remained.

A Saeboflex was indicated and was fitted on a trial basis on 5 October 2016. After the fitting, P was able to pick up a ball placed in front of her with her right hand and put it down again in the same place. All four digits flexed and extended satisfactorily. The trial ended on 31 October 2016.

The possibility that the same kind of exercises could be continued with a Saebo glove was investigated. A trial of it commenced on 216 November and ended on 29 November 2016. It was discontinued because it could not consistently overcome the finger tone for extension.

Full details of these trials, the problems, solutions and grasp/release records are given here.

The decision was eventually taken to purchase a Saeboflex and continue the therapy with it. The cost was 770 with VAT exemption for disability.

12 December 2016

Fitted at Ysbyty Alltwen (Betsi Cadwalader NHS Trust) for SaeboFlex by physiotherapist KJ.

1 February 2017

Despite prompt payment to Saebo UK on 20 December 2017 it was not until today that the Saeboflex was received by the patient. An apparently delayed email and the time it took for the unit to arrive from the USA were factors.

saebofles_bought_close.jpg (113574 bytes) saebofles_bought.jpg (90074 bytes)

The unit comes with four thumb springs and four fingers springs. They are colour coded blue, red, yellow and silver according to diminishing strength. P started with red springs on both thumb and fingers. Bead line lengths were set to: thumb 5, index 7; 3rd 11, 4th 9; and 5th 9. In each case, the next bead in sequence lodged in the retainer. In the same sequence, the digit cap sizes were F2, F2, C2, C2 & A. The large cap on the index finger was due to previous injury and resulting swelling.

This unit caused pain at a pressure point near the back of the wrist (marked with a red arrow in the image). As an interim solution a foam pad was inserted at the proximal end of the hand pad (see image above right). This discomfort was not experienced with the trial unit. The reason is that the foam of the hand pad extended well beyond its rim, thus cushioning the sharp edge of the hand pad. A wider hand pad was requested from Saebo UK and it was supplied promptly.

Another source of pain in the trial was from the hard plastic of some of the digit caps at finger DIP joints. With the current version the only painful pressure was at the thumb IP joint. This was eliminated by inserting a neoprene foam pad under the cap. It is just visible in the image above right.

The main exercise in what follows comprised standing at a table and picking up a Poof ball at one side and placing it on a narrow support on the other side, then returning the ball to the start, all with the affected hand.  

2 February 2017: 94 grasp/releases (cycles) in 50 min. Neural fatigue was noticed from 30 min onwards.
3 Feb: 217 cycles in two 20-min sessions.
5 Feb: 184 cycles in 50 min.
6 Feb: 395 cycles in two sessions of 40 & 35 min.
8 Feb: 403 cycles in two sessions of 50 & 25 min.

9 Feb: 398 cycles in two sessions of 50 & 30 min.
10 Feb: 129 cycles in 30 min
11 Feb: 420 cycles in two sessions of 30 & 55 min.
13 Feb: 420 cycles in two sessions of 60 & 25 min.
14 Feb: 420 cycles in two sessions.
15 Feb: 262 cycles
16 Feb: 420 cycles
18 Feb: 424 cycles
19 Feb: 294 cycles
21 Feb: 423 cycles
22 Feb: 400 cycles
25 Feb: 424 cycles
27 Feb: 168 cycles
28 Feb: The fingers spring was changed from red to yellow, a weaker spring, as finger extension in each cycle was getting quicker.
420 cycles
2 March: 210 cycles
3 March: The exercise was increased in complexity by touching a ball on a raised support during each cycle.
387 cycles
4 March: 168 cycles
5 March: 336 cycles. Stacked eight 3cm cubes with Saeboflex on, and 7 with it removed. (Subsequent data summarised in the chart below.)

The following chart summarises all data including the trial in October 2016. The graph goes to baseline on days when the Saeboflex was not used.

 grasp_release_graph2.jpg (159986 bytes)